Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs
支持 ICU 代理决策者的干预措施的阶梯楔形试验
基本信息
- 批准号:8930192
- 负责人:
- 金额:$ 51.11万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2014
- 资助国家:美国
- 起止时间:2014-09-19 至 2019-06-30
- 项目状态:已结题
- 来源:
- 关键词:AddressAdultAdvance Care PlanningAffectAmericanBereavementCaringCessation of lifeClinicalCommunicationCost SavingsCritical IllnessDecision MakingEconomicsEmotionalEmpirical ResearchEngineeringEnsureFamilyFamily memberFutureGoalsHealthHealth Care CostsHealthcareHealthcare SystemsHospital CostsHospitalizationIntensive Care UnitsInterventionIntervention TrialLength of StayLettersLifeMental DepressionMulticenter TrialsNursesOutcomePainPalliative CarePatientsPilot ProjectsPost-Traumatic Stress DisordersProcessProxyPsychologyPublic HealthRandomizedRandomized Controlled TrialsRegretsResearchResearch PersonnelResourcesRoleServicesSiteSocial WorkSocial WorkersSolutionsStructureSurveysSymptomsSystemTestingTimeTrainingUncertaintyUnited StatesVulnerable PopulationsWorkanxiety symptomsbehavioral economicsdesigneffective interventionefficacy testingempoweredend of lifeexperiencefollow-uphealth care service utilizationimprovedindexinginnovationinstrumentintervention effectmeetingsmembernoveloutcome forecastpost-traumatic stresspreferencepreventprimary outcomeprogramspsychological distresspsychological outcomesskills trainingsuccesssuccessful interventionsurrogate decision makertreatment as usual
项目摘要
DESCRIPTION (provided by applicant): Three decades of research in the United States indicates that Americans who are dying often spend their final days in pain and receiving treatments they would not choose. One in five deaths among adults occurs in or shortly after discharge from an intensive care unit, where there are well-documented problems with clinician- family communication and end-of-life care. These deficiencies are associated with high rates of adverse bereavement outcomes among family members and poor quality end-of-life care. Unfortunately, there are no practical, generalizable interventions proven effective in mitigating these public health problems. In a pilot project, we developed the PARTNER intervention (PAiring Re-engineered ICU Teams with Nurse- driven Emotional Support and Relationship-building), an interdisciplinary intervention that 1) gives new responsibilities and advanced communication skills training to the local nurse leaders and social work members of the ICU team; 2) changes care "defaults" to ensure frequent clinician-family meetings; 3) adds protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician- family meetings, and 4) increases use of palliative care services for patients with a poor prognosis. Our 2-year pilot study documented that the intervention is feasible, sustainable, and is associated with shorter ICU length of stay and lower hospital costs. The objective of this proposal is to conduct a multi-center, randomized stepped wedge trial testing the PARTNER intervention in 5 ICUs among 1000 patients with advanced critical illness and their surrogates. In Aim 1, we will assess the intervention's impact on surrogates' symptoms of anxiety, depression, PTSD, and decisional regret over 6 months of follow-up. In Aim 2, we will use validated instruments to assess the intervention's impact on communication about end-of-life decisions and patients' end-of-life experiences. In Aim 3, we will assess the intervention's impact on health care utilization during the index hospitalization and over 6 months of follow-up. The PARTNER intervention will have high impact if successful because it will be a pragmatic solution to important public health problems that potentially affect more than 600,000 adults who die annually in ICUs. The intervention is innovative in its theoretical grounding in decision psychology and behavioral economics, the breadth and intensity of support provided to surrogates, the systems-level design of the intervention, and the strategy to use the existing clinical team to deploy the intervention instead of hiring external interventionists. The work is feasible in our hands because our team of established investigators developed and successfully pilot-tested the intervention, and because we have a proven record of success conducting multi-center trials in ICUs.
描述(由申请人提供):美国三十年的研究表明,临终的美国人常常在痛苦中度过最后的日子,并接受他们不愿选择的治疗。五分之一的成年人死亡发生在重症监护病房或出院后不久,那里存在临床医生与家人的沟通和临终关怀方面的问题。这些缺陷与家庭成员中不良丧亲后果的高发生率和临终关怀质量差有关。不幸的是,没有任何实际的、普遍的干预措施被证明可以有效缓解这些公共卫生问题。在一个试点项目中,我们开发了 PARTNER 干预措施(将重新设计的 ICU 团队与护士驱动的情感支持和关系建立配对),这是一种跨学科干预措施,1) 为当地护士领导和 ICU 团队的社会工作成员提供新的职责和高级沟通技巧培训; 2) 改变护理“默认”以确保频繁的临床医生与家庭会议; 3) 在临床医生家庭会议之前和会议期间增加对代理人的规范化、护士管理的辅导和情感支持,以及 4) 增加对预后不良患者的姑息治疗服务的使用。我们为期 2 年的试点研究证明,该干预措施是可行的、可持续的,并且与更短的 ICU 住院时间和更低的住院费用相关。该提案的目的是开展一项多中心、随机阶梯楔形试验,在 5 个 ICU 中对 1000 名晚期危重病患者及其代理人进行 PARTNER 干预测试。在目标 1 中,我们将评估干预措施对代理人在 6 个月的随访期间的焦虑、抑郁、创伤后应激障碍和决策后悔症状的影响。在目标 2 中,我们将使用经过验证的工具来评估干预措施对临终决策和患者临终经历沟通的影响。在目标 3 中,我们将评估干预措施对指数住院期间和超过 6 个月的随访期间医疗保健利用率的影响。如果成功,PARTNER 干预措施将产生巨大影响,因为它将成为重要公共卫生问题的务实解决方案,这些问题可能影响每年在 ICU 中死亡的超过 600,000 名成年人。该干预措施的创新之处在于其决策心理学和行为经济学的理论基础、为代理人提供的支持的广度和强度、干预措施的系统级设计以及利用现有临床团队部署干预措施而不是雇用外部干预人员的策略。这项工作在我们手中是可行的,因为我们的资深研究人员团队开发了该干预措施并成功进行了试点测试,而且我们拥有在 ICU 进行多中心试验的成功记录。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Douglas B White其他文献
Racial Differences in Shared Decision-Making About Critical Illness.
关于重大疾病的共同决策的种族差异。
- DOI:
- 发表时间:
2024 - 期刊:
- 影响因子:39
- 作者:
D. Ashana;Whitney Welsh;D. Preiss;Jessica Sperling;HyunBin You;Karissa Tu;Shannon S. Carson;Catherine L Hough;Douglas B White;M. Kerlin;Sharron L. Docherty;Kimberly S Johnson;Christopher E. Cox - 通讯作者:
Christopher E. Cox
Critical Care: A Second Special Issue of the Blue Journal
重症监护:蓝色杂志第二期特刊
- DOI:
- 发表时间:
2024 - 期刊:
- 影响因子:24.7
- 作者:
C. Calfee;M. Harhay;E. Schenck;N. D. Ferguson;Leo Heunks;Douglas B White;Laurent J Brochard - 通讯作者:
Laurent J Brochard
Critical Care: A Special Issue of the Blue Journal
重症监护:蓝色杂志特刊
- DOI:
10.1164/rccm.202401-0233ed - 发表时间:
2024 - 期刊:
- 影响因子:24.7
- 作者:
C. Calfee;M. Harhay;E. Schenck;N. D. Ferguson;Leo Heunks;Douglas B White;Laurent J Brochard - 通讯作者:
Laurent J Brochard
Douglas B White的其他文献
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{{ truncateString('Douglas B White', 18)}}的其他基金
Randomized Trial of a Scalable, Interactive Tool to Support Surrogate Decision-makers of Elderly Critically Ill Patients
支持老年危重患者代理决策者的可扩展交互式工具的随机试验
- 批准号:
10238779 - 财政年份:2020
- 资助金额:
$ 51.11万 - 项目类别:
Randomized Trial of a Scalable, Interactive Tool to Support Surrogate Decision-makers of Elderly Critically Ill Patients
支持老年危重患者代理决策者的可扩展交互式工具的随机试验
- 批准号:
10649739 - 财政年份:2020
- 资助金额:
$ 51.11万 - 项目类别:
Randomized Trial of a Scalable, Interactive Tool to Support Surrogate Decision-makers of Elderly Critically Ill Patients
支持老年危重患者代理决策者的可扩展交互式工具的随机试验
- 批准号:
10450052 - 财政年份:2020
- 资助金额:
$ 51.11万 - 项目类别:
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
指导以患者为导向的研究,以改善晚期呼吸衰竭患者的替代决策
- 批准号:
10208950 - 财政年份:2019
- 资助金额:
$ 51.11万 - 项目类别:
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
指导以患者为导向的研究,以改善晚期呼吸衰竭患者的替代决策
- 批准号:
10445305 - 财政年份:2019
- 资助金额:
$ 51.11万 - 项目类别:
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
指导以患者为导向的研究,以改善晚期呼吸衰竭患者的替代决策
- 批准号:
9804716 - 财政年份:2019
- 资助金额:
$ 51.11万 - 项目类别:
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
指导以患者为导向的研究,以改善晚期呼吸衰竭患者的替代决策
- 批准号:
10000984 - 财政年份:2019
- 资助金额:
$ 51.11万 - 项目类别:
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure
指导以患者为导向的研究,以改善晚期呼吸衰竭患者的替代决策
- 批准号:
10641976 - 财政年份:2019
- 资助金额:
$ 51.11万 - 项目类别:
Developing a Web and Tablet based Tool to Improve Communication and Shared Decision Making between Clinicians and Surrogates in ICUs
开发基于网络和平板电脑的工具,以改善 ICU 中临床医生和代理人之间的沟通和共享决策
- 批准号:
8881427 - 财政年份:2015
- 资助金额:
$ 51.11万 - 项目类别:
Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs
支持 ICU 代理决策者的干预措施的阶梯楔形试验
- 批准号:
9088130 - 财政年份:2014
- 资助金额:
$ 51.11万 - 项目类别:
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