Communication quality during family meetings in the intensive care unit: how does quality impact health outcomes?

重症监护病房家庭会议期间的沟通质量：质量如何影响健康结果？

基本信息

批准号：
10718011
负责人：
Allison M Scott
金额：
$ 65.53万
依托单位：
PENNSYLVANIA STATE UNIV HERSHEY MED CTR
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：
2023-08-16 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10718011
关键词：
Address Affect Anxiety Attention Black race COVID-19 pandemic Caring Clinical Communication Data Decision Making Disparity Economic Conditions Economics Education Environment Family Family member Future Goals Health Health Professional Health education Healthcare Individual Intensive Care Units Intervention Intrinsic factor Knowledge Length of Stay Longitudinal, observational study Measures Mediating Mediation Mental Depression Modeling Neighborhoods Outcome Pathway interactions Patient-Focused Outcomes Patients Perception Personality Traits Post-Traumatic Stress Disorders Protocols documentation Psychological Stress Questionnaires Research Risk Rural Rural Community Severity of illness Social Conditions Stress Testing Therapeutic Trust Underrepresented Populations Ventilator Work demographics design distrust experience health care availability hispanic community improved innovation meetings outcome disparities pandemic disease patient oriented post-pandemic post-traumatic symptoms programs psychological outcomes rural underrepresented shared decision making social health determinants trait trial design underserved community

项目摘要

ABSTRACT When poor communication between clinicians and family members of ICU patients, disparities related to social determinants of health (SDOH), and a heightened distrust of healthcare professionals all coalesced during the COVID-19 pandemic, “the perfect storm” emerged. Improving communication and trust in healthcare professionals is critical in high-stakes ICU environments where the need for shared decision-making demands that clinicians rapidly establish rapport and therapeutic alliance with family members of non-capacitated patients. Many well-designed trials testing ICU communication interventions have had negative or minimally impactful results, perhaps in part because we have only a rudimentary understanding of how SDOH impact communication in the ICU, a clinical context where underrepresented individuals also suffer from disparities. The goals of this R01 are to conduct a mediation analysis that will: 1) examine SDOH’s impact on communication between family members and ICU clinicians; 2) identify mechanisms of action related to how communication quality affects distrust of healthcare professionals and therapeutic alliance; and 3) determine how these factors contribute to or mediate outcomes for family members of ICU patients. This longitudinal, observational study will collect data from 320 family members from 5 ICUs serving underrepresented rural, Black, and Hispanic communities in 3 states. Our primary health outcome is the provision of family-centered care (as measured by the Patient Perceptions of Patient Centeredness questionnaire- Family Version). Secondary health outcomes include family members’ psychological stress (anxiety, depression, symptoms of post-traumatic stress disorder) and measures of patient ICU utilization (e.g., ICU LOS, ventilator days). Mediating factors to be examined include communication quality, healthcare distrust, and therapeutic alliance. Moderating factors include family members’ intrinsic traits (e.g., personality traits and decision-making style). We hypothesize that: 1) poor SDOH yield poor outcomes and result in less attention to family-centered care and worse ICU patient utilization outcomes; and 2) higher communication quality will improve the therapeutic relationship and healthcare trust and result in improved attention to family-centered care and improved ICU patient utilization outcomes among all patients regardless of SDOH. Using our results, we will adapt a prominent conceptual model of communication to address the high-stakes communication needs of families from underserved communities. Completing this work will advance the field by providing data to allow new understanding of how SDOH and other factors (e.g., communication quality, trust) relate to provision of patient- and family-centered care in the post-pandemic context. The knowledge gained will inform new content and concrete communication strategies for future ICU interventions aiming to facilitate high-quality communication, help to restore trust in healthcare, and improve therapeutic alliances in pursuit of achieving patient- and family- centered ICU care.

抽象的当新来者与 ICU 患者家属之间沟通不畅时，与社会关系有关的差异健康决定因素 (SDOH) 以及对医疗保健专业人员的肠胃不信任都在 COVID-19 大流行引发了改善医疗保健领域的沟通和信任的“完美风暴”。在需要共同决策的高风险 ICU 环境中，专业人员至关重要与无行为能力的家庭成员迅速建立融洽关系和治疗联盟许多精心设计的测试 ICU 沟通干预措施的试验结果为阴性或最低限度。有影响力的结果，也许部分是因为我们对 SDOH 如何影响只有初步的了解 ICU 中的沟通，在这种临床环境中，代表性不足的个体也存在差异。 R01 的目标是进行中介分析，该分析将： 1) 检查 SDOH 对 2）确定与如何相关的行动机制沟通质量影响对医疗保健专业人员和治疗联盟的不信任；3) 确定这些因素如何影响或调节 ICU 患者家庭成员的结果观察性研究将收集来自 5 个 ICU 的 320 名家庭成员的数据，这些 ICU 服务于代表性不足的农村地区、我们三个州的黑人和西班牙裔社区的主要健康成果是提供以家庭为中心的服务。护理（通过患者对患者中心性的看法问卷 - 家庭版进行测量）。次要健康结果包括家庭成员的心理压力（焦虑、抑郁、创伤后应激障碍）以及患者 ICU 使用率的衡量（例如 ICU LOS、呼吸机天数）。要检查的中介因素包括沟通质量、医疗保健不信任和治疗联盟。调节因素包括家庭成员的内在特征（例如人格特征和决策风格）。我们追求的是：1) 较差的 SDOH 会产生较差的结果，并导致对以家庭为中心的护理的关注较少 ICU 患者使用结果较差；2) 更高的沟通质量将改善治疗效果关系和医疗保健信任，从而提高对以家庭为中心的护理的关注并改善 ICU 无论 SDOH 如何，我们都会根据我们的结果调整所有患者的患者利用结果。突出的沟通概念模型，以满足家庭的高风险沟通需求完成这项工作将通过提供数据来推动该领域的发展。了解 SDOH 和其他因素（例如沟通质量、信任）如何与提供患者相关的大流行后背景下以家庭为中心的护理所获得的知识将为新的内容和内容提供信息。未来 ICU 干预措施的具体沟通策略，旨在促进高质量的沟通，帮助恢复对医疗保健的信任，并改善治疗联盟，以实现患者和家庭的目标以 ICU 为中心的护理。