Promoting Behavior Change to Increase Engagement in Advance Care Planning

描述（由申请人提供）：提前护理计划（ACP）的概念正在演变。ACP最初被概念化为一个过程，通过该过程，患者可以提前指定他们在无法做出决定时想要接受的治疗。传统上，它包括完成预先指示（AD）。然而，事实表明，完成文件虽然很可能是必要的，但其本身并不足以改善寿命终了的结果。这导致了ACP作为患者与代理人之间以及患者与医生之间的沟通行为的更新概念，其重点不是对特定治疗的偏好，而是更广泛的护理目标。这些新的概念实现了许多重要的成果，包括提高临终决策的质量，减少与替代决策相关的负担，并有助于确保患者在临终时接受的护理符合他们的核心价值观。 对参与ACP患者的干预研究的评论得出结论，他们只有适度的影响。大多数旨在提高ACP参与率的干预措施都侧重于完成AD，并假设患者已为参与做好准备。然而，越来越多的证据表明，个人的参与意愿各不相同，针对准备好参与的人的干预材料对处于早期准备阶段的人无效。在这方面，ACP与许多其他健康行为相似，健康行为改变模型已成为成功干预的框架。该项目建立在一个身体的工作证明了跨理论模型（TTM）的适用性，以ACP。TTM是一种健康行为改变的模型，已被用作针对广泛行为的大量且不断增长的有效干预措施的基础。目前的建议旨在制定一种互动的、个性化的、针对性的干预措施，这种干预措施可以以成本效益高的方式向大部分人口提供，同时也适合于个人。在本提案中，ACP被定义为由四个部分组成：1）阐明护理目标; 2）与代理医生就这些目标进行沟通; 3）与医生就这些目标进行沟通; 4）完成书面文件。具体目标是：主要目标1：制定一项专门针对老年人的干预措施，以提高老年人参与老年护理方案的比例：主要目标2：通过对提供干预措施的试点测试程序和评估干预材料的可接受性和清晰度，确定老年人干预措施的可行性。主要目标3。根据参与者的反馈修改干预材料。

DESCRIPTION (provided by applicant): The concept of advance care planning (ACP) is evolving. ACP was originally conceptualized as the process by which patients could specify in advance the treatment they would want to receive if they became decisionally incapable. Traditionally, it consisted of the completion of advance directives (AD). However, it has been shown that the completion of documents, while most likely necessary, is not in and of itself sufficient to improve end-of-life outcomes. This has led to newer conceptions of ACP as an act of communication, between patients and surrogates, and between patients and physicians, that focuses not on preferences for specific treatments but rather on broader goals of care. These newer conceptions achieve a number of important outcomes, including improving the quality of end-of-life decision-making, decreasing the burden associated with surrogate decision-making, and helping to ensure that the care patients receive at the end of life is consistent with their core values. Reviews of intervention studies to engage patients in ACP conclude that they have had only modest effects. The majority of interventions designed to increase rates of ACP participation have focused on the completion of ADs and also assume that patients are prepared for this participation. There is growing evidence, however, that individuals have variable readiness to participate, and that intervention materials aimed at persons who are ready to participate will not be effective for those at earlier stages of readiness. In this way, ACP is similar to many other health behaviors, for which models of health behavior change have served as the framework for successful interventions. This project builds upon a body of work demonstrating the applicability of the Transtheoretical Model (TTM) to ACP. The TTM is a model of health behavior change that has been used as the foundation for a large and growing number of effective interventions aimed at a wide range of behaviors. The current proposal seeks to develop an interactive, individualized, TTM-tailored intervention which can be delivered cost-effectively to large segments of a population, and at the same time, be tailored to individuals. In this proposal, ACP is defined as consisting of four components: 1) clarification of goals of care; 2) communication with surrogates physicians regarding these goals; 3) communication with physicians regarding these goals; and 4) completion of written documents. The specific aims are: Primary Aim 1: To develop a TTM-tailored intervention designed to increase the rates of older persons' participation in ACP: Primary Aim 2: To determine the feasibility of the TTM intervention by pilot-testing procedures for delivering the intervention and assessing the acceptability and clarity of intervention materials. Primary Aim 3. To revise the intervention materials based on participants' feedback.