Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults: The VIDEO-PCE Randomized Clinical Trial.
Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults: The VIDEO-PCE Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2023.32556
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Paasche-Orlow MK
中科院分区：
文献类型：
--
作者：
Volandes AE;Zupanc SN;Lakin JR;Cabral HJ;Burns EA;Carney MT;Lopez S;Itty J;Emmert K;Martin NJ;Cole T;Dobie A;Cucinotta T;Joel M;Caruso LB;Henault L;Dugas JN;Astone K;Winter M;Wang N;Davis AD;Garde C;Rodriguez PM;El-Jawahri A;Moseley ET;Das S;Sciacca K;Ramirez AM;Gromova V;Lambert S;Sanghani S;Lindvall C;Paasche-Orlow MK
这项阶梯式楔形集群随机临床试验评估了姑息治疗教育工作者向医院环境中的老年人实施循证护理目标 (GOC) 视频干预是否可以改善 GOC 记录。在医院环境中实施由姑息治疗教育者 (PCE) 提供的循证护理目标 (GOC) 视频干预能否改善老年患者的 GOC 记录？在这项务实的阶梯式楔形集群随机临床试验中，包括来自 2 家美国医院 14 个病房的 10~802 名 65 岁或以上成年人，随机分配到接受 GOC 视频干预的医院病房的患者比随机分配到接受常规护理的医院病房的患者拥有更多的 GOC 文件。在此试验中，使用 PCE 提供的 GOC 视频干预改善了医院环境中老年人的 GOC 记录。尽管护理目标 (GOC) 沟通有好处，但许多住院患者从未向临床医生传达他们的目标或偏好。评估姑息治疗教育者 (PCE) 提供的 GOC 视频干预是否提高了 GOC 记录率。这项务实的阶梯式楔形整群随机临床试验纳入了 2021 年 7 月 1 日至 2022 年 10 月 31 日期间入住纽约和波士顿 2 家城市医院 14 个病房之一的 65 岁或以上患者。干预措施涉及 PCE（接受过 GOC 沟通培训的社会工作者和护士），使用 29 种语言的简短、经过认证的视频决策辅助库，促进 GOC 与患者和/或其决策者进行对话。对照组患者接受常规护理。主要结果是 GOC 文档，其中包括目标对话、维持生命治疗的限制、姑息治疗、临终关怀或限时试验的任何文档，并通过自然语言处理获得。共有 10 802 名患者（平均 [SD] 年龄，78 [8] 岁；51.6% 男性）入住 14 个医院单位中的 1 个。 6023 名患者中，有 3744 名患者 (62.2%) 在干预阶段记录了护理目标，而在常规护理阶段，4779 名患者中有 2396 名患者 (50.1%) 记录了护理目标 (P < .001)。黑人或非裔美国人（1376 人中的 865 人 [62.9%] vs 1125 人中的 596 人 [53.0%]）、西班牙裔或拉丁裔人（548 人中的 311 人 [56.8%] vs 451 人中的 218 人 [48.3%]）、非英语人士（1059 人中的 586 人 [55.3%] vs与常规护理阶段相比，干预阶段期间，863 人中的 405 人 [46.9%]）以及患有阿尔茨海默病和相关痴呆症的人（681 人中的 520 人 [76.4%] vs 570 人中的 355 人 [62.3%]）的比例更高。在这项针对老年人的阶梯式楔形集群随机临床试验中，与常规护理相比，PCE 提供的 GOC 视频干预导致 GOC 记录率更高，其中包括黑人或非裔美国人、西班牙裔或拉丁美洲人、非英语人士以及阿尔茨海默病和相关痴呆症患者。研究结果表明，这种以患者为中心的护理服务形式可能是一种有益的决策支持工具。 ClinicalTrials.gov 标识符：NCT04857060
This stepped-wedge cluster randomized clinical trial assesses whether implementation of an evidence-based goals-of-care (GOC) video intervention delivered by palliative care educators to older adults in a hospital setting improves GOC documentation. Can implementing an evidence-based goals-of-care (GOC) video intervention delivered by palliative care educators (PCEs) in hospital settings improve GOC documentation among older patients? In this pragmatic, stepped-wedge cluster randomized clinical trial that included 10 802 adults aged 65 years or older from 14 units at 2 US hospitals, patients randomized to hospital units receiving the GOC video intervention had more GOC documentation than patients randomized to hospital units receiving usual care. In this trial, the use of a GOC video intervention delivered by PCEs improved GOC documentation for older adults in hospital settings. Despite the benefits of goals-of-care (GOC) communication, many hospitalized individuals never communicate their goals or preferences to clinicians. To assess whether a GOC video intervention delivered by palliative care educators (PCEs) increased the rate of GOC documentation. This pragmatic, stepped-wedge cluster randomized clinical trial included patients aged 65 years or older admitted to 1 of 14 units at 2 urban hospitals in New York and Boston from July 1, 2021, to October 31, 2022. The intervention involved PCEs (social workers and nurses trained in GOC communication) facilitating GOC conversations with patients and/or their decision-makers using a library of brief, certified video decision aids available in 29 languages. Patients in the control period received usual care. The primary outcome was GOC documentation, which included any documentation of a goals conversation, limitation of life-sustaining treatment, palliative care, hospice, or time-limited trials and was obtained by natural language processing. A total of 10 802 patients (mean [SD] age, 78 [8] years; 51.6% male) were admitted to 1 of 14 hospital units. Goals-of-care documentation during the intervention phase occurred among 3744 of 6023 patients (62.2%) compared with 2396 of 4779 patients (50.1%) in the usual care phase (P < .001). Proportions of documented GOC discussions for Black or African American individuals (865 of 1376 [62.9%] vs 596 of 1125 [53.0%]), Hispanic or Latino individuals (311 of 548 [56.8%] vs 218 of 451 [48.3%]), non-English speakers (586 of 1059 [55.3%] vs 405 of 863 [46.9%]), and people living with Alzheimer disease and related dementias (520 of 681 [76.4%] vs 355 of 570 [62.3%]) were greater during the intervention phase compared with the usual care phase. In this stepped-wedge cluster randomized clinical trial of older adults, a GOC video intervention delivered by PCEs resulted in higher rates of GOC documentation compared with usual care, including among Black or African American individuals, Hispanic or Latino individuals, non-English speakers, and people living with Alzheimer disease and related dementias. The findings suggest that this form of patient-centered care delivery may be a beneficial decision support tool. ClinicalTrials.gov Identifier: NCT04857060
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