Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making

通过帮助不同的老年人做好决策来改善预先护理计划

• 批准号: 8727435
• 负责人: REBECCA L SUDORE
• 金额: $ 62.18万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8727435
• 关键词: Address; Advance Care Planning; Advance Directives; Affect; Attitude; Behavior; Behavioral; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Communication; Complex; Decision Making; Disease; Double-Blind Method; Educational process of instructing; Elderly; Ethnic Origin; Face; Focus Groups; Future; General Hospitals; Goals; Health; Individual; Intervention; Lead; Life; Linear Models; Malignant Neoplasms; Measures; Mechanical ventilation; Medical; Methods; Minority; Modeling; Nurses; Office Visits; Outcome; Patient Outcomes Assessments; Patient Self-Report; Patients; Physicians; Population Heterogeneity; Preparation; Primary Health Care; Procedures; Public Health; Race; Randomized; Reading; Reporting; Research; Research Personnel; San Francisco; Self Efficacy; Social Workers; Specific qualifier value; Stress; Subgroup; Surveys; Techniques; Testing; Time; United States National Institutes of Health; Work; aged; arm; base; cohort; cost; design; efficacy testing; efficacy trial; empowerment; end of life; fifth grade; health literacy; improved; literacy; loved ones; novel; older patient; patient oriented; preference; public health relevance; safety net; satisfaction; surrogate decision maker; theories; web site

DESCRIPTION (provided by applicant): Millions of diverse, older adults and their surrogate decision makers will face many complex, ongoing decisions over the course of chronic and advanced illness. Preparation for decision is making or advance care planning (ACP), has traditionally focused on making decisions about life-prolonging procedures (e.g., mechanical ventilation) by completing advance directives. Yet, advance directives often fail to prepare patients to identify their values or to communicate with surrogates and clinicians. Therefore, the research team developed a broader paradigm of ACP that focuses instead on preparing patients to communicate their wishes and to participate with clinicians in making real-time, complex medical decisions over the course of illness. The research team has created an easy-to-understand, patient-centered website called PREPARE that is based on this new ACP paradigm. PREPARE teaches patients, through videos and modeling of ACP behaviors, how to identify their wishes and communicate with surrogates and clinicians. The objective of this proposal is to test PREPARE in a double-blind, randomized, efficacy trial. The aims of this study are: (1) to determine the efficacy of PREPARE to engage ethnically diverse, older adults in a range of ACP behaviors (i.e., identify and discuss wishes with surrogates and clinicians as well as complete advance directives), and (2) to assess whether the efficacy of PREPARE varies by patient subgroups, such as race/ethnicity and literacy level. The researchers will also obtain input from patients, surrogates, and clinicians about implementation of PREPARE in safety-net settings. Methods: 500 patients aged e 55 years with chronic illness from San Francisco General Hospital will be randomly assigned to either the intervention arm (PREPARE plus an advance directive) or the control arm (advance directive only). Main outcomes of patient- reported engagement in ACP will be measured with validated surveys at 1 week, 3, 6, and 12 months (Aim 1). We will use mixed-effects generalized linear models to assess differences in longitudinal outcomes between arms and control for variables that differ between arms. We will also adjust for clustering by clinician. To assess efficacy by patient subgroups, we will include interaction terms of race/ethnicity and literacy by study arm in the modeling (Aim 2). Relevance to NIH and public health: If PREPARE is efficacious, the researchers will have a novel, practical, scalable ACP guide that will be easy to use and disseminate within diverse populations. This will result in diverse, older adults who are prepared to communicate their wishes and make complex medical decisions over the course of serious and chronic illness.

描述（由申请人提供）：数百万不同的老年人及其代理决策者将在慢性和晚期疾病过程中面临许多复杂的持续决策。决策准备是决策或预先护理计划（ACP），传统上侧重于做出有关延长生命程序的决策（例如，机械通气）通过完成预先指令。然而，预先指示往往不能让患者做好准备，以确定他们的价值观或与代理人和临床医生沟通。因此，研究小组开发了一种更广泛的ACP范式，重点是让患者准备好传达他们的愿望，并与临床医生一起在疾病过程中做出实时，复杂的医疗决策。该研究小组创建了一个易于理解的，以患者为中心的网站，称为“ACP”，该网站基于这种新的ACP范式。通过ACP行为的视频和建模，EQUEE教授患者如何确定他们的愿望并与代理人和临床医生沟通。本提案的目的是在双盲、随机、有效性试验中测试BAE。 本研究的目的是：（1）确定BAE在一系列ACP行为（即，确定并与代理人和临床医生讨论愿望，以及完成预先指示），以及（2）评估ECOME的疗效是否因患者亚组而异，如种族/民族和识字水平。 研究人员还将从患者、代理人和临床医生那里获得关于在安全网环境中实施CIPE的信息。研究方法：来自San弗朗西斯科总医院的500例年龄在55岁以上的慢性病患者将被随机分配至干预组（CTEE+预先指导）或对照组（仅预先指导）。将在1周、3、6和12个月时通过经验证的调查测量患者报告的ACP参与的主要结局（目标1）。我们将使用混合效应广义线性模型来评估组间和对照组间纵向结果的差异。我们还将根据临床医生的聚类进行调整。为了按患者亚组评估疗效，我们将在建模中按研究组纳入人种/种族和文化的相互作用项（目的2）。与NIH和公共卫生的相关性：如果EAE有效，研究人员将拥有一种新颖，实用，可扩展的ACP指南，易于在不同人群中使用和传播。这将导致多样化的老年人，他们愿意在严重和慢性疾病的过程中表达自己的愿望并做出复杂的医疗决定。