Feasibility testing of a decision aid to support shared decision making about inv

支持有关投资的共同决策的决策辅助的可行性测试

• 批准号: 8755354
• 负责人: Negin Hajizadeh
• 金额: $ 25.28万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8755354
• 关键词: Acute respiratory failure; Advance Care Planning; Aging; Ambulatory Care Facilities; Applications Grants; Caring; Cause of Death; Cessation of life; Chronic Obstructive Airway Disease; Clinical; Clinical Research; Communication; Communication Research; Communities; Comprehension; Critical Care; Critical Illness; Decision Aid; Decision Making; Discipline; Educational workshop; Elderly; Engineering; Enrollment; Feasibility Studies; Focus Groups; Hospitalization; Human; Individual; Institutes; International; Interview; Knowledge; Language; Lead; Life; Manuscripts; Measures; Mechanical ventilation; Medical; Methods; Mission; Modeling; Motivation; Online Systems; Outcome; Patient Preferences; Patients; Performance; Population; Preparation; Quality of life; Research; Risk; Safety; System; Telephone; Testing; Time; United States; Work; alternative treatment; base; comparative effectiveness; design; effectiveness research; improved; meetings; outcome forecast; patient oriented; post intervention; preference; primary outcome; prognostic; public health relevance; secondary outcome; shared decision making; surrogate decision maker; tool; usability

DESCRIPTION (provided by applicant): Chronic Obstructive lung disease (COPD) is the third leading cause of death in the United States. People over age 65 have the highest burden of COPD, especially the more advanced forms of the disease.1, 2 acute respiratory failures is a common cause of hospitalization and death in patients with severe COPD. One of the treatment choices for patients with acute respiratory failure is invasive mechanical ventilation (a "breathin machine"). However, if patients survive, this treatment has associated complications and may lead to a poor quality of life. Patients with severe COPD are often uninformed about the tradeoffs associated with invasive mechanical ventilation and therefore at risk of receiving default critical care that is not congruent with their preferences. This proposal"s hypothesizes that if that patients with severe COPD are effectively informed in advance of critical illness abou their personalized prognoses and likely tradeoffs of invasive mechanical ventilation treatment, they will be more prepared to make critical care decisions and more likely to receive preference-congruent care. The research seeks to better inform severe COPD patients and surrogate decision makers about treatment options for acute respiratory failure and personalized outcomes in advance of critical illness. The proposed method is to support doctor-patient communication and shared decision making about mechanical ventilation and advance care planning. The tool proposed is a brief, web-based decision aid, "InformedTogether". "InformedTogether" integrates comparative effectiveness research on invasive versus noninvasive mechanical ventilation for severe COPD, with patient-centered language doctors can use to communicate choices and outcomes, and to elicit patients" preferences. The "InformedTogether" decision aid targets several clinician barriers to communication and shared decision making about advance care planning which include: a lack of prognostic estimates for alternative treatment options, a lack of time, and difficulty communicating with patients, especially when prognosis is poor. It also targets several patient barriers to informed decision making which include: lack of prognostic information; lack of opportunity to consider tradeoffs & preferences, and; denial/ discomfort discussing dying. The decision aid design will adhere to the International Patient Decision Aid Standards and will be guided by principles of Human Factors Engineering (the scientific discipline used to enhance the interaction between humans and systems to optimize performance, increase learnability, minimize error, and increase safety). The specific aims are: (1) To revise a brief, decision aid ('InformedTogether') which supports shared decision making between doctors and severe COPD patients about treatments for acute respiratory failure. (2) To test the decision aid 'InformedTogether' for quality and feasibility of implementation. This work will support communication of research results to aging and older people and aims to improve informed decision making and preference- congruent care in this population, meeting one of the missions of the National Institutes of Aging.

描述（由申请人提供）：慢性阻塞性肺病（COPD）是美国第三大死亡原因。年龄超过65岁的人有COPD的最高负担，特别是更先进的形式的疾病。1，2急性呼吸衰竭是一个常见的原因住院和死亡的严重COPD患者。急性呼吸衰竭患者的治疗选择之一是有创机械通气（“呼吸机”）。然而，如果患者存活，这种治疗具有相关的并发症，并可能导致生活质量差。重度COPD患者通常不了解有创机械通气相关的权衡，因此有接受与其偏好不一致的默认重症监护的风险。该提案假设，如果重度COPD患者在危重病发生前被有效告知他们的个性化治疗和有创机械通气治疗的可能权衡，他们将更有准备地做出危重护理决策，更有可能接受偏好一致的护理。该研究旨在更好地告知严重COPD患者和代理决策者关于急性呼吸衰竭的治疗方案和危重疾病之前的个性化结局。所提出的方法是支持医患沟通和共享决策有关的机械通气和提前护理计划。拟议的工具是一个简短的、基于网络的决策辅助工具“InformedTogether”。“InformedTogether”整合了有创与无创机械通气治疗重度COPD的比较有效性研究，医生可以使用以患者为中心的语言来传达选择和结果，并引出患者的偏好。“InformedTogether”决策辅助工具针对临床医生在沟通和共享有关提前护理计划的决策方面的几个障碍，包括：缺乏替代治疗方案的预后估计、缺乏时间以及难以与患者沟通，尤其是在预后不良时。它还针对患者做出知情决策的几个障碍，其中包括：缺乏预后信息;缺乏考虑权衡和偏好的机会，以及;否认/不适讨论死亡。决策辅助设计将遵循国际患者决策辅助标准，并以人为因素工程（用于增强人与系统之间的交互以优化性能、提高可学习性、最大限度减少错误并提高安全性的科学学科）原则为指导。具体目标是：（1）修订一个简短的决策辅助工具（“InformedTogether”），该工具支持医生和严重COPD患者就急性呼吸衰竭的治疗进行共同决策。(2)测试决策辅助工具“InformedTogether”的质量和可行性， 实施.这项工作将支持向老龄化和老年人传播研究成果，旨在改善这一人群的知情决策和偏好一致的护理，满足美国国立老龄研究所的任务之一。