Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention

推进对话有助于提高疾病轨迹 (CHAT) 干预意识

• 批准号: 10668058
• 负责人: PARAG GOYAL
• 金额: $ 23.04万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668058
• 关键词: Address; Advance Care Planning; Aging; Area; Awareness; Behavior; Behavioral Model; Caregivers; Caring; Chronic; Communication; Communication Tools; Competence; Data; Decision Making; Disease; EFRAC; Elderly; Eligibility Determination; Enrollment; Feedback; Future; Goals; Health; Healthcare; Heart; Heart failure; Hospitalization; Image; Impairment; Internist; Intervention; Interview; Knowledge; Learning; Life; Malignant Neoplasms; Managed Care Programs; Medical; Methods; Modeling; Monitor; Nurses; Palliative Care; Participant; Patient Care; Patient Outcomes Assessments; Patients; Persons; Physician-Patient Relations; Physicians; Primary Care Physician; Prognosis; Public Health; Quality of Care; Quality of life; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Personnel; Scientist; Self Care; Self Determination; Self Efficacy; Self Management; Specialist; Structure; Survival Rate; Symptoms; Syndrome; System; Techniques; Telephone; Terminal Disease; Text; Therapeutic Intervention; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Videoconferencing; acceptability and feasibility; advanced disease; animation; behavior change; driving behavior; health goals; health training; implementation science; improved; innovation; intervention refinement; patient engagement; patient oriented; patient population; pilot test; preservation; primary outcome; psychologic; social; standard care; symptom management; symptomatic improvement; theories; therapy development; tool; treatment arm; treatment as usual

PROJECT SUMMARY Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome that disproportionately impacts older adults and is associated with high symptom burden, reduced quality of life, and a 5-year survival rate less than 50%. Yet, few patients with HFpEF understand the condition, its anticipated trajectory, and/or prognosis. This has several important implications, as our preliminary data show: (1) 33% of patients with a prior hospitalization for HFpEF are unaware that they have a form of heart failure; (2) symptom burden is high and engagement in symptom management is low; and (3) advanced care planning (ACP) is vastly underutilized among this patient population. Symptom management and ACP are key features of palliative care, but palliative care is either utilized at terminal disease stages or not at all. To address the urgent need to improve symptom management and ACP earlier in the disease than has traditionally been done, we developed the Conversations Helpful for Awareness of Illness Trajectory (CHAT) intervention. This intervention is grounded in self-determination theory, which outlines the importance of competence, autonomy, and relatedness in driving behavior change. CHAT will provide knowledge (competence), improve patient activation and self-efficacy (autonomy), and strengthen the patient-physician relationship (relatedness) through a combination of online patient-facing video-based modules using the Patient Activated Learning System (PALS) platform and a health coach who will guide patients through the online modules to promote active engagement. The objectives of this proposal are to: (1) refine the CHAT intervention by incorporating key stakeholders’ feedback through semi- structured qualitative interviews of patients, caregivers, and physicians, and (2) pilot test the CHAT intervention for feasibility, acceptability, and preliminary efficacy through a pilot randomized controlled trial. MPIs Goyal and Shen have complementary areas of expertise in HFpEF, implementation science, communication-based interventions, and social psychological frameworks. The investigator team also includes a primary care physician with expertise in intervention development who also created PALS, a nurse scientist with expertise in heart failure self-care and patient-reported outcomes, and a geriatrician/palliative care specialist with expertise in decision-making in heart failure and implementation science. The long-term objective is to develop a model for communicating illness trajectory to promote proactive patient engagement in managing symptoms (and improve QOL), and engagement in ACP. This proposal seeks to move beyond traditional siloed approaches of care to address the need to “incorporate palliative care approaches for aging-related conditions by healthcare practitioners who are not palliative care specialists.”

项目摘要 心力衰竭，保留的射血分数（HFPEF）是一种老年综合征，对影响不成比例 老年人与高症状伯恩（Burnen）相关，生活质量降低，生存率较低 超过50％。然而，很少有HFPEF患者了解这种情况，预期的轨迹和/或预后。 正如我们的初步数据所示：（1）33％的先前患者 HFPEF的住院并不意识到它们具有心力衰竭的形式。 （2）症状灼伤很高，并且 参与症状管理很低； （3）高级护理计划（ACP）的未被充分利用 在这个患者人群中。症状管理和ACP是姑息治疗的关键特征，但 姑息治疗要么在绝症阶段使用，要么根本不使用。解决迫切需要改善的需求 症状管理和疾病中的ACP比传统上的早期，我们开发了 对话有助于意识到疾病轨迹（CHAT）干预。该干预措施基于 自决理论，概述了驾驶能力，自主权和相关性的重要性 行为改变。聊天将提供知识（能力），改善患者的激活和自我效能感 （自治），并通过在线结合加强患者的关系（相关性） 使用患者激活学习系统（PAL）平台和健康状况的基于视频的模块和健康的模块 教练将指导患者通过在线模块以促进积极参与。目标的目标 提案将是：（1）通过半通过半通过将关键利益相关者的反馈纳入聊天干预措施 患者，看护人和医生的结构性定性访谈，以及（2）试验测试聊天干预措施 通过飞行员随机对照试验的可行性，可接受性和初步效率。 Mpis Goyal和 沉在HFPEF，实施科学，基于传播的HFPEF方面具有互补的专业知识领域 干预措施和社会心理框架。调查员团队还包括初级保健 具有干预开发专业知识的物理学，他们还创建了PALS，一位具有专业知识的护士科学家 心力衰竭自我保健和患者报告的结果，以及具有专业知识的老年医生/姑息治疗专家 在心力衰竭和实施科学领域的决策中。长期目标是开发一个模型 传达疾病轨迹以促进积极主动的患者参与症状（和 改善QOL），并参与ACP。该提议试图超越传统的孤立方法 护理需要解决“通过医疗保健结合与衰老相关状况的姑息治疗方法 不是姑息治疗专家的从业者。”