A communication tool to assist severely injured older adults

摘要 每年有近50万老年人因创伤入院。对许多人来说 受伤的患者，坠落或车祸造成的伤害是导致20%的住院和40%的住院的临终事件- 年死亡率。严重的创伤会给老年患者带来他们不想要的激进治疗负担。 因为这些治疗在延长生存期或使患者恢复生活质量方面的能力往往有限。 他们在受伤前就有过。鉴于治疗的负担和不良的预后，严重受伤的老年人 将受益于有助于及早获得姑息治疗的决策支持干预措施，这可以 减少不必要的侵入性操作，解决症状并明确目标。这项建议服务于长远的- 改善老年人与家人共同面临决策的沟通的长期目标 关于侵入性治疗--以便他们的治疗选择反映个人的偏好和目标。 “帮助严重受伤的老年人的沟通工具”是一款为期两年的R21，它回应了 具体到PA-13-355，用于“为重症患者开发和评估创新的决策辅助工具” 老年患者和/或他们的代理决策者。我们的研究团队开发了一种小说 一种称为“最好情况/最坏情况”的交流工具，它使用叙事和图形辅助来说明选项， 表达不确定性，并在患者潜在健康的背景下描述结果。我们有 证明外科医生可以学习使用该工具，并且在急性护理环境中患者可以接受， 我们现在需要调整和测试这一工具，以便在一群最有可能受益于 及早获得姑息治疗。这个项目有两个目标：目标1，适应最好/最坏的情况 创伤环境的沟通工具；目标2，测试教导创伤护理提供者使用 关于通信质量的最佳情况/最坏情况工具。 该奖项将产生一个用于创伤环境的决策干预，关于 干预对沟通的影响，以及未来大规模疗效研究的初步数据。这个 研究具有创新性，因为它测试了一种新颖的、理论上站稳脚跟的干预措施， 而家庭最有可能受益。这项研究具有重要意义，因为如果干预有效，它 提供了一种低成本的策略，以改善与老年创伤患者家属的沟通。我们是 在本奖项的范围内很好地实现我们的目标，因为我们正在调整现有的 干预和评估一个重要的中间结果--沟通质量，具有很高的 有可能影响下游的健康结果。

ABSTRACT Nearly 500,000 older adults are admitted to the hospital annually with traumatic injury. For many severely injured patients, injury from a fall or car crash is a terminal event leading to a 20% in-hospital and 40% one- year mortality. Severe traumatic injury can burden older patients with aggressive treatments they do not want because these treatments often have limited ability to prolong survival or return patients to the quality of life they had before their injury. Given the burdens of treatment and poor prognosis, severely injured older adults would benefit from decision support interventions that facilitate early access to palliative care, which can reduce unwanted invasive procedures, address symptoms and clarify goals. This proposal serves the long- term goal of improving communication for older adults who, together with their family, are facing decisions about invasive treatments—so that their treatment choices reflect personal preferences and goals. “A communication tool to assist severely injured older adults” is a two-year R21 that responds specifically to PA-13-355 for “development and evaluation of innovative decision aids for seriously ill older patients and/or their proxy decision makers.” Our research team has developed a novel communication tool called “best case/worst case” that employs narrative and a graphic aid to illustrate options, express uncertainty and describe outcomes within the context of the patient's underlying health. We have demonstrated that surgeons can learn to use the tool and it is acceptable to patients in the acute care setting, we now need to adapt and test this tool for use with a cohort of patients who are most likely to benefit from early access to palliative care. This project has two aims: Aim 1, to adapt the best case/worst case communication tool to the trauma setting; Aim 2, to test the effect of teaching trauma care providers to use the best case/worst case tool on the quality of communication. This award will produce a decision-making intervention for use in the trauma setting, knowledge about the effect of the intervention on communication, and preliminary data for a future large-scale efficacy study. The research is innovative because it tests a novel, theoretically grounded intervention in a setting where patients and families are most likely to benefit. The research is significant because if the intervention is effective, it offers a low-cost strategy to improve communication with families of older patients with traumatic injury. We are well positioned to achieve our objectives within the scope of this award because we are adapting an existing intervention and evaluating an important intermediate outcome —quality of communication— with high potential to impact downstream health outcomes.