Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Clinically Ill Older Adults at High Risk of Death or Severe Disability - Supplement

针对死亡或严重残疾高风险的临床疾病老年人的专业姑息治疗与重症监护相结合的随机试验 - 补充

• 批准号: 10714105
• 负责人: Yael Schenker
• 金额: $ 39.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10714105
• 关键词: Academy; Acute; Administrative Supplement; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Area; Caregiver support; Caregivers; Caring; Communication; Complex; Critical Care; Critical Illness; Data; Elderly; Enhancement Technology; Family; Family Caregiver; Goals; Group Processes; Health; Hospitalization; Hospitals; Intervention; Light; Medicine; Methods; Outcome; Palliative Care; Parents; Patient Care; Patient Preferences; Patient-Centered Care; Patients; Physicians; Provider; Quality of Care; Research Personnel; Signal Transduction; Specialist; Technology; Training Programs; Treatment Efficacy; Work; arm; clinical care; disability; efficacy evaluation; end of life; evidence base; functional decline; high risk; hospital readmission; improved; innovation; medical specialties; mortality risk; older patient; patient engagement; pilot trial; programs; randomized trial; skill acquisition; skills; usability

ABSTRACT The National Academy of Medicine has identified improving clinicians’ serious illness communication skills (SICS) as a priority area to improve patient and family outcomes near the end of life. SICS are particularly important for hospitalized patients with moderate-to-severe Alzheimer’s disease or related dementias (ADRD) because: 1) patients’ preferences vary substantially regarding goals of care in this context; and 2) hospitalization often signals a worsening health trajectory with cascading readmissions and functional decline, and therefore presents an opportunity to engage in robust goals of care conversations. However, a critical barrier to achieving widespread improvements in this aspect of care for hospitalized ADRD patients is the absence of a scalable, empirically-validated way to help clinicians acquire the complex communication skills needed to engage patients and families in goals of care discussions in the hospital setting. The parent R01 on which this supplement builds is an RCT among critically ill older patients assessing the efficacy of an intervention involving goals-of-care conversations delivered by palliative care (PC) specialists to improve patient and family caregiver outcomes. The broad focus of both the parent R01 and this ADRD supplement is on caregiver support and patient-centered care through enhanced clinician-patient-caregiver communication. In light of the workforce shortages for PC specialists, improving the skills of non-PC specialists, which is the goal of the supplement proposal, is a critical strategy to increase care quality for hospitalized ADRD patients. Our goal is to create and disseminate a technology-enhanced intervention that is both scalable and empirically-validated to help hospital-based physicians and advanced practice providers (APPs) acquire the skills needed to effectively conduct goals-of-care conversations for hospitalized patients with ADRD and their families. Therefore, in Aim 1, we will use a nominal group process to engage a diverse stakeholder panel in the construction of the technology-enhanced SICS intervention for clinicians treating patients with ADRD. In Aim 2, we will conduct a single-arm pilot trial to evaluate the feasibility, acceptability, and efficacy (i.e., skills acquisition) of the SICS intervention. The proposed work will have high impact because it will yield the preliminary data needed for a successful R01 application to conduct an RCT to determine the impact of the scalable SICS intervention on the outcomes of hospitalized patients with ADRD and their caregivers. The project is innovative because it seeks to develop the first empirically-validated SICS intervention for clinicians of patients with ADRD that leverages technology to achieve high scalability. The work is feasible in our hands because we are a team of established investigators with a strong commitment to improving patient and caregiver outcomes in ADRD.

抽象的 美国国家医学院已经确定了改善临床医生的严重疾病 沟通技巧（SIC）是改善末期患者和家庭成果的优先领域 生活。 SIC对于中度至重度阿尔茨海默氏症的住院患者尤其重要 疾病或相关痴呆症（ADRD）是因为：1）患者的偏好在 在这种情况下的护理目标； 2）住院通常会标志着令人担忧的健康轨迹 级联再入院和功能下降，因此有机会参与 强大的护理对话目标。但是，实现宽度的关键障碍 住院ADRD患者护理的这一方面的改善是缺乏可扩展的， 经验验证的方法来帮助临床医生获得所需的复杂沟通技巧 在医院环境中，让患者和家人参与护理讨论的目标。 该补充剂构建的父r01是重病老年患者的RCT 评估涉及姑息治疗目标对话的干预效率 护理（PC）专家改善患者和家庭护理人员的成果。两者的广泛重点 父母R01和此ADRD补充剂通过护理人员支持和以患者为中心的护理 增强的临床医生沟通。鉴于PC的劳动力短缺 专家，提高了非PC专家的技能，这是补充建议的目标， 是提高住院ADRD患者护理质量的关键策略。 我们的目标是创建和传播一种技术增强的干预措施 可扩展且经验证实，以帮助医院的医生和高级实践 提供者（应用程序）获得有效进行护理目标对话所需的技能 住院的ADRD患者及其家人。因此，在AIM 1中，我们将使用名义组 吸引潜水员利益相关者小组参与技术增强的SICS的过程 治疗ADRD患者的临床医生的干预措施。在AIM 2中，我们将进行单臂飞行员 试用SIC的可行性，可接受性和效率（即技能获取） 干涉。 拟议的工作将产生很大的影响，因为它将产生所需的初步数据 为了成功进行R01应用程序以确定可伸缩SIC的影响 干预住院的ADRD患者及其护理人员的结果。该项目是 创新性是因为它试图为临床医生开发第一个经验验证的SICS干预措施 有利用技术来达到高扩展性的ADRD患者。这项工作是可行的 我们的双手是因为我们是一个成立的调查员团队，对 改善ADRD的患者和护理人员的结果。