Improving goals-of-care discussions for patients with chronic life-limiting illness and acute respiratory failure

改善慢性生命限制性疾病和急性呼吸衰竭患者的护理目标讨论

• 批准号: 10347636
• 负责人: Robert Ying-Fu Lee
• 金额: $ 18.79万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10347636
• 关键词: Acute respiratory failure; Admission activity; Adopted; Adoption; Area; Behavioral; Caring; Chronic; Chronic Disease; Clinical Investigator; Clinical Trials; Communication; Data; Decision Making; Discipline of Nursing; Documentation; Electronic Health Record; Environment; Environmental Risk Factor; Ethnic Origin; Etiology; Exclusion; Expectancy; Family; Foundations; Future; Goals; Guidelines; Health; Health system; Incidence; Intensive Care; Intervention; Interview; Lead; Life; Logistic Regressions; Measurement; Measures; Mechanical ventilation; Medicine; Mentors; Methods; Minority; Natural Language Processing; Observational Study; Outcome; Outpatients; Palliative Care; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Population; Process; Prognosis; Public Health; Publishing; Race; Reporting; Research; Research Activity; Research Design; Research Methodology; Research Training; Scientist; Severity of illness; Structure; Surveys; Testing; Theoretical Domains framework; Time Factors; Training; Training Activity; Universities; Washington; Work; analytical method; base; behavior change; career; cohort; cost; design; disability; effectiveness implementation study; effectiveness implementation trial; experience; high risk; improved; improved outcome; medical schools; mortality risk; novel strategies; patient oriented research; preference; primary outcome; prognostic; randomized trial; secondary outcome; shared decision making; therapy design; usability

PROJECT SUMMARY/ABSTRACT Patients with chronic life-limiting illness who develop acute respiratory failure are at high risk of death and disability. Because some such patients would choose to forego life-sustaining treatments in certain conditions, it is important that ICU clinicians assess patients’ values, goals, and treatment preferences, and incorporate these findings into shared decision-making to provide goal-concordant care. Unfortunately, my preliminary data as well as qualitative studies of other hospitalized populations suggest that ICU clinicians often miss opportunities to assess or incorporate patients’ goals of care into decision-making. This may lead to the delivery of unwanted intensive care and life-sustaining treatments, which is harmful to both patients and families, and results in the delivery of high-cost, low-value care. The proposed research in this application will use multimethod and mixed-methods approaches to: (1) examine current implementation of goals-of-care discussions for patients with acute respiratory failure and chronic life- limiting illness; (2) identify potentially modifiable clinician behavioral determinants that underlie deficiencies in goals-of-care communication, and iteratively redesign an existing outpatient communication-priming intervention toward the goal of promoting high-quality goals-of-care discussions in the ICU; and, (3) conduct a pilot randomized trial of the redesigned communication-priming intervention to improve the occurrence and quality of documented goals-of-care discussions for patients with acute respiratory failure and chronic life- limiting illness. Through a combination of mentored research activities and formal research training, I will receive valuable research training in analytical methods to enhance the validity of studies that use “real-world” data, application of mixed-methods research to inform health intervention design, and clinical trials. The proposed research and training activities will prepare me for a career as an independent clinical investigator, and will form the foundation for a body of research designed to improve outcomes for patients with acute respiratory failure. These research and training activities will be facilitated by the academically rich research environments of the University of Washington Schools of Medicine, Nursing, and Public Health, as well as the Cambia Palliative Care Center of Excellence at UW Medicine.

项目总结/文摘