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Using the Emergency Department Visit to Promote Advance Care Planning

利用急诊科就诊促进预先护理计划

基本信息

批准号：
10461844
负责人：
Angelo Volandes
金额：
$ 57.09万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10461844
关键词：
Accident and Emergency department Address Adult Advance Care Planning Agreement American Americas Black Populations Caring Cessation of life Clinical Clinical Trials Cognitive Communication Consensus Data Decision Aid Documentation Effectiveness of Interventions Elderly Electronic Health Record Electronic Mail Emergency Care Emergency Department patient Emergency Department-based Intervention Emergency Situation Emergency department visit Ethnic Origin Event Family Fright Goals Health Expenditures Health Personnel Health Status Hispanic Populations Hospital Nursing Institute of Medicine (U.S.)Instruction Intervention Length of Stay Life Measures Medical Modeling Not Hispanic or Latino Nursing Homes Outcome Patient Preferences Patients Physicians Positioning Attribute Process Provider Race Randomized Randomized Controlled Trials Reporting Research Secure Social Workers Structure Subgroup Testing Time Treatment Efficacy Update Visit Work advanced disease aged base care preference care providers efficacy trial empowered end of life end of life care ethnic minority health care service utilization health literacy high risk population hospital utilization implementation strategy improved intervention effect loved ones older patient preference racial minority satisfaction secondary outcome shared decision making treatment as usual

项目摘要

1 Project Summary 2 3 During the last few months of life, many older adults receive care that is discordant with their preferences, 4 increases suffering, and disrupts closure and grieving. The process of advance care planning (ACP) helps 5 patients have control over their end-of-life care by empowering patients to define and document what care they 6 would like to receive while they still have the cognitive and physical abilities to consider and express these 7 preferences. ACP improves patient and family satisfaction with the dying process, increases the likelihood that 8 patients receive the care they want, and reduces healthcare expenditures. Unfortunately, few older adults have 9 completed ACP and even fewer have documented their end-of-life care preferences in a way that is accessible 10 in a timely manner to medical providers. In a recent Institute of Medicine report on Death and Dying in America, 11 increasing ACP among older adults was identified as a major public priority. Primary care providers, who typically 12 have long-term relationships with patients and understand the details of their medical condition, are well 13 positioned to have end-of-life care conversations. Unfortunately, for several reasons these conversations often 14 do not occur: primary providers don’t want patients to think they’ve given up hope; patients think they are too 15 healthy to benefit from these conversations; and educating patients about end-of-life options takes time. U.S. 16 emergency department (ED) visits provide access to a large number of older adults with advanced illness who 17 are likely to benefit from ACP and provide a unique and important opportunity to overcome these barriers to 18 ACP. Specifically, emergency providers are unlikely to fear undermining a long-term relationship with the patient, 19 older adults who are receiving ED care are unlikely to think they are too healthy to benefit from ACP, and there 20 is ample opportunity during the ED visit to educate patients and initiate a conversation about end-of-life care 21 preferences. The overarching goal of this project is to develop evidence to support the use of an ED-based 22 intervention to promote ACP. We propose a randomized controlled trial of 900 older adults receiving care at 23 three U.S. EDs. Patients receiving the intervention will watch a 5-minute certified video decision aid about ACP 24 and have a structured conversation with a social worker about their values and preferences. The social worker 25 will then send a secure electronic message to the patient’s primary provider sharing with them the patient’s initial 26 preferences and providing instructions as to how to document the patient’s preferences in a manner that is widely 27 accessible to the patient’s medical providers. Following the clinical model of shared decision making, patients 28 will be encouraged by the social worker to deliberate further on their preferences and then have an informed 29 conversation with their primary provider or admitting physician regarding care preferences. Outcomes will include 30 documentation of ACP conversations and preferences, agreement between expressed and documented 31 preferences, and hospital days assessed 3 and 6 months after the ED visit. The results of this study will establish 32 the efficacy of this intervention and provide information to support and inform implementation.

1个项目摘要 2. 3在生命的最后几个月里，许多老年人接受的护理与他们的偏好不符， 4增加痛苦，扰乱闭合和悲伤。高级护理计划(ACP)的流程有助于 5患者可以通过授权患者定义和记录他们的临终关怀来控制他们的临终关怀 6想在他们还有认知和身体能力来考虑和表达这些时接受 7.偏好。ACP提高了患者和家属对死亡过程的满意度，增加了 8名患者得到了他们想要的护理，并减少了医疗费用。不幸的是，很少有老年人有这样的经历 9个已完成的ACP和更少的人以可访问的方式记录了他们的临终关怀偏好 10及时向医疗服务提供者报告。在最近一份医学研究所关于美国死亡和死亡的报告中， 11.增加老年人的非物质文化遗产被确定为一项主要的公共优先事项。初级保健提供者，他们通常 12名与患者有长期关系，并了解他们的医疗状况细节，很好 13准备进行临终关怀对话。不幸的是，出于几个原因，这些对话经常 14不会发生：初级提供者不希望患者认为他们已经放弃了希望；患者认为他们也放弃了希望从这些对话中受益的15人是健康的；教育患者有关临终选择需要时间。美国 16次急诊科(ED)就诊为大量患有晚期疾病的老年人提供了途径 17个可能从机场核心计划中受益，并为克服这些障碍提供了一个独特而重要的机会 18ACP。具体地说，急诊提供者不太可能担心破坏与患者的长期关系，正在接受急诊护理的19名老年人不太可能认为他们太健康而无法从ACP中受益，而且在急诊室访问期间，20岁是足够的机会来教育患者并发起关于临终关怀的对话 21个偏好。该项目的总体目标是开发证据来支持使用基于ED的 22.促进机场核心计划的干预措施。我们建议对900名接受护理的老年人进行随机对照试验。 23三本美国版。接受干预的患者将观看关于ACP的5分钟认证视频决策辅助 24岁，并与社会工作者就他们的价值观和偏好进行有条理的对话。社会工作者 25然后向患者的主要提供者发送一条安全的电子消息，与他们共享患者的初始 26偏好，并提供关于如何以广泛传播的方式记录患者偏好的说明 27患者的医疗提供者可以访问。遵循共享决策的临床模式，患者 28社会工作者将鼓励他们进一步考虑自己的喜好，然后有一个知情的 29与他们的主要提供者或入院医生就护理偏好进行对话。结果将包括 30记录ACP对话和首选项，明示和记录之间的协议 31个偏好，并在急诊科就诊后3个月和6个月评估住院天数。这项研究的结果将确立 32评估这一干预措施的效果，并提供信息，以支持和通报实施情况。