I kua na'u "Let Me Carry Out Your Last Wishes" Advance Care Planning for Native Hawaiian Elders

I kua nau“让我实现您最后的愿望”夏威夷原住民长者预先护理计划

• 批准号: 10379275
• 负责人: Marjorie K. Leimomi Mala Mau
• 金额: $ 67.92万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-20 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10379275
• 关键词: Address; Advance Care Planning; Advance Directives; Age; Ambulatory Care; Animals; Assisted Living Facilities; Boston; Caregivers; Caring; Clinic; Collaborations; Communication; Communities; Conflict (Psychology); Counseling; Data; Decision Making; Development; Documentation; Elderly; Electronic Health Record; Exhibits; Family; Family Caregiver; Focus Groups; Fostering; Friends; Funding; Future; Goals; Grant; Group Interviews; Hawaiian; Health; Health Insurance; Healthcare; Healthcare Systems; Hospice Care; Indigenous; Individual; Insurance; Intervention; Intervention Studies; Knowledge; Life; Literature; Medical; Methods; Modeling; Morbidity - disease rate; Native Hawaiian; Native-Born; Oceans; Oral; Outcome; Palliative Care; Patient Preferences; Patients; Persons; Plants; Population; Process; Provider; Quality of Care; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Research Design; Services; Surveys; Testing; Time; Training Programs; Translating; United States National Institutes of Health; Use Effectiveness; Work; base; care systems; collaborative approach; community based participatory research; design; end of life; end of life care; evidence base; falls; health care delivery; health care disparity; health care service utilization; hospice environment; improved; innovation; intervention program; meetings; member; mortality; multidisciplinary; non-Native; palliative; pilot test; preference; programs; randomized trial; recruit; response; social; therapy design; therapy development; tool; user-friendly

Communication surrounding serious illness decision making is formalized in Advance Care Planning (ACP), a process involving verbal or written information designed to inform patients of possible medical options including palliative and hospice care services. Numerous studies have suggested that improved ACP rates better align health care delivery with patient preferences. Despite expansion of ACP services in the health care system, Native Hawaiians (NHs) consistently have negligible rates of ACP and low use of palliative and hospice care services. To address these shortcomings, our multi-disciplinary community and research group has partnered to create the I kua na'u "Let Me Carry Out Your Last Wishes" ACP video intervention. Our Community-Based Collaborative Approach will create, develop and test the I kua na'u comprehensive video-based ACP program honoring the history, opinions, and culture of NHs. Indeed, NH culture is primarily an oral tradition in which the spoken word permeates the life of NHs and is the normal way of interacting with neighbors, including in its most recent adaptation with the use of video media. The I kua na'u program will include videos tailored for the different settings in which older NHs live and get medical care. The videos will explain the importance of ACP, empower NHs to tell their story ('olelo Kama'ilio; "Talk Story") by allowing the recording of personal video declarations of ACP wishes, and the ability to share the personal video declaration with family, friends and clinicians. The overall objective is to conduct a five-year program that includes two years of development of the I kua na'u ACP video program with focus group testing, and then three years of implementation in the NH community. Demonstrating the effectiveness of using the video program in NHs represents an essential step to implement this tool in practice. The Specific Aims are: (1) To conduct focus groups and group interviews of NH elders, their families, and their providers to inform the creation and pilot-testing of NH ACP videos that would embrace the NH concept of I kua naʻu - "Let me help carry out your last wishes" among three different types of organizations serving NH elders and their families (NH Homestead, Group Assisted Living, and Ambulatory Care). (2) To compare the ACP engagement, knowledge, decisional conflict, and ACP completion rates in 220 NHs over the age of 55 in: (a) a pre-post study design in 110 people living on Homestead or Assisted Living using the video intervention, and (b) a randomized trial of 110 people recruited from Ambulatory Clinics. (3) To conduct a qualitative assessment of personal video declarations from 165 NHs using the intervention. (4) To compare ACP documentation and end-of-life health care utilization of NHs compared to non-NHs living in Hawaiʻi before and after the intervention program using electronic health records and/or insurance data. Conventional ACP programs do not meet the unique needs of NHs. Creating and implementing a unique video-based intervention for NHs can help support decision making in this community and decrease disparities in serious illness care.

关于重大疾病决策的沟通在预先护理计划（ACP）中正式确立