Optimizing an Early Palliative Care Intervention for Advanced HF Patients

优化晚期心力衰竭患者的早期姑息治疗干预

• 批准号: 10821109
• 负责人: Rachel D Wells
• 金额: $ 24.9万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-07 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10821109
• 关键词: Address; Adult; Advance Care Planning; Affect; African American population; Anxiety; Behavior Therapy; Cardiomyopathies; Care given by nurses; Caregivers; Cities; Clinical Investigator; Clinical Trials; Communication; Complex; Consultations; Data; Decision Making; Development; Disease; Doctor of Philosophy; Dose; Educational workshop; Effectiveness; Elderly; Enrollment; Family Caregiver; Feedback; Funding; Future; Goals; Guidelines; Health Care Costs; Health Services Accessibility; Healthcare; Healthcare Systems; Heart failure; Hospitalization; Hospitals; Individual; Intervention; Interview; Kansas; Knowledge; Knowledge acquisition; Lead; Learning Skill; Life; Maintenance; Manuals; Measures; Mediator; Mental Depression; Mentorship; Methods; Modeling; Moods; Morbidity - disease rate; Outcome; Outpatients; Pain intensity; Pain interference; Palliative Care; Participant; Patient-Focused Outcomes; Patients; Persons; Phase; Population Intervention; Postdoctoral Fellow; Prevalence; Problem Solving; Procedures; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Research; Research Ethics; Research Personnel; Research Priority; Research Training; Self Care; Self Efficacy; Strategic Planning; Structure; Symptoms; System; Telephone; Testing; Training; Translating; Underserved Population; Work; acceptability and feasibility; automated text message; design; emotional distress; experience; follow-up; formative assessment; health care service utilization; health related quality of life; improved; improved outcome; innovation; intervention effect; mortality; multiphase optimization strategy; pilot test; post intervention; primary outcome; rural dwellers; secondary outcome; skills; sociodemographics; symposium; symptom management; systematic review; telephone session

PROJECT SUMMARY/ABSTRACT This K99/R00 application describes the background and experience of the applicant, Rachel Wells, PhD, RN, and her plan to acquire the knowledge and training necessary to become a leading independent clinical investigator in developing and testing early palliative care interventions that optimize the outcomes of underserved individuals living with advanced heart failure (HF). This training and proposed research are of importance because: 1) substantial unmet palliative care needs of persons living with advanced HF; 2) few investigators are examining the mechanisms underlying palliative care intervention components to optimize intervention effect; and 3) the development of efficacious and scalable palliative care interventions in HF is a key research priority. The overall K99 goals are to gain advanced research training in developing behavioral interventions, conducting randomized controlled trials using the Multiphase Optimization Strategy (MOST), and advanced research ethics to refine and pilot test components of a lay navigator-led early palliative care intervention for underserved persons with advanced HF in the Southern U.S. The goal of the UPHOLDS intervention (Utilizing Palliative Care for Heart Failure Optimized using Lay Navigators to Decrease Suffering), will be to improve quality of life (QOL) by activating advanced HF patients through trained lay navigators coaching. The specific training objectives during the K99 phase are to: (1) develop and tailor interventions that are: 1a) manualized with rigorous fidelity procedures for enhanced replication and scalability; 1b) tailored to underserved populations; and 1c) led by lay navigators; (2) develop skills to design and lead RCTs using the MOST framework; and (3) continue training in research ethics. A comprehensive training plan has been developed in concert with mentorship team of senior research experts and includes intensive face-to-face mentorship, formal coursework/workshops, clinical trial observerships, and conference attendance. The K99 research aim will be met using interviews with a) underserved persons with advanced HF, b) lay healthcare navigators, and c) palliative care and HF clinicians, to modify and refine the content, format and delivery of HF palliative care intervention components. The overall goal during the R00 phase is to conduct an optimization pilot using a 23 factorial design to assess acceptability, feasibility, and potential efficacy of the newly refined UPHOLDS intervention. The research specific aims during the R00 phase are to: 1) determine the feasibility and acceptability of using a highly innovative MOST factorial design approach to enroll and retain 40 advanced HF patients for 24 weeks and 2) explore the preliminary efficacy of individual intervention components and component interactions on patient outcomes (QOL, primary outcome) at 12- and 24- weeks after baseline. The results will directly support an R01 application to conduct a fully powered MOST factorial trial to test the effects of individual palliative care intervention components on advanced HF patient outcomes.

项目总结/文摘