Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial.
Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial.
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DOI：
10.1136/bmjopen-2020-045084
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发表时间：
2021-03-22
期刊：
影响因子：
2.9
通讯作者：
Barnato A
中科院分区：
文献类型：
--
作者：
Mohan D;O'Malley AJ;Chelen J;MacMartin M;Murphy M;Rudolph M;Barnato A
在美国，只有不到一半的人有书面的提前护理计划（ACP）。住院治疗为医生提供了一个启动ACP对话的机会。尽管有专家的建议，但医院的医生（医院医生）并不经常参与这些谈话，而是为危重病人保留这些谈话。本研究的目的是测试一种新的行为干预对医院医生ACP谈话发生率的影响，这些医院是从220家美国急症医院抽取的分层随机样本，这些医院由一个正在进行ACP质量改进的大型全国性急症医生诊所组成。我们开发了Hopewell Hospitalist，这是一款基于理论的冒险电子游戏，旨在改变医生对ACP对话的态度，并增加他们参与对话的动机。计划中的研究是一项实用的楔形跨期III期试验，测试Hopewell Hospitalist增加ACP对话的功效。我们将随机选取40家医院，按他们接受干预的月份（步骤）进行选择。我们的目标是每一步从多达8家医院招募30名医院医生来完成干预，扮演霍普韦尔医院医生至少2小时。主要结果是参与医院管理的65岁及以上患者的ACP账单。我们假设干预措施将在传播后的季度增加ACP计费，并且有80%的能力检测到1%的绝对增长，99%的能力检测到3.5%的绝对增长。达特茅斯人类受试者保护委员会已经批准了这项研究方案，该方案已在clinicaltrials.gov上注册。我们将通过稿件和试验网站发布结果。试用结束后，Hopewell Hospitalist将在iOS应用程序商店免费下载。NCT04557930。
Fewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill. The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative. We developed Hopewell Hospitalist, a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy of Hopewell Hospitalist for increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playing Hopewell Hospitalist for at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase. Dartmouth’s Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. Hopewell Hospitalist will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial. NCT04557930.
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DOI：
10.1136/bmj.j5416
发表时间：
2017-12-12
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Mohan D;Farris C;Fischhoff B;Rosengart MR;Angus DC;Yealy DM;Wallace DJ;Barnato AE
通讯作者：
Barnato AE
DOI：
10.1016/j.ijhcs.2018.01.004
发表时间：
2018-04-01
影响因子：
5.4
作者：
O'Brien, Heather L.;Cairns, Paul;Hall, Mark
通讯作者：
Hall, Mark
DOI：
10.1186/1748-5908-6-42
发表时间：
2011-04-23
期刊：
Implementation science : IS
影响因子：
--
作者：
Michie S;van Stralen MM;West R
通讯作者：
West R
DOI：
10.1097/acm.0b013e318217e119
发表时间：
2011-06
期刊：
Academic medicine : journal of the Association of American Medical Colleges
影响因子：
--
作者：
McGaghie WC;Issenberg SB;Cohen ER;Barsuk JH;Wayne DB
通讯作者：
Wayne DB
影响因子：
4.2
作者：
Hinyard, Leslie J.;Kreuter, Matthew W.
通讯作者：
Kreuter, Matthew W.