Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure

指导以患者为导向的研究，以改善晚期呼吸衰竭患者的替代决策

• 批准号: 10641976
• 负责人: Douglas B White
• 金额: $ 11.02万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641976
• 关键词: Active Learning; Acute respiratory failure; Address; Affect; Attitude; Award; Behavior; Caring; Collaborations; Communication; Country; Data; Data Set; Decision Making; Disease; Doctor of Philosophy; Ethics; Evidence based intervention; Family; Fostering; Funding; Goals; Growth; Health Services Research; Health system; Infrastructure; Intervention; Interview; Lead; Learning; Medical Care Costs; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mid-Career Clinical Scientist Award (K24); Midcareer Investigator Award in Patient-Oriented Research; National Heart, Lung, and Blood Institute; Observational Study; Outcome; Patient-Centered Care; Patient-Focused Outcomes; Patients; Physicians; Positioning Attribute; Principal Investigator; Prognosis; Psyche structure; Psychology; Public Health; Reading; Research; Research Personnel; Resource Development; Resources; Respiratory Failure; Role; Science; Scientist; Senior Scientist; Social Psychology; Structure; Techniques; Testing; Time; Training; United States; United States National Institutes of Health; Universities; Utility Theories; Work; career; career development; effective intervention; end of life; improved; improved outcome; innovation; insight; medical schools; mentoring community; next generation; overtreatment; patient oriented; patient oriented research; preference; programs; public health relevance; shared decision making; skills; success; surrogate decision maker; surrogate decision making; symposium

ABSTRACT The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Douglas White to train, mentor, and support the career development of clinician-scientists focused on developing and testing interventions to improve surrogate decision making for incapacitated patients with advanced respiratory failure. Patients with acute respiratory failure and a poor prognosis often receive intensive, burdensome treatments near the end of life that are inconsistent with their values and preferences. This is an important public health problem because 1) patient-centered care near the end of life is a central aspect of ethical, humane care, and 2) overtreatment near the end of life contributes to the disproportionate costs of medical care near the end of life in the U.S. Although the scope of the problems is well documented, there are few evidence-based interventions to improve patient outcomes. Solving this problem will require the collaboration of scientists with expertise in decision science, organizational behavior, and health services research. Dr. White is extremely well positioned to lead these efforts. He is a midcareer investigator with a mature, NIH-funded program of research on surrogate decision making in acute respiratory failure. He has an extensive track record of successful mentoring in patient-oriented research. He has assembled a team of senior scientists and collaborators to accomplish the proposed research and mentoring plan. He will increase his skills as a mentor and expand his scientific expertise by participating in targeted career development activities in mentoring, organizational science, and the psychology of group decision making. The scientific goal of this proposal is for Dr. White and his mentees to use the existing data and infrastructure of his ongoing R01s to develop new lines of research exploring the roles of interprofessional team functioning and group decision making on outcomes for incapacitated patients with acute respiratory failure. In Aim 1 the team will conduct a mixed methods study to characterize clinicians’ attitudes and actual practices related to interprofessional team collaboration in providing decision support to surrogates of patients with advanced respiratory failure (Aim 1a), then conduct exploratory analyses examining associations between team functioning and outcomes of patients with advanced respiratory failure (Aim 1b). In Aim 2 they will use the largest dataset in existence of audiorecorded clinician-family conferences about goals of care in ICUs to determine whether and how clinicians elicit the values and preferences of incapacitated patients from surrogates (Aim 2a), then conduct exploratory analyses examining associations with patient outcomes (Aim 2b). Together, these scientific aims and career development activities will expand Dr. White’s ability to train the next generation of patient-oriented researchers in developing interventions to improve surrogate decision making for patients with advanced respiratory failure.

摘要

项目成果

Weighted Lottery to Equitably Allocate Scarce Supply of COVID-19 Monoclonal Antibody.

• DOI: 10.1001/jamahealthforum.2023.2774
• 发表时间: 2023-09-01
• 期刊: JAMA HEALTH FORUM
• 作者: McCreary, Erin K.;Essien, Utibe R.;Chang, Chung-Chou H.;Butler, Rachel A.;Pathak, Parag;Soenmez, Tayfun;Uenver, M. Utku;Steiner, Ashley;Chrisman, Maddie;Angus, Derek C.;White, Douglas B.
• 通讯作者: White, Douglas B.

Policies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study.

美国学术教学医院强制道德咨询政策：多地点调查研究。

• DOI: 10.1097/ccm.0000000000004343
• 发表时间: 2020
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Neal,JonathanB;Pearlman,RobertA;White,DouglasB;Tolchin,Benjamin;Sheth,KevinN;Bernat,JamesL;Hwang,DavidY
• 通讯作者: Hwang,DavidY

Structural Inequities, Fair Opportunity, and the Allocation of Scarce ICU Resources.

结构性不平等、公平机会和稀缺 ICU 资源的分配。

• DOI: 10.1002/hast.1285
• 发表时间: 2021
• 期刊: The Hastings Center report
• 作者: White,DouglasB;Lo,Bernard
• 通讯作者: Lo,Bernard

Association Between Shared Decision-Making During Family Meetings and Surrogates' Trust in Their ICU Physician.

家庭会议期间的共同决策与代理人对其 ICU 医生的信任之间的关联。

• DOI: 10.1016/j.chest.2022.10.028
• 发表时间: 2023
• 期刊: Chest
• 影响因子: 9.6
• 作者: Lincoln,TaylorE;Buddadhumaruk,Praewpannarai;Arnold,RobertM;Scheunemann,LeslieP;Ernecoff,NatalieC;Chang,Chung-ChouH;Carson,ShannonS;Hough,CatherineL;Curtis,JRandall;Anderson,Wendy;Steingrub,Jay;Peterson,MichaelW;Lo,Bernard
• 通讯作者: Lo,Bernard

Promoting equity with a multi-principle framework to allocate scarce ICU resources.

• DOI: 10.1136/medethics-2021-107456
• 发表时间: 2022-03
• 期刊: Journal of medical ethics
• 影响因子: 4.1
• 作者: White D;Lo B
• 通讯作者: Lo B