Group Visits for Advance Care Planning Among Older Adults with Heart Failure

对患有心力衰竭的老年人进行团体访问以制定预先护理计划

• 批准号: 9317187
• 负责人: Sangeeta C Ahluwalia
• 金额: $ 20.84万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9317187
• 关键词: Address; Advance Care Planning; Advance Directives; Agreement; American; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Cognitive; Communication; Comorbidity; Complex; Cues; Data; Decision Making; Disease; Disease Management; Documentation; Educational Curriculum; Effectiveness; Elderly; Emotional; Evaluation; Face; Feedback; Foundations; Future; Geriatrics; Healthcare; Heart; Heart failure; Individual; Intervention; Interview; Life; Logistics; Measures; Medical; Methodology; Methods; Modeling; Nature; Outcome; Participant; Patient Participation; Patients; Persuasive Communication; Physicians; Preparation; Process; Provider; Public Health Practice; Readiness; Reporting; Research; Research Design; Resources; Risk; Sample Size; Self Efficacy; Social support; Statistical Data Interpretation; Structure; Surveys; Testing; Thinking; Time; Training; Uncertainty; Visit; Work; base; clinical practice; design; experience; follow-up; hands-on learning; improved; loved ones; multiple chronic conditions; outcome forecast; preference; prototype; skills; social; social learning; treatment choice

Background: Early advance care planning (ACP) is critical for older adults with heart failure (HF), who face an uncertain trajectory marked by increasingly complex treatment decisions. HF is highly prevalent among the elderly, who typically have a high burden of comorbidity that further complicates the disease trajectory, with implications for the use of life- prolonging interventions. Our approach to ACP has recently shifted from a narrow focus on advance directives to helping patients identify and communicate their broad healthcare values early in the illness trajectory to prepare them for in-the- moment decision making. Unfortunately, the time, skills, and resources required for patient-provider discussions about values clarification often results in delayed or overlooked ACP communication. A group visit approach to values clarification offers economies of scale while also leveraging aspects of social learning to enhance patient engagement in ACP and values clarification. Although group visits have been effectively used in chronic disease management, this model has not yet been applied to the ACP-values clarification context. Purpose: To establish the acceptability, feasibility and preliminary impact of using group visits for ACP focused on values clarification among elderly HF patients and their surrogates in preparation for a planned R01 trial. Specific Aims (1) Refine an ACP-HF group visit intervention based on input from older HF patients, their surrogates, and their primary providers; and (2) Evaluate the acceptability, feasibility and preliminary impact on ACP-relevant outcomes of the ACP-HF group visit intervention among older HF patients, their surrogates, and their primary providers. Research Design/Methods: This is a mixed-methods study of an ACP-HF group visit intervention focused on values clarification. In Aim 1, we will conduct 3 prototype ACP-HF group visits and 2 follow-up group visits and then conduct cognitive interviews and administer brief surveys to elicit focused feedback from participants. We will use surveys to elicit feedback from the patient participants' primary providers on a prototype group visit summary note to tailor the communication between the group visit intervention and the clinical setting. We will use these data to refine the conduct and curriculum of the prototype intervention in preparation for pilot-testing. In Aim 2, we will pilot 6 ACP-HF group visits and 2 follow-up group visits and assess the acceptability, feasibility, and preliminary impact on ACP-relevant outcomes of the visits through pre-post survey evaluations, semi-structured interviews, structured observations of the group visits, and exploratory statistical analyses. We will also collect feedback from primary providers on the perceived utility and quality of the information provided to them about their patients' participation in the group visits. Implications: Findings from this study will provide the methodological and logistical foundation for a planned R01 trial to evaluate the effectiveness of an ACP-HF group visit intervention. This study will also advance our understanding of how to efficiently incorporate the complex and time-consuming process of values clarification into clinical practice through the use of group visits.

背景：早期提前护理计划（ACP）对老年心力衰竭（HF）患者至关重要，他们面临着不确定的 越来越复杂的治疗决策。HF在老年人中高度流行，他们通常 有很高的合并症负担，使疾病轨迹进一步复杂化，对生命的使用产生影响- 延长干预措施。我们对机场核心计划的态度，最近已从狭隘地集中于预先指示，转为协助 患者在疾病轨迹的早期识别并传达其广泛的医疗保健价值观，为他们在 时刻决策。不幸的是，患者-提供者讨论以下问题所需的时间、技能和资源 价值观的澄清往往导致ACP沟通的延迟或被忽视。价值观的团体访问方法 澄清提供了规模经济，同时还利用社会学习的各个方面，以提高患者的参与度， ACP和值澄清。虽然小组访视已有效地用于慢性病管理， 模型尚未应用于ACP值澄清上下文。 目的：确定对ACP进行团体访问的可接受性、可行性和初步影响，重点是 在老年HF患者及其替代者中进行价值澄清，为计划的R 01试验做准备。 具体目标（1）根据老年HF患者及其代理人的输入， （2）评价可接受性、可行性和对非加太相关成果的初步影响 的ACP-HF组访问老年HF患者，他们的代理人和他们的主要提供者之间的干预。 研究设计/方法：这是一项针对价值观的ACP-HF组访视干预的混合方法研究 澄清。在目标1中，我们将进行3次原型ACP-HF组访视和2次随访组访视，然后进行 认知访谈和管理简短的调查，以从参与者那里获得有针对性的反馈。我们将使用调查， 从患者参与者的主要提供者那里获得关于原型组访视总结说明的反馈， 小组访视干预与临床环境之间的沟通。我们将利用这些数据来完善 和课程的原型干预准备试点测试。在目标2中，我们将试点6 ACP-HF组 访视和2次后续小组访视，并评估可接受性、可行性和对ACP相关 通过事前事后调查评价、半结构化访谈、 小组访问和探索性统计分析。我们还将收集主要提供者对 向他们提供的关于他们的病人参加小组访问的信息的效用和质量。 意义：本研究的结果将为计划中的R 01试验提供方法学和后勤基础 评价ACP HF组访视干预的有效性。这项研究也将促进我们对 如何有效地将复杂而耗时的价值澄清过程纳入临床实践 通过集体参观。