Personalized End of Life Care in Safety-Net hospitals: Implementation of the 3 Wishes Project

安全网医院的个性化临终关怀：实施“三个愿望”项目

基本信息

批准号：
10736466
负责人：
THANH H NEVILLE
金额：
$ 54.4万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-17 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10736466
关键词：
Address Adoption Bereavement Budgets Caring Cessation of life Clinical Collaborations Compassion Consolidated Framework for Implementation Research County Critical Illness Data Direct Costs Disadvantaged Distress Effectiveness Elements Emotional Empathy Evaluation Family Family member Foundations Grief reaction Health Health Services Health Services Accessibility Healthcare Hospitalization Hospitals Inequity Intensive Care Units Intervention Interview Job Satisfaction Language Leadership Life Experience Limited English Proficiency Los Angeles Low income Measurement Measures Medical Medicine Mental Depression Methods Modeling Multi-Institutional Clinical Trial Music Nurses Palliative Care Patient-Centered Care Patients Patients&apos Rooms Perception Physicians Play Population Post-Traumatic Stress Disorders Public Hospitals Qualitative Research Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Research Design Resource-limited setting Resources Sampling Scientist Services Spirituality Structure Survey Methodology Surveys System Thinness Training Uninsured Variant Work advanced disease burnout coping cost design distrust effectiveness/implementation study empowerment end of life end of life care experience health care settings implementation barriers implementation outcomes implementation process implementation science implementation strategy implementation/effectiveness improved innovation loved ones low health literacy neglect novel patient oriented patient population primary outcome psychological symptom safety net satisfaction secondary outcome structural determinants tool treatment as usual

项目摘要

Project Summary Compassionate end-of-life (EOL) care is foundational to medicine, but providing patients and families in safety-net hospitals (SNHs) with the sense that they are physically and emotionally supported during a patient’s terminal hospitalization can be challenging. SNHs are public hospitals that primarily provide services to low-income and uninsured patients on a minimal budget. Although high quality EOL care is an important unmet need in SNHs, its provision is fraught with barriers and challenges. Language barriers, low health literacy, and cultural differences can make it difficult for families in SNHs to perceive empathy and support during the EOL. Deaths in the intensive care unit (ICU) for underserved families can be traumatic, and families of patients who die in the ICU often suffer from depression and post-traumatic stress disorder. Palliative care interventions are needed, but implementation is often resource-prohibitive. The 3 Wishes Project (3WP) is a palliative care intervention that aims to achieve a dignified and compassionate EOL experience by empowering the clinical team to elicit and fulfill small wishes for critically ill patients who are dying in the ICU. Although the 3WP has been shown to improve a family’s experience of their loved one’s EOL care, ease bereavement, and enhance clinician work satisfaction in academic centers, it has not been implemented and evaluated in low-resource hospitals. We believe that this patient-centered and clinician-partnered initiative can improve the EOL experience in SNHs, but that it must be adapted to the contextual differences and needs of low-resource hospitals. We propose to obtain and use stakeholder input to customize a multi-component 3WP Toolkit that will facilitate 3WP implementation in SNHs. Using the tailored Toolkit, we will implement and evaluate the 3WP in the three SNHs of the Los Angeles County Department of Health Services. We will conduct a pragmatic type 2 hybrid effectiveness-implementation study to evaluate the quality of EOL ICU care, bereaved families’ psychological symptoms, and clinician burnout as compared to usual care. We will use the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to guide a mixed-methods evaluation of the 3WP implementation in SNHs. Our team of clinicians and scientists have collaborated previously and have expertise in EOL care, implementation science, qualitative research, research in the safety-net system, and 3WP implementation. We hypothesize that our novel effectiveness-implementation approach will demonstrate that the 3WP addresses key gaps in palliative care in SNHs, which have historically had less ability to implement novel interventions. The results of this study will provide a roadmap to implement interventions in SNHs and lay the foundation for broader dissemination, adoption, and sustainment of the 3WP in diverse healthcare settings.

项目概要富有同情心的临终关怀 (EOL) 是医学的基础，但为患者和家庭提供安全网医院 (SNH) 让他们感觉在医疗期间得到了身体和情感上的支持患者的终末住院治疗可能具有挑战性。SNH 是主要提供服务的公立医院。尽管高质量的 EOL 护理很重要，但对低收入和未投保的患者来说，预算很少。由于 SNH 的需求未得到满足，其提供充满了障碍和挑战，而且健康状况不佳。识字率和文化差异可能使 SNH 中的家庭难以感受到同情和支持在生命终止期间，重症监护病房 (ICU) 中服务不足的家庭的死亡可能会给家庭带来创伤。在 ICU 死亡的患者通常患有抑郁症和创伤后应激障碍。干预措施是必要的，但实施起来往往资源匮乏。三个愿望项目 (3WP) 是一项姑息治疗干预措施，旨在实现有尊严和通过授权临床团队激发并实现危重患者的小愿望，提供富有同情心的 EOL 体验尽管 3WP 已被证明可以改善在 ICU 中濒临死亡的患者的家庭体验。亲人的临终关怀，缓解丧亲之痛，提高学术中心临床医生的工作满意度，我们认为，这种以患者为中心的方法尚未在资源匮乏的医院得到实施和评估。临床医生合作的举措可以改善 SNH 的 EOL 体验，但必须适应资源匮乏医院的背景差异和需求。我们建议获取并使用利益相关者的意见来定制一个多组件 3WP 工具包，该工具包将使用定制的工具包，我们将在 SNH 中实施并评估 3WP 的实施情况。洛杉矶县卫生服务部的三个 SNH 我们将开展务实的 2 类活动。混合有效性实施研究，评估 EOL ICU 护理质量、死者家属的护理质量与常规护理相比，心理症状和临床医生倦怠我们将使用综合护理。实施研究框架 (CFIR) 和 RE-AIM（范围、有效性、采用、实施和维护）框架来指导 3WP 的混合方法评估在 SNH 中的实施。我们的超级明星和科学家团队之前曾合作过，并且拥有 EOL 护理方面的专业知识，实施科学、定性研究、安全网系统研究以及 3WP 实施。开发我们新颖的有效性实施方法将证明 3WP 解决了 SNH 姑息治疗方面的主要差距，历史上实施新干预措施的能力较差。本研究的结果将为 SNH 实施干预措施提供路线图，并为在不同的医疗保健环境中更广泛地传播、采用和维持 3WP。