Improving patient care in severe acute brain injury: a web/mobile/tablet-based communication and decision support tool for clinicians and families in the neuro-ICU

改善严重急性脑损伤患者的护理：为神经重症监护病房的临床医生和家属提供基于网络/移动/平板电脑的通信和决策支持工具

基本信息

批准号：
10589141
负责人：
Nils Henninger
金额：
$ 20.56万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-09 至 2024-12-31
项目状态：
已结题

项目摘要

Project Summary / Abstract Every 30 seconds an adult in the U.S. suffers a severe acute brain injury (SABI) after a traumatic brain injury, large ischemic stroke or intracerebral hemorrhage, resulting in 200,000 deaths and >900,000 survivors living with disability annually. Every day, surrogate decision makers face the difficult “goals of care” decision in intensive care units (ICUs) to continue or withdraw life support while considering the patient’s long-term prognosis. The stakes for ill-informed goals of care decisions and miscommunications about the prognosis are especially high in patients with SABI; there is the potential for a premature decision leading to the death of a patient who may potentially have survived with a good outcome had treatment been continued, or, conversely, prolongation of life with severe physical and cognitive dysfunction which the patient would not have chosen. In this proposal, we seek to develop a pragmatic, scalable, conceptually grounded intervention to overcome ongoing problems with high stakes decision-making by surrogates of patients with SABI in ICUs. Our long-term goal is to improve the clinical care for SABI patients in neuroICUs by enhancing clinician-family communication and empowering surrogates to make better informed decisions concordant with patient values. To achieve our goal, we will develop a web and mobile/tablet-based intervention for use by surrogates and clinicians (this R21), then test in a multicenter, randomized trial the intervention’s impact on patient outcomes, the quality of surrogate decision- making, families’ psychological outcomes, and health care utilization (subsequent R01). In our previous research we developed a highly usable and acceptable, tailored, paper-based decision aid for families of critically ill SABI patients. Now we plan to widen the tool’s use by leveraging a digital platform, which is more portable and shareable among family members when geographically distant or not allowed to visit the ICU (as during the COVID-19 pandemic) and allows integration of videos to reach lower-literacy groups. We propose a tool that prepares families for their surrogate role and discussions with clinicians; provides balanced information to families on prognosis and all available treatment options; provides tailored information about the patient and family to clinicians in advance of family meetings; and serves as a communication guide for clinicians in the clinician-family meeting. The project’s Specific Aims are to 1) develop an adaptive, user-friendly digital decision aid and communication (DA+C) tool by applying user experience design and eye tracking; 2) assess usability and acceptability of the new DA+C tool; and 3) conduct a pilot study in surrogates of SABI patients at high risk of death and disability to assess the DA+C tool’s feasibility in the ICU and explore its impact on key elements of decision making quality. The research will have high impact as it will yield a rigorously developed intervention and crucial preliminary data needed to conduct a multicenter trial to assess the intervention’s impact on patient, family and health-systems outcomes. The proposed research is innovative through application of user experience design and eye tracking methods. The work is feasible in our hands, as we have the expertise needed, have successfully used all methods proposed here and have obtained buy-in from all relevant clinical services.

项目摘要 /摘要每30秒在美国，成年人在创伤性脑损伤后遭受严重的急性脑损伤（SABI），大型缺血性中风或脑内出血，导致200,000人死亡，> 900,000次生存每年残疾。每天，代孕决策者在密集型中面临艰难的“护理目标”决定护理单位（ICU）在考虑患者的长期预后，继续或撤回生命支持。这对不明智的护理决策目标和对预后的误解的赌注特别高 SABI患者；有可能提前决定，导致患者死亡可能继续以良好的结果生存，或者相反，延长了生命患者不会选择严重的身体和认知功能障碍。在这个建议中，我们寻求开发务实的，可扩展的，概念上根的干预措施，以克服持续的问题 ICU中SABI患者的替代者的高股票决策。我们的长期目标是改善通过增强临床家庭沟通和授权，为神经元中的SABI患者提供临床护理代替代人做出更好的知情决定与患者价值观一致。为了实现我们的目标，我们将开发基于网络和移动/平板电脑的干预措施，以供代理人和临床医生（此R21）使用，然后在多中心，随机试验该干预对患者结局的影响，替代决策的质量 - 创造，家庭的心理成果和医疗保健利用（随后的R01）。在我们以前的研究中我们为患病的家族开发了一个高度可用，可接受的，量身定制的纸质决策援助患者。现在，我们计划通过利用数字平台来扩展工具的使用，该平台更便携，并且当地理位置遥远或不允许访问ICU时，家庭成员之间可共享（如 COVID-19大流行），并允许视频的整合到达较低的数字群体。我们提出了一个工具为家庭准备代孕角色和与临床医生的讨论做准备；提供平衡的信息家庭提示和所有可用的治疗选择；提供有关患者的量身定制信息，在家庭会议之前向临床医生家人；并作为临床医生的传播指南临床家庭会议。该项目的具体目的是1）制定自适应，用户友好的数字决定通过应用用户体验设计和眼睛跟踪，援助与通信（DA+C）工具； 2）评估可用性和新的DA+C工具的可接受性； 3）对SABI患者的替代替代研究进行试点研究死亡和残疾评估DA+C工具在ICU中的可行性，并探讨其对关键要素的影响决策质量。这项研究将产生很大的影响，因为它将进行严格开发的干预措施，并且进行多中心试验所需的关键初步数据，以评估干预对患者，家庭的影响和健康系统成果。拟议的研究是通过应用用户体验创新的设计和眼睛跟踪方法。正如我们拥有的专业知识一样，这项工作在我们手中是可行的成功地使用了此处提出的所有方法，并从所有相关临床服务中获得了买入。