Communicating with Surrogate Decision Makers about Incapacitated ICU Patients' Values

与代理决策者就无行为能力 ICU 患者的价值观进行沟通

• 批准号: 8835393
• 负责人: Leslie Page Scheunemann
• 金额: $ 6.76万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-15 至 2016-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8835393
• 关键词: Acute respiratory failure; Address; Affect; American; Behavior; Behavior Therapy; Caring; Communication; Communities; Consensus; Critical Care; Data; Decision Making; Delphi Study; Disease; Effectiveness of Interventions; Ensure; Environment; Evidence based intervention; Family; Future; Goals; Healthcare; Hospitals; Individual; Intervention; Left; Life; Long-Term Care; Measures; Mechanical ventilation; Medical; Mentors; Modern Medicine; Outcome; Outcome Measure; Outcomes Research; Patient Preferences; Patient-Centered Care; Patients; Physicians; Public Health; Publications; Recommendation; Research; Research Infrastructure; Research Methodology; Review Literature; Testing; Training; Uncertainty; Universities; behavior change; experience; functional disability; improved; innovation; instrument; meetings; novel; patient oriented; pre-clinical; programs; psychological distress; public health relevance; simulation; skills; skills training; success; surrogate decision maker; symposium; tool

DESCRIPTION (provided by applicant): Patient-centered care - defined as care that is respectful of and consistent with patients' values - is a central goal of modern medicine. Three decades of research demonstrate that incapacitated patients with serious ill- ness often receive medical care that is not patient-centered. From a public health standpoint, this issue is particularly concerning in the case of acute respiratory failure requiring mechanical ventilation because it affects 800,000 American patients per year. A growing body of evidence suggests that one important factor contributing to the problem is that clinicians inadequately elicit and incorporate incapacitated patients' values into treatment decisions. Indeed, in our preliminary research, clinicians did not ask about patients' values at all in half of ICU family conferences about treatment decisions. When they did ask, their inquiries were typically superficial. Therefore, interventions are needed to increase clinician communication about patient values to improve patient-centered decision-making. However several important gaps impede progress: 1) there currently is no efficient mechanism to train physicians to elicit and incorporate patients values into treatment decisions; 2) there is a paucity of evidence about exactly how clinicians should elicit and incorporate patients' values into life support decisions, making it difficult to identify which behaviors interventions should target; and 3) no measure exists to assess the effectiveness of interventions. This project makes the first steps toward addressing each of these three barriers. First, drawing on the established simulation infrastructure at the University of Pittsburgh, we will refine and pilot test a novel high fidelity simulation that will serve as th means to train physician's in future interventional studies. Second, we will conduct a modified Delphi study among a diverse stakeholder panel to develop consensus recommendations about how clinicians should communicate with surrogates about incapacitated patients' values. Third, we will combine the results of our preliminary data, literature review, and the Delphi into an outcome measure to allow us to quantify how clinicians elicit and incorporate incapacitated ICU patients' values into treatment decisions. This project will provide the applicant with essential training in critical care outcomes research through didactic training, intensive mentoring, experiential research, and participation in a community of learners as detailed in her training plan. It will generate critical preliminary data for a K23 application to further refine the outcom measure and to develop an intervention to improve clinician communication about incapacitated patients' values, and subsequently an R01 application to test the effectiveness of the intervention in improving patient and family outcomes.

描述（由申请人提供）：以患者为中心的护理-定义为尊重并符合患者价值观的护理-是现代医学的中心目标。三十年的研究表明，患有严重疾病的无行为能力患者通常接受的医疗护理不是以患者为中心的。从公共卫生的角度来看，这个问题在需要机械通气的急性呼吸衰竭的情况下尤其令人担忧，因为它每年影响80万美国患者。越来越多的证据表明，造成这一问题的一个重要因素是，临床医生没有充分地引出和纳入无行为能力的患者的价值观到治疗决定。事实上，在我们的初步研究中，临床医生在一半的ICU家庭会议中根本没有询问患者的价值观。当他们问的时候，他们的询问通常是肤浅的。因此，需要采取干预措施，增加临床医生对患者价值观的沟通，以改善以患者为中心的决策。然而，几个重要的差距阻碍了进展：1）目前没有有效的机制来培训医生，以引出患者的价值观并将其纳入治疗决策; 2）缺乏关于临床医生应该如何引出患者的价值观并将其纳入生命支持决策的证据，这使得难以确定哪些行为干预应该针对;（3）没有评估干预措施有效性的措施。该项目为解决这三个障碍中的每一个迈出了第一步。首先，利用大学建立的模拟基础设施 我们将改进和试点测试一种新的高保真模拟，将作为培训医生在未来的介入研究的手段。其次，我们将在不同的利益相关者小组中进行修改后的德尔菲研究，以制定关于临床医生应如何与代理人就无行为能力患者的价值观进行沟通的共识建议。第三，我们将结合联合收割机的初步数据，文献综述，和德尔菲的结果，使我们能够量化临床医生如何引出和纳入无行为能力的ICU患者的价值观到治疗决策。该项目将通过教学培训，强化指导，体验式研究以及参与学习者社区为申请人提供关键护理结果研究方面的基本培训，详见她的培训计划。它将为K23应用程序生成关键的初步数据，以进一步完善结果测量，并开发干预措施，以改善临床医生对无行为能力患者价值观的沟通，随后是R 01应用程序，以测试干预措施在改善患者和家庭结局方面的有效性。