Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design.
Testing a Culturally Tailored Advance Care Planning Intervention (MY WAY) for an American Indian Tribe: Protocol for a Quasi-Experimental Waitlist Control Design.
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DOI：
10.2196/50654
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发表时间：
2023-12-29
影响因子：
1.7
通讯作者：
Schweinhart, April
中科院分区：
文献类型：
--
作者：
Anderson, Elizabeth;Goins, R Turner;Haozous, Emily A;Schweinhart, April
美洲印第安人和阿拉斯加原住民的临终关怀很差，包括更多的住院治疗和较少使用临终关怀和不复苏命令。虽然提前护理计划（ACP）可以改善临终关怀，但美国印第安人和阿拉斯加原住民的ACP率不成比例地低。我们为美国印第安部落社区定制并提供了一个现有的基于证据的ACP计划。在这里，我们提出了评估干预的可行性和有效性的协议。我们通过参与者招募、参与者评估（可接受性、适当性、理解性和满意度）和干预保真度来衡量可行性。招募通过参与者筛选、资格、入组和保留来衡量。参与者对干预措施的评价通过调查进行衡量。忠诚度是通过直接观察和“让你的愿望关于你（我的方式）忠诚度检查表工具”来测量的。为了评估干预措施的有效性，我们采用了准实验性的等待名单控制设计，其中有2个队列，每个队列在三个不同的场合进行调查。干预的有效性进行了评估：ACP障碍和促进者以及ACP自我效能，准备和完成。共有166名参与者接受了资格筛选; 11名被认为不合格，155名参与者入选研究。在入组的患者中，113人完成了干预，并将纳入后续分析。我们已于2023年1月完成数据收集，并正在进行分析。研究招募是成功的，我们希望参与者将报告高水平的可接受性，适当性，理解和满意度的干预。我们希望干预措施的实施具有保真度，并将显示ACP障碍的减少和ACP促进者，自我效能，准备和完成的增加。招募的参与者是我们希望的两倍多，这表明这个部落社区的成员愿意参与临终ACP。我们能够实施一个等待名单的研究设计，以表明一个文化定制的ACP计划的部落社区是可行的。ClinicalTrials.gov NCT 05304117; https://clinicaltrials.gov/study/NCT05304117 DERR 1 -10.2196/50654
American Indian and Alaska Native peoples experience poor end-of-life care, including more hospitalizations and lower use of hospice and do-not-resuscitate orders. Although advance care planning (ACP) can improve end-of-life care, ACP rates are disproportionately low in American Indians and Alaska Natives. We culturally tailored and delivered an existing evidence-based ACP program for an American Indian tribal community. Here, we present the protocol for assessing the intervention’s feasibility and efficacy. We measured feasibility via participant recruitment, participants’ evaluation (acceptability, appropriateness, comprehension, and satisfaction), and intervention fidelity. Recruitment was measured with participant screening, eligibility, enrollment, and retention. Participant’s evaluation of the intervention was measured with surveys. Fidelity was measured with direct observation and the Make Your Wishes About You (MY WAY) Fidelity Checklist Tool. To assess the intervention’s efficacy, we used a quasi-experimental waitlist control design with 2 cohorts who were surveyed each on three separate occasions. The intervention’s efficacy was assessed by the following: ACP barriers and facilitators as well as ACP self-efficacy, readiness, and completion. A total of 166 participants were screened for eligibility; 11 were deemed ineligible, and 155 participants were enrolled in the study. Of those enrolled, 113 completed the intervention and will be included in subsequent analyses. We finalized data collection in January 2023, and analyses are underway. Study enrollment was successful, and we expect that participants will report high levels of acceptability, appropriateness, comprehension, and satisfaction with the intervention. We expect that the intervention was implemented with fidelity and will demonstrate decreases in ACP barriers and increases in ACP facilitators, self-efficacy, readiness, and completion. Enrolling over twice as many participants as we had hoped suggests that members of this tribal community are willing to engage in end-of-life ACP. We were able to implement a waitlist study design to show that a culturally tailored ACP program for a tribal community is feasible. ClinicalTrials.gov NCT05304117; https://clinicaltrials.gov/study/NCT05304117 DERR1-10.2196/50654