Improving Advance Care Planning in Oncology: A Pragmatic, Cluster-Randomized Trial Integrating Patient Videos and Clinician Communication Training

改善肿瘤学的预先护理计划：一项结合患者视频和临床医生沟通培训的务实、整群随机试验

• 批准号: 10459292
• 负责人: James A. Tulsky
• 金额: $ 164.37万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10459292
• 关键词: Address; Adopted; Advance Care Planning; Advanced Malignant Neoplasm; Aging; American; Cancer Burden; Caring; Clinic; Cluster randomized trial; Communication; Consultations; Decision Aid; Electronic Health Record; Elements; Enrollment; Family; Feeling; Future; Goals; Hawaii; Health; Health system; Healthcare Systems; Hospitals; Individual; Infrastructure; Institute of Medicine (U.S.); Intervention; Intervention Studies; Intervention Trial; Knowledge; Life; Malignant Neoplasms; Measures; Medical; Medical Societies; Minnesota; New York; North Carolina; Oncologist; Oncology; Organ; Outcome; Palliative Care; Patient Recruitments; Patient-Focused Outcomes; Patients; Phase; Population; Process; Protocols documentation; Public Health; Quality of Care; Randomized Controlled Trials; Regrets; Resuscitation Orders; Science; Subgroup; System; Technology; Testing; Time; Training; United States National Institutes of Health; Work; acute care; base; cancer care; comparison intervention; effectiveness evaluation; end of life; end of life care; end-of-life communication; evidence base; experience; hospice environment; human old age (65+); implementation tool; improved; improved outcome; innovation; older patient; patient oriented; pilot test; preference; programs; satisfaction; skills; skills training; tool

Project Summary/Abstract Too many older Americans with advanced cancer die every year receiving aggressive interventions at the end of life that do not reflect their values, goals, and preferences. Advance Care Planning (ACP) is the most consistent modifiable factor associated with better end-of-life communication and goal-concordant care. However, clinicians often do not possess the communication skills needed for high-quality ACP conversations and patients are often unable to imagine their options for medical care to make informed decisions. To address this gap, we have developed a Comprehensive ACP Program that combines two well-tested, evidence- based, and complementary interventions: clinician communication skills training and patient video decision aids. This inclusive ACP approach treats patients and clinicians as equal stakeholders providing both with the communication skills and tools needed to optimally make informed decisions before the toughest choices arise. We have shown the efficacy of the elements of the Comprehensive ACP intervention in several small randomized controlled trials for older patients with cancer. The overall objective of this proposal is to conduct a pragmatic stepped wedge cluster randomized trial (SW-CRT) in three large health care systems: Duke Health, the Mayo Clinic, and Northwell Health. During the first UG3 year, we will establish the organization, processes, and infrastructure necessary to develop all aspects of a pragmatic SW-CRT of the intervention for 4,500 patients over 65 with advanced cancer and pilot test the study protocol in one oncology clinic in each system (Aim 1). During the four years of the UH3 stage, we will conduct a SW-CRT in 36 oncology clinics in the three systems and evaluate the effectiveness of the intervention by comparing the following outcomes: 1. Advance care plans completion; 2. Medical orders for resuscitation preferences; 3. Palliative care consultations; and 4. Hospice use (Aim 2). We will use established electronic health record systems at each health system to obtain outcomes. We hypothesize that a higher proportion of patients in the intervention phase (vs. control) will: complete advance care plans (primary trial outcome), have documented electronic medical orders for resuscitation preferences, be seen in palliative care consultations, and enroll in hospice. We will also characterize detailed patient-centered outcomes in a subgroup of 450 patients, including video declarations of individual preferences (Aim 3). Clinician communication training along with video decision support is a practical, evidence-based, and innovative approach to uniformly provide robust ACP. This work has the potential to improve the quality of care provided to millions of older Americans with cancer.

项目概要/摘要 每年有太多患有晚期癌症的美国老年人最终在接受积极干预措施后死亡 的生活不反映他们的价值观、目标和偏好。预先护理计划 (ACP) 是最重要的 与更好的临终沟通和目标一致的护理相关的一致的可修改因素。 然而，临床医生通常不具备高质量 ACP 对话所需的沟通技巧 患者往往无法想象他们的医疗护理选择以做出明智的决定。致地址 为了弥补这一差距，我们制定了一项综合 ACP 计划，该计划结合了两个经过充分测试的证据- 基于和补充的干预措施：临床医生沟通技巧培训和患者视频决策 艾滋病。这种包容性 ACP 方法将患者和临床医生视为平等的利益相关者，为双方提供 在最艰难的选择出现之前做出最佳明智决策所需的沟通技巧和工具。 我们已经在几个小型项目中展示了综合 ACP 干预措施的有效性 针对老年癌症患者的随机对照试验。该提案的总体目标是开展 在三个大型医疗保健系统中进行的实用阶梯楔形聚类随机试验 (SW-CRT)：杜克大学健康中心、 梅奥诊所和诺斯韦尔健康中心。在第一个 UG3 年中，我们将建立组织、流程、 以及为 4,500 人制定实用的 SW-CRT 干预措施的各个方面所需的基础设施 65 岁以上患有晚期癌症的患者，并在每个系统的一个肿瘤诊所对研究方案进行试点测试 （目标 1）。在 UH3 阶段的四年中，我们将在三个国家的 36 个肿瘤诊所进行 SW-CRT 系统并通过比较以下结果来评估干预措施的有效性： 1. 推进 护理计划完成； 2. 复苏偏好的医疗指令； 3.姑息治疗咨询；和 4. 临终关怀用途（目标 2）。我们将使用每个卫生系统已建立的电子健康记录系统来获取 结果。我们假设处于干预阶段（与对照相比）的较高比例的患者将： 完整的预先护理计划（主要试验结果），已记录电子医疗订单 复苏偏好、接受姑息治疗咨询并参加临终关怀。我们还将 描述 450 名患者亚组中以患者为中心的详细结果，包括视频声明 个人偏好（目标 3）。临床医生沟通培训以及视频决策支持是 实用、基于证据的创新方法来统一提供稳健的 ACP。这部作品有 改善为数百万患有癌症的美国老年患者提供的护理质量的潜力。

项目成果

Palliative Care Consultation in Hospitalized Patients With COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs.

• DOI: 10.1016/j.jpainsymman.2020.12.015
• 发表时间: 2021-08
• 期刊: Journal of pain and symptom management
• 影响因子: 4.7
• 作者: Lopez S;Finuf KD;Marziliano A;Sinvani L;Burns EA
• 通讯作者: Burns EA

Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies.

• DOI: 10.1016/j.hjdsi.2020.100432
• 发表时间: 2021-06
• 期刊: Healthcare (Amsterdam, Netherlands)
• 作者: Tuzzio L;Meyers CM;Dember LM;Grudzen CR;Melnick ER;Staman KL;Huang SS;Richards J;DeBar L;Vazquez MA;Green BB;Coronado GD;Jarvik JG;Braciszewski J;Ho PM;Wells BL;James K;Toto R;D'Onofrio G;Volandes A;Kuklinski MR;Catalano RF;Sterling SA;Morse EF;Curtis L;Larson EB
• 通讯作者: Larson EB

Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic.

大流行期间，在住院的老年人中，与非典型老年人相关的患者因素和医院结果与非典型的表现有关。

• DOI: 10.1093/gerona/glab171
• 发表时间: 2022-04-01
• 期刊: The journals of gerontology. Series A, Biological sciences and medical sciences
• 作者: Marziliano A;Burns E;Chauhan L;Liu Y;Makhnevich A;Zhang M;Carney MT;Dbeis Y;Lindvall C;Qiu M;Diefenbach MA;Sinvani L
• 通讯作者: Sinvani L

Video Intervention and Goals-of-Care Documentation in Hospitalized Older Adults: The VIDEO-PCE Randomized Clinical Trial.

• DOI: 10.1001/jamanetworkopen.2023.32556
• 发表时间: 2023-09-05
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Volandes AE;Zupanc SN;Lakin JR;Cabral HJ;Burns EA;Carney MT;Lopez S;Itty J;Emmert K;Martin NJ;Cole T;Dobie A;Cucinotta T;Joel M;Caruso LB;Henault L;Dugas JN;Astone K;Winter M;Wang N;Davis AD;Garde C;Rodriguez PM;El-Jawahri A;Moseley ET;Das S;Sciacca K;Ramirez AM;Gromova V;Lambert S;Sanghani S;Lindvall C;Paasche-Orlow MK
• 通讯作者: Paasche-Orlow MK

Clinical Outcomes of Patients Hospitalized with Coronavirus Disease 2019 (COVID-19) in Boston.

• DOI: 10.1007/s11606-021-06622-x
• 发表时间: 2021-05
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: El-Jawahri A;Bohossian HB;Paasche-Orlow MK;Lakin JR;Johnson PC;Cooper Z;Jagielo AD;Brannen EN;Reynolds MJ;Coogan K;Vaughn D;Volandes A
• 通讯作者: Volandes A