Amelioration of Claustrophobia and Disruptive Patient Motion in MR Imaging

描述(由申请人提供)：幽闭恐惧症和扰乱患者运动--磁共振检查的长期常见障碍--可以通过由训练有素的工作人员进行非药物行为干预来预防或改善。这种干预的潜在好处非常显著，因为目前的做法是取消研究或给药镇静。无法完成核磁共振扫描对美国每年估计有70万名患者造成不利影响，他们要么被剥夺了诊断，由于运动而导致诊断延误和翻译错误，要么暴露在药物镇静的风险中，包括死亡。反过来，成像设施通常无法填满 突然腾出扫描槽，并冒着大量收入和效率损失的风险。由此产生的负面患者体验进一步降低了患者满意度。长期目标是通过培训设施工作人员，通过高级融洽技能和安慰语言帮助患者，为闭锁恐惧症和磁共振成像中破坏性的患者运动提供经过验证的、临床上可行的非药物改善方法。第一阶段的成果包括设计一个Comfort Talk(R)培训的原型，以及一个设施特定地点可定制的在线培训支持平台，以支持核磁共振工作人员进行个性化的技能发展。结果：根据国家基准，显著减少了取消，提高了效率和患者满意度。第二阶段的目标是能够对基础广泛的商业化的假定好处进行扩展和最终测试。具体目标1利用“翻转课堂”原则，为培训员培训和认证开发一个可扩展的原型：从基于网络的预备课程开始--在现场培训期间最大限度地为相互反馈和教学技能练习提供时间。实践和认证将包括传统的测试和角色扮演，这些将逐步在线转移到虚拟环境中，在虚拟环境中，候选人培训师的化身与虚拟 患者的化身应该选择适当的舒适性谈话(R)策略。在目标2中，将通过开发内部培训师冠军；为无法参加现场培训的核心员工和不在高度焦虑和疼痛易发地区工作的人员提供支持性在线课程；以及可定制的Comfort Talk(R)患者应用程序，与该网站联合品牌，实现患者层面的垂直整合，从而实现机构内计划的采用。需要 针对特定地点，针对员工的词汇和行为模式进行个性化使用 将通过捕获和分析网站条目进行整合，以实现针对特定患者群体和情况的定制文化意识内容的扩展，并进一步整合到后续培训材料中。目标3旨在明确评估Comfort Talk(R)培训的效果，包括新培训的培训师和当地冠军。在俄亥俄州立大学和杜克大学医学中心的12个核磁共振卫星的前瞻性随机设计中，将评估对患者满意度、经济结果和投资回报的影响。

DESCRIPTION (provided by applicant): Claustrophobia and disruptive patient motion-longtime common impediments to MRI examination-can be prevented or ameliorated with a non-pharmacologic behavioral intervention administered by trained staff. The potential benefits of such an intervention are highly significant as current practice alternatives are to cancel the study or administer sedation. Inability to complete their MRI scans adversely affects an estimated 700,000 patients every year in the US who are either deprived of a diagnosis, subject to diagnostic delays and interpretation errors due to motion, or are exposed to risks of pharmacologic sedation, including death. The imaging facilities, in turn, typically cannot fill the suddenly vacated scan slots and risk considerable lost revenue and efficiency. The resulting negative patient experiences further lower patient satisfaction ratings. The long-term goal is to provide a validated, clinically feasible means for non-pharmacologic amelioration of claustrophobia and disruptive patient motion in MR imaging, by training facility staff to assist patients through advanced rapport skills and comforting language. Phase I accomplishments include designs of a prototype of Comfort Talk(R) Training and a facility-site-specific customizable online Training Support Platform to support MRI staffs in personalizing their skill development. The results: significantly reduced cancellations, improved efficiency and increased patient satisfaction based on national benchmarks. The goal of Phase II is to enable scaling and definitive testing of the hypothesized benefits for broad-based commercialization. Specific Aim 1 pursues development of a scalable, prototype for trainer training and certification using the "flipped classroom" principle: beginning with preparatory web-based course-work to maximize time for mutual feedback and pedagogical skill practice during live training. Practice and certification will include traditional tests and role-play, which will be progressively moved online into virtual environments within which a Candidate Trainer's avatar interacting with virtual Patient avatars is expected to choose appropriate Comfort Talk(R) strategies. In Aim 2, intra-institutional program adoption will be pursued through developing internal Trainer-Champions; supportive online courses for core staff who cannot participate in live training and for personnel who do not work in high anxiety and pain prone areas; and a customizable Comfort Talk(R) patient app, co-branded with the site to enable vertical integration to the patient level. The need for site-specific individualization with regard to use of vocabulary and behavior patterns of staff will be integrated by capture and analysis of site entries to enable scaling of customized culture-conscious content for specific patient populations and situations and further integration in subsequent training materials. Aim 3 targets unequivocal assessment of the effect of Comfort Talk(R) training, including the newly trained trainers and local champions. In a prospective randomized design at 12 MRI satellites of the Ohio State and Duke University Medical Center effects on patient satisfaction, economic outcomes, and return-on-investment will be assessed.