Development of an Interactive Bioethics Training Module for Healthcare Providers Treating Patients Who Need Liver Transplant for Alcohol-associated Liver Disease

为治疗酒精相关性肝病需要肝移植的患者的医疗保健提供者开发交互式生物伦理学培训模块

• 批准号: 10785093
• 负责人: ANDREW M. CAMERON
• 金额: $ 13.29万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10785093
• 关键词: Abstinence; Address; Alcoholic Hepatitis; Alcoholic Liver Diseases; Area; Award; Bioethics; Cessation of life; Clinical; Data; Development; Distress; Education; Educational Curriculum; Educational Intervention; Educational Materials; Educational Psychology; Educational process of instructing; Ethics; Exercise; Feeling; Foundations; Future; Health Personnel; Health Professional; Instruction; Interview; Justice; Learning; Learning Module; Life; Liver; Liver diseases; Methodology; Morals; Organ Donor; Parents; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Positioning Attribute; Process; Provider; Psychological Theory; Qualifying; Research; Research Methodology; Resource Sharing; Resources; Series; Stigmatization; Surveys; Testing; Training Activity; Transplant Recipients; Transplantation; United States; addiction; alcohol abstinence; alcohol use disorder; clinical care; clinical practice; clinically relevant; design; education resources; health empowerment; health training; implicit bias; interest; iterative design; liver transplantation; mortality; novel; patient subsets; post-transplant; programs; promote resilience; resilience; social stigma; tool; transplant centers; trustworthiness; unconscious bias

PROJECT SUMMARY Alcohol-associated liver disease (ALD) accounts for nearly half of liver-related deaths in the United States and is the leading indication for liver transplant (LT). Historically, many transplant centers have required a 6-month alcohol abstinence period to qualify for a liver transplant. However, the subset of patients with ALD who have severe alcoholic hepatitis (SAH) are unlikely to survive 6 months, with 70-80% mortality in 3 months. A 6- month abstinence requirement limits access to LT for patients with SAH. Early liver transplantation (ELT), or the practice of proceeding with a transplant without waiting for a 6-month abstinence period, is the only life- saving treatment available for most patients with SAH. Since its introduction a decade ago, ELT for SAH has sparked debate on issues of fair and responsible allocation of scarce donor organs. Healthcare providers who treat patients with ALD have expressed conflicting feelings and moral distress about center-level ELT practices, particularly related to the selection process and post-transplant clinical care. Recent research data providing evidence of successful patient outcomes after ELT have not resolved healthcare providers’ moral distress, especially related to stigmatization of patients with alcohol use disorder and concerns about trustworthiness or deservingness. Healthcare providers’ perceptual schemas and unconscious biases are persistent barriers to the expansion and sustainment of ELT. To aid in the expansion of ELT nationally, ethics training for healthcare providers and research collaborators is needed. Bioethics educational interventions have been shown to alleviate moral distress, increase resilience, and empower healthcare workers to exercise moral agency. We will develop a novel, interactive training module that situates key bioethics concepts within real clinical practice and teaches foundations of ethical reasoning to help healthcare providers navigate moral distress related to ELT. We will use design-based research methodology to create an online training module that will include a) foundations of bioethics and ethical reasoning and their application to clinical scenarios in ELT b) self-reflexive exercises to examine unconscious biases and c) selectable instructional pathways tailored to the learner’s moral distress. The training module will be part of a larger endeavor to share resources, including an ethical framework (as outlined in the parent award) and educational materials, for transplant centers nationally. We envision this module to be the first in a series, culminating in a comprehensive and customizable online bioethics curriculum.

项目概要 在美国，酒精相关性肝病 (ALD) 占肝脏相关死亡的近一半 是肝移植 (LT) 的主要适应症 从历史上看，许多移植中心都需要 6 个月的时间。 然而，有部分 ALD 患者有资格进行肝移植。 严重酒精性肝炎 (SAH) 不太可能存活 6 个月，3 个月内死亡率为 70-80% A 6-。 一个月的禁欲要求限制了 SAH 患者接受 LT 的机会，或 不等待6个月的禁欲期就进行移植的做法是唯一的生命- 自十年前推出以来，ELT 治疗 SAH 已为大多数 SAH 患者节省了治疗费用。 引发了关于公平和负责任地分配稀缺捐赠器官问题的辩论。 治疗 ALD 的患者对中心级 ELT 表达了矛盾的感受和道德困扰 实践，特别是与选择过程和移植后临床护理相关的最新研究数据。 提供 ELT 后患者成功结果的证据并没有解决医疗保健提供者的道德问题 痛苦，尤其是与酒精使用障碍患者的耻辱和对酒精使用障碍的担忧有关 医疗保健提供者的感知模式和无意识偏见。 扩展和维持英语教学的持续障碍。 为了帮助在全国范围内扩展 ELT，我们对医疗保健提供者和研究合作者进行了道德培训 事实证明，生物伦理学教育干预措施可以减轻道德困扰，增强复原力， 并赋予医护人员行使道德能动性的能力。我们将开发一种新颖的互动培训。 该模块将关键的生物伦理学概念置于真实的临床实践中，并教授伦理学的基础 我们将使用基于设计的推理来帮助医疗保健提供者应对与 ELT 相关的道德困扰。 创建在线培训模块的研究方法，其中包括：a) 生物伦理学基础和 道德推理及其在 ELT 临床场景中的应用 b) 自我反思练习以检查 无意识的偏见和c）针对学习者的道德困境量身定制的可选择的教学途径。 培训模块将成为共享资源的更大努力的一部分，包括道德框架（如 在全国移植中心的家长奖和教育材料中概述了这一点。 该模块将成为系列中的第一个模块，最终形成全面且可定制的在线生物伦理学 课程。

项目成果

Projected 20- and 30-Year Outcomes for Pediatric Liver Transplant Recipients in the United States.

美国儿童肝移植受者 20 年和 30 年的预计结果。

• 发表时间: 2020
• 影响因子: 2.9
• 作者: Bowring, Mary G;Massie, Allan B;Chu, Nadia M;Bae, Sunjae;Schwarz, Kathleen B;Cameron, Andrew M;Bridges, John F P;Segev, Dorry L;Mogul, Douglas B
• 通讯作者: Mogul, Douglas B

Approaching Alcohol Use Disorder After Liver Transplantation for Acute Alcoholic Hepatitis.

急性酒精性肝炎肝移植后的酒精使用障碍。

• 发表时间: 2021
• 作者: Ting, Peng;Gurakar, Ahmet;Wheatley, Jason;Chander, Geetanjali;Cameron, Andrew M;Chen, Po
• 通讯作者: Chen, Po

Evaluation of Early vs Standard Liver Transplant for Alcohol-Associated Liver Disease.

酒精相关性肝病的早期肝移植与标准肝移植的评估。

• 发表时间: 2021
• 影响因子: 16.9
• 作者: Herrick;Punchhi, Gopika;Greenberg, Ross S;Strauss, Alexandra T;Boyarsky, Brian J;Weeks;Krach, Michelle R;Anders, Robert A;Gurakar, Ahmet;Chen, Po;Segev, Dorry L;King, Elizabeth A;Philosophe, Benjamin;O
• 通讯作者: O

Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease.

与早期肝移植治疗严重酒精相关性肝病相关的患者反思、挑战和支持。

• 发表时间: 2023-07-01
• 作者: Chen, Po;Sung, Hannah C;Punchhi, Gopika;Krach, Michelle;Greenberg, Ross;Gianaris, Kevin;Teles, Mayan;Kaplow, Katya;Wheatley, Jason;Cameron, Andrew M;Chander, Geetanjali
• 通讯作者: Chander, Geetanjali

Discovery and characterization of cross-reactive intrahepatic antibodies in severe alcoholic hepatitis.

严重酒精性肝炎中交叉反应性肝内抗体的发现和表征。

• 发表时间: 2023-12-06
• 影响因子: 7.7
• 作者: Ahmadi, Ali Reza;Song, Guang;Gao, Tianshun;Ma, Jing;Han, Xiaomei;Hu, Ming;Cameron, Andrew M;Wesson, Russell N;Philosophe, Benjamin;Ottmann, Shane;King, Elizabeth;Gurakar, Ahmet;Qi, Le;Peiffer, Brandon;Burdick, James;Anders, Robert;Zhou
• 通讯作者: Zhou