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.

摘要 美国国家医学院已确定改善临床医生的严重疾病 沟通技巧（SICS）作为一个优先领域，以改善病人和家庭的结果接近尾声 生命SICS对于患有中度至重度阿尔茨海默病的住院患者尤为重要 疾病或相关痴呆症（ADRD），因为：1）患者的偏好差异很大， 在这种情况下的护理目标;和2）住院治疗往往标志着健康轨迹恶化， 级联再入院和功能下降，因此提供了一个机会， 护理对话的强大目标。然而，实现广泛传播的一个关键障碍 在对住院ADRD患者的护理方面的改进是缺乏可扩展的， 经过临床验证的方法，帮助临床医生获得所需的复杂沟通技能， 让病人和家属参与医院环境中的护理目标讨论。 本补充材料所基于的母体R 01是一项在危重老年患者中开展的RCT 评估干预的有效性，包括姑息治疗提供的护理目标对话， 护理（PC）专家，以改善患者和家庭护理人员的结果。两者的广泛焦点 父母R 01和本ADRD补充是关于照顾者支持和以病人为中心的护理，通过 加强临床医生-患者-护理人员的沟通。鉴于PC的劳动力短缺 专家，提高非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。 我们的目标是创造和传播一种技术增强的干预措施， 可扩展且经过医学验证，可帮助医院医生和高级实践 提供者（APP）获得有效进行护理目标对话所需的技能， ADRD住院患者及其家属。因此，在目标1中，我们将使用一个名义组 在技术增强型SICS的建设过程中， 治疗ADRD患者的临床医生的干预。在目标2中，我们将进行单臂试验 评估可行性、可接受性和有效性的试验（即，技能获取） 干预 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 对于成功的R 01应用程序，执行RCT以确定可扩展SICS的影响 干预对ADRD住院患者及其照顾者结局的影响。该项目 创新，因为它旨在为临床医生开发第一个经过验证的SICS干预措施 利用技术实现高度可扩展性的ADRD患者。这项工作在 我们的手，因为我们是一个团队的建立调查与坚定的承诺， 改善ADRD患者和护理人员的结局。