SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care.
SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care.
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分享选择：为初级保健中患有和不患有痴呆症的老年人进行高级护理规划干预的务实试验的设计和理由。
DOI：
10.1016/j.cct.2022.106818
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发表时间：
2022-08
影响因子：
2.2
通讯作者：
Wolff, Jennifer L.
中科院分区：
文献类型：
--
作者：
Dy, Sydney M.;Scerpella, Daniel L.;Cotter, Valerie;Colburn, Jessica;Roth, David L.;McGuire, Maura;Giovannetti, Erin Rand;Walker, Kathryn A.;Hussain, Naaz;Sloan, Danetta H.;Boyd, Cynthia M.;Cockey, Kimberley;Sharma, Neha;Saylor, Martha Abshire;Smith, Kelly M.;Wolff, Jennifer L.
提前护理计划(ACP)和家庭参与在痴呆症中特别重要，而初级保健是一个关键设置。这项试验的目的是检查共享选择的影响和实施情况，这是一种干预措施，旨在通过积极支持ACP和家庭参与初级保健来改善患有和不患有痴呆症的老年人的沟通。我们对两个卫生系统的55种不同的初级保健做法进行了随机分组，以进行干预或常规护理。共享选择是一种多组分的干预措施，旨在通过患者和家属参与ACP、议程设置以及为所有65岁以上的患者共享对患者门户的访问来改善沟通。主要结果包括在电子健康记录(EHR)中记录所有患者在12个月时接受维持生命治疗的预先指示或医嘱，以及严重疾病患者亚组在死亡后6个月内接受可能负担沉重的护理。我们计划对痴呆症患者进行先验子分析。数据来源包括卫生系统电子健康记录和马里兰州卫生信息交换。我们使用混合方法来评估干预和实施促进者和障碍的吸收、保真度和适应性。这项整群随机的实用试验考察了ACP，重点放在痴呆症患者的关键人群、在不同环境中的实施以及试验设计和结果提取的创新方法。混合方法方法使人们能够了解快速变化的卫生保健系统中的干预、提供和促进者以及实施的障碍。ClinicalTrials.gov标识：NCT04819191
Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care. We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care. SHARING Choices is a multicomponent intervention that aims to improve communication through patient and family engagement in ACP, agenda setting, and shared access to the patient portal for all patients over 65 years of age. The primary outcomes include documentation of an advance directive or medical orders for life-sustaining treatment in the electronic health record (EHR) at 12 months for all patients and receipt of potentially burdensome care within 6 months of death for the subgroup of patients with serious illness. We plan a priori sub-analysis for patients with dementia. Data sources include the health system EHRs and the Maryland health information exchange. We use a mixed-methods approach to evaluate uptake, fidelity and adaptation of the intervention and implementation facilitators and barriers. This cluster-randomized pragmatic trial examines ACP with a focus on the key population of those with dementia, implementation in diverse settings and innovative approaches to trial design and outcome abstraction. Mixed-methods approaches enable understanding of intervention delivery and facilitators and barriers to implementation in rapidly changing health care systems. ClinicalTrials.gov Identifier: NCT04819191
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
4.4
作者：
Epstein, Ronald M.;Street, Richard L., Jr.
通讯作者：
Street, Richard L., Jr.
影响因子：
2.1
作者：
Hirschman, Karen B.;Kapo, Jennifer M.;Karlawish, Jason H. T.
通讯作者：
Karlawish, Jason H. T.
影响因子：
--
作者：
Hammes, BJ;Rooney, BL
通讯作者：
Rooney, BL
影响因子：
2.5
作者：
Huang J;Roth DL
通讯作者：
Roth DL