Improving Medical Decision Making for Older Patients with End Stage Renal Disease

改善老年终末期肾病患者的医疗决策

• 批准号: 10830174
• 负责人: Michael Paasche-Orlow
• 金额: $ 231.1万
• 依托单位: TUFTS 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: 2020-04-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10830174
• 关键词: Address; Advance Care Planning; Aging; American; Cardiopulmonary Resuscitation; Caregivers; Caring; Cessation of life; Chronic Kidney Failure; Communication; Complex; Conflict (Psychology); Control Groups; Counseling; Decision Aid; Decision Making; Dialysis procedure; Documentation; Early Intervention; Education; Effectiveness; Elderly; Electronic Health Record; Emotional; End stage renal failure; Family Caregiver; Intervention; Kidney; Kidney Diseases; Knowledge; Language; Length; Life; Longevity; Medical; Methods; Natural Language Processing; Palliative Care; Patient Care Planning; Patient Focused Care; Patient Self-Report; Patients; Persons; Physicians; Pilot Projects; Population; Process; Prognosis; Quality of Care; Quality of life; Randomized; Randomized, Controlled Trials; Research; Supportive care; Technology; Testing; Time; Use Effectiveness; Video Recording; Visual; Vulnerable Populations; Work; Writing; aged; care delivery; care outcomes; clinical practice; cost per quality-adjusted life year; design; efficacy study; evidence base; improved; innovation; literacy; older patient; preference; primary outcome; randomized trial; secondary outcome; success; symptom management; tool; treatment as usual; treatment planning; verbal; visual information

A growing number of older patients are living with chronic kidney disease (CKD) due to advances in life- prolonging technologies and the aging of the population. As CKD advances towards end-stage renal disease (ESRD), even life-prolonging technologies cannot extend life indefinitely, especially for patients who have a poor prognosis and for whom decisions about medical interventions become particularly important. Consequently, older patients with advanced CKD need to communicate with their physicians about their preferences regarding CPR, dialysis and supportive kidney care (medical management of symptoms of advanced CKD without dialysis) in order to make crucial decisions impacting the length and quality of their lives. Communication surrounding medical 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 CPR, dialysis and supportive kidney care. Traditional ACP for patients with ESRD relies on ad hoc verbal descriptions of treatment options. This approach is limited because these options are difficult to envision. We have developed a video decision aid for reviewing CPR, dialysis and non-dialytic treatment preferences in ESRD. The tool, which is available in both English and Spanish, also allows patients to video record their preferences ("video declaration") and share their preferences with their clinicians and caregivers. The overall objective of this study is to conduct a multi-center randomized trial of the video intervention (vs. usual care) to test the hypothesis that the video better informs older persons with advanced CKD and poor prognosis of their treatment options and leads to more ACP documentation, informed decision making, and improved quality of life. We will compare ACP documentation after one year (or at time of death) among 600 patients aged 75 or older with advanced CKD and poor prognosis randomly assigned to either the video intervention or usual care (Aim 1). We will compare ESRD treatment preferences, decisional conflict, ACP engagement and conversations, and concordance of preferences stated after the video intervention or usual care with ESRD care delivery after one year (or at time of death) (Aim 2). We will explore the quality of life, longevity, and cost per Quality Adjusted Life Year (QALY) associated with patients' ESRD treatment decisions in the video vs. control groups (Aim 3). We will also conduct a qualitative assessment of the video declarations as well as barriers and facilitators for intervention success (Aims 4 and 5). ESRD in older patients involves complex decision making. It is imperative that we develop and evaluate early interventions to deliver more patient- focused care to this rapidly growing segment of the population. Using videos to enhance communication offers an opportunity to improve care of this vulnerable group of patients. Video is a practical, evidence-based, and innovative approach that has the potential to improve the quality of care provided to tens of thousands of older Americans.

由于生活水平的提高，越来越多的老年患者患有慢性肾脏疾病(CKD)- 延长技术和人口老龄化。慢性肾脏病进展为终末期肾病 (ESRD)，即使是延长生命的技术也不能无限期地延长生命，特别是对于患有 预后不佳，对他们来说，关于医疗干预的决定变得特别重要。 因此，患有晚期CKD的老年患者需要与他们的医生沟通他们的 关于心肺复苏、透析和支持性肾脏护理的偏好(症状的医疗处理 无需透析的高级CKD)，以便做出影响其长度和质量的关键决策 活着。围绕医疗决策的沟通在高级护理计划(ACP)中被形式化， 涉及口头或书面信息的流程，旨在告知患者可能的医疗选择，包括 心肺复苏术、透析和支持性肾脏护理。终末期肾病患者的传统ACP依赖于临时口头 治疗选项的说明。这种方法是有限的，因为这些选择很难想象。我们 我开发了一个视频决策辅助工具，用于审查CPR、透析和非透析治疗的偏好 ESRD。该工具有英语和西班牙语两种版本，还允许患者视频记录他们的 偏好(“视频声明”)，并与他们的临床医生和照顾者分享他们的偏好。整体而言 本研究的目的是进行视频干预(与常规护理相比)的多中心随机试验，以 测试以下假设：视频可以更好地向患有晚期CKD且预后不良的老年人提供信息 治疗选项并导致更多的ACP文档、明智的决策制定和提高的质量 生活。我们将比较一年后(或死亡时)600名75岁或以上患者的ACP记录。 患有晚期CKD且预后较差的老年人随机分配到视频干预或常规护理 (目标1)。我们将比较ESRD治疗偏好、决策冲突、ACP参与度和 视频干预或ESRD日常护理后陈述的对话和偏好的一致性 一年后(或死亡时)提供护理(目标2)。我们将探讨生活质量、寿命和成本 视频中与患者的ESRD治疗决策相关的每个质量调整生命年(QALY)与 对照组(目标3)。我们还将对视频声明以及 干预成功的障碍和促进者(目标4和5)。老年患者的终末期视网膜病变复杂 做决定。我们必须开发和评估早期干预措施，以提供更多的患者- 集中护理这一快速增长的人口部分。使用视频增强沟通优惠 这是一个改善对这一弱势群体的护理的机会。视频是一种实用的、基于证据的 有可能提高向数万名老年人提供的护理质量的创新方法 美国人。

项目成果

Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial.

• DOI: 10.1136/bmjopen-2021-059313
• 发表时间: 2022-04-08
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Eneanya ND;Lakin JR;Paasche-Orlow MK;Lindvall C;Moseley ET;Henault L;Hanchate AD;Mandel EI;Wong SPY;Zupanc SN;Davis AD;El-Jawahri A;Quintiliani LM;Chang Y;Waikar SS;Bansal AD;Schell JO;Lundquist AL;Tamura MK;Yu MK;Unruh ML;Argyropoulos C;Germain MJ;Volandes A
• 通讯作者: Volandes A