Avatar-Based Decision Support Technology for Surrogate Decision Makers

针对代理决策者的基于阿凡达的决策支持技术

• 批准号: 8433655
• 负责人: Ronald Lee Hickman
• 金额: $ 47.55万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8433655
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Advance Care Planning; Advocate; Aging; American; Anxiety; Area; Caring; Chronic Care; Complex; Conflict (Psychology); Data; Decision Aid; Decision Making; Decision Support Systems; Deterioration; Development; Distress; Elderly; Electronics; Elements; Evaluation; Face; Family member; Frequencies; Friends; Future; Goals; Health; Health Status; Health Technology; Healthcare; Hospitalization; Hospitals; Impaired cognition; Individual; Intervention; Investigation; Knowledge; Medical; Mental Depression; Nature; Nursing Homes; Outcome; Patient Preferences; Patients; Persons; Phase; Population; Preparation; Probability; Quality of life; Randomized Clinical Trials; Readiness; Regrets; Relative (related person); Research; Resources; Resuscitation; Risk; Role; Self Efficacy; Signal Transduction; Skilled Nursing Facilities; Stress; System; Taxes; Technology; Testing; Time; Training; Uncertainty; Visit; arm; base; clinical practice; design; experience; functional status; loved ones; novel; preference; programs; psychological distress; public health relevance; satisfaction; simulation; surrogate decision maker; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): One of the most burdensome responsibilities faced by any family member is making health care decisions for a loved one who is decisionally impaired. Given the aging of the population and increasing options for treatment of acute illnesses, most Americans will find themselves facing this tremendous challenge of assuming the surrogate decision maker role for a relative or friend. Despite the frequency with which family members face this taxing responsibility, we have yet to identify effective ways to support them in decision making. This project builds on an established decision support framework and the team's prior experience with health technology. We aim to create an interactive, avatar-based, tailored intervention using serious gaming technology to deliver decision support to surrogate decision makers in preparation for post-discharge decisions about a patient's resuscitation and rehospitalization status. The purpose of this study is the development and evaluation of a novel decision support strategy that, if shown to be effective, can be widely disseminated and offered to surrogate decision makers facing the many significant health care decisions required in the acute and chronic care of their cognitively impaired loved one. The project is planned in two phases: Phase 1 will consist of the creation, development, and design of an interactive, avatar-based, individually tailored electronic program that will engage and prepare family members for the role of surrogate decision maker. Phase 2 will be a three-arm, randomized, clinical trial comparing the tailored, avatar-based simulation system, "electronic Surrogate Decision Maker Resources and Tailored Training" (eSMARTT) with a non-tailored passive educational program, "electronic Nursing Home Decision Aid" (eNHDA), and with usual care (UC). By engaging surrogate decision makers as co-designers and evaluators of decision support strategies, this application will generate data that will have a significant impact on clinical practice and the future direction of research in this area.

描述（由申请人提供）：任何家庭成员面临的最繁重的责任之一是为在决策受损的亲人做出医疗决定。鉴于人口老龄化以及急性疾病治疗的越来越多的选择，大多数美国人会发现自己面临着这一巨大的挑战，即假设对亲戚或朋友的替代决策者角色。尽管家庭成员面临这种纳税责任的频率，但我们尚未确定在决策中支持他们的有效方法。该项目建立在既定的决策支持框架以及团队先前在卫生技术方面的经验。我们旨在使用认真的游戏技术创建一种基于阿凡达的互动，基于阿凡达的量身定制干预措施，以为替代决策者提供决策支持，以准备有关患者复苏和重新介绍状态的退行后决策。这项研究的目的是对新型决策支持策略的发展和评估，如果证明是有效的，可以广泛传播并提供替代决策者，以面对急性和慢性护理对认知障碍所需要的许多重要的医疗保健决策。该项目分为两个阶段：第1阶段将包括一个基于互动的，基于阿凡达的单独量身定制的电子程序的创建，开发和设计，该计划将吸引和准备家庭成员的代理决策者的作用。第2阶段将是一项三臂，随机的临床试验，比较了量身定制的基于阿凡达的模拟系统，“电子替代决策者资源和量身定制的培训”（ESMARTT）和非销售的被动教育计划，“电子护理家庭决策援助”（ENHDA）（ENHDA），以及通常的护理（UC）。通过将替代决策者作为决策者和决策支持策略的评估者，该应用程序将生成对临床实践和该领域的研究方向产生重大影响的数据。