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.

项目摘要/摘要 患有慢性生命受限疾病的患者发生急性呼吸衰竭的死亡风险很高， 残疾。因为一些这样的患者在某些情况下会选择放弃维持生命的治疗， ICU临床医生评估患者的价值观、目标和治疗偏好，并将 将这些发现转化为共享决策，以提供目标一致的护理。不幸的是，我的初步数据 以及对其他住院人群的定性研究表明，ICU临床医生经常错过 评估或将患者的护理目标纳入决策的机会。这可能会导致 提供不需要的重症监护和维持生命的治疗，这对患者和 家庭，并导致提供高成本、低价值的护理。 本申请中提出的研究将使用多方法和混合方法的方法来：(1)检查 目前急性呼吸衰竭和慢性生活患者护理目标讨论的执行情况 限制疾病；(2)确定潜在的可修改的临床医生行为决定因素，这些决定因素是导致疾病缺陷的基础 护理目标沟通，并反复重新设计现有的门诊沟通-启动 对在重症监护病房促进高质量护理目标讨论的目标进行干预；以及，(3)开展 重新设计的沟通-启动干预措施的试点随机试验，以改善发病和 记录的急性呼吸衰竭和慢性生活患者护理目标讨论的质量- 限制疾病。 通过导师指导的研究活动和正式的研究培训相结合，我将获得宝贵的 分析方法方面的研究培训，以提高使用“真实世界”数据、应用的研究的有效性 为健康干预设计和临床试验提供信息的混合方法研究。拟议的研究和 培训活动将为我成为一名独立的临床调查员做好准备，并将形成 为旨在改善急性呼吸衰竭患者预后的一系列研究奠定基础。 这些研究和培训活动将得到大学丰富的学术研究环境的推动。 华盛顿大学医学院、护理学和公共卫生学院，以及Cambia缓和医院 威斯康星大学医学院卓越护理中心。