Improving shared decision making in lung disease

改善肺部疾病的共同决策

• 批准号: 10662450
• 负责人: Joanna Lee Hart
• 金额: $ 69.91万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662450
• 关键词: Advance Care Planning; Ambulatory Care Facilities; American; Baptist Church; Behavioral; Benefits and Risks; Black race; Caregiver well-being; Caregivers; Caring; Case Study; Cause of Death; Characteristics; Chronic Obstructive Pulmonary Disease; Clinic Visits; Clinical; Cognitive; Cohort Studies; Communication; Communities; Decision Making; Decision Theory; Disparity; Distress; Elderly; Emotional; Emotions; Family Caregiver; Foundations; Funding; Future; Geography; Goals; Health; Health system; Healthcare; Individual; Intervention; Investigation; Knowledge; Link; Lung; Lung diseases; Measurement; Measures; Mediating; Methodology; Methods; Modeling; Mood Disorders; National Heart, Lung, and Blood Institute; Outcome; Palliative Care; Participant; Patients; Pennsylvania; Personal Satisfaction; Predisposition; Prospective, cohort study; Quality of life; Race; Reporting; Research Infrastructure; Risk; Role; Rural; Symptoms; Testing; Thinking; Time; United States National Institutes of Health; Universities; Update; Work; burden of illness; care delivery; clinical care; clinical decision-making; cohort; coping; emotional symptom; expectation; experience; forest; health management; health related quality of life; improved; individual patient; informal caregiver; innovation; insight; novel; optimism; patient expectation; patient population; patient subsets; patient-clinician communication; physical symptom; preference; prevent; provider communication; psychologic; recruit; shared decision making; sociodemographics; socioeconomics; success; therapy development; treatment risk

PROJECT SUMMARY Patients’ health expectations lie at the foundation of their preference-sensitive choices, such as whether to pursue comfort-oriented therapies as a primary or concurrent strategy. To achieve high-quality shared decision making, patients with serious illnesses must form accurate expectations for their future health. However, many patients have inaccurate expectations, limiting their ability to make decisions concordant with their values. Chronic obstructive pulmonary disease (COPD) is an incurable lung disease of older adults and a leading cause of death worldwide. Patients with COPD and their caregivers frequently experience a high burden of symptoms, mood disorders, and difficulty coping, yet underuse advance care planning and palliative treatments. Existing evidence reveals that patients with COPD are at risk for expectation inaccuracies and our preliminary work reveals that overly optimistic expectations are associated with worse quality of life over time. Our overarching objective is to promote the well-being of patients living with COPD through the delivery of care concordant with individual patients’ values. This work proposes a novel application of behavioral theories of decision making and innovative methodologies to the common problem of goal-discordant care. This is a prospective cohort study among 420 patients with severe COPD plus their family caregivers recruited from Wake Forest Baptist Health, Geisinger Health System, and the University of Pennsylvania Health System. These three health systems represent diverse communities, including rural and Black communities where COPD is disproportionately burdensome, and have robust research infrastructures. The specific aims of this study are to: 1) identify patient and caregiver characteristics associated with inaccurate health expectations, 2) quantify associations between patients’ and caregivers’ expectation accuracy and well-being, and 3) identify mechanisms through which clinician communication influences expectation accuracy. The study team has the requisite content expertise, methodological expertise, and prior success conducting investigations of this type. Completion of this project will provide mechanistic insights into ways to promote optimal shared decision making in serious illness using state-of-the-art methods to test a novel conceptual model. This work will result in key targets for intervention development to improve expectation management and decision making among patients with serious illness.

项目总结 患者的健康预期取决于他们对偏好敏感的选择，例如是否 将以舒适为导向的治疗作为主要或同时进行的策略。实现高质量的共享决策 因此，患有严重疾病的患者必须对未来的健康形成准确的预期。然而，许多人 患者有不准确的期望，限制了他们做出与自己价值观一致的决定的能力。 慢性阻塞性肺疾病(COPD)是一种无法治愈的老年人肺部疾病，是一种主要的 全球范围内的死因。慢性阻塞性肺疾病患者及其照顾者经常经历沉重的负担 症状、情绪障碍和应对困难，但未充分利用提前护理计划和姑息治疗 治疗。现有证据显示，慢性阻塞性肺疾病患者存在预期不准确的风险，我们的 初步研究表明，随着时间的推移，过度乐观的预期会导致生活质量下降。 我们的首要目标是通过提供护理来促进慢性阻塞性肺疾病患者的福祉 符合个别患者的价值观。这项工作提出了一种新的行为理论的应用 对目标不一致护理这一常见问题的决策和创新方法。这是一个 420名重症COPD患者及其家庭照顾者的前瞻性队列研究 维克森林浸信会健康、盖辛格健康系统和宾夕法尼亚大学健康系统。 这三个保健系统代表不同的社区，包括农村和黑人社区 慢性阻塞性肺病负担过重，而且拥有强大的研究基础设施。这样做的具体目的是 研究的目的是：1)确定与不准确的健康预期相关的患者和照顾者特征；2) 量化患者和照顾者的期望准确性和幸福感之间的关联，以及3)确定 临床医生沟通影响预期准确性的机制。 研究团队拥有必要的内容专业知识、方法专业知识和先前成功进行的 这种类型的调查。该项目的完成将提供对如何促进 在严重疾病中使用最先进的方法测试新的概念性的最优共享决策 模特。这项工作将产生干预发展的关键目标，以改善期望管理 以及重病患者的决策。