I kua na'u "Let Me Carry Out Your Last Wishes" Advance Care Planning for NativeHawaiian Elders

围绕严重疾病决策的沟通在预先护理计划(ACP)中正式确定， 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 姑息和临终关怀服务。大量研究表明，改善的ACP比率更好地符合 根据患者的喜好提供医疗服务。尽管在医疗保健系统中扩大了ACP服务， 夏威夷原住民(NHS)的ACP发生率一直可以忽略不计，姑息性和临终关怀的使用率很低 服务。为了解决这些不足，我们的多学科社区和研究小组已经合作 为制作i夸那奴《让我实现你的遗愿》非加太视频干预。我们以社区为基础 协作性方法将创建、开发和测试I Kua na‘u基于视频的全面ACP计划 尊重英国国民健康保险制度的历史、观点和文化。事实上，NH文化主要是一种口头传统，其中 口语渗透到NHS的生活中，是与邻居互动的正常方式，包括在其 最近一次改编使用了视频媒体。I Kua na‘u计划将包括为 年长的国民健康保险制度生活和接受医疗保健的不同环境。这些视频将解释机场核心计划的重要性， 通过允许录制个人视频，使NHS能够讲述他们的故事(‘Olelo Kama’ilio；‘Talk Story’) ACP愿望声明，并能够与家人、朋友和 临床医生。总的目标是进行一个五年计划，其中包括两年的发展 I Kua na‘u ACP视频节目与焦点小组测试，然后在NH实施三年 社区。演示在NHS中使用视频计划的有效性是实现以下目标的关键一步 在实践中实施此工具。具体目标是：(1)对NH进行焦点小组和小组访谈 长辈、他们的家人和他们的提供者告知NH ACP视频的创建和试点测试，该视频将 拥抱i Kua naʻu的NH概念-在三种不同的类型中，让我帮助实现您的遗愿 为NH老人及其家人提供服务的组织(NH Homestead、团体辅助生活和流动 关爱)。(2)比较220名被调查者的ACP参与度、知识、决策冲突和ACP完成率 55岁以上的国民健康保险制度：(A)对110名生活在原住地或辅助生活的人进行研究前的设计 使用视频干预，以及(B)从门诊招募的110人的随机试验。(3)至 使用干预措施对165个NHS的个人视频声明进行定性评估。(4)至 将NHS与非NHS的ACP文档和临终关怀利用率进行比较 HAWAIʻI在干预计划前后使用电子健康记录和/或保险数据。 传统的ACP计划不能满足NHS的独特需求。创建和实施独特的 对NHS的基于视频的干预可以帮助支持该社区的决策并减少差距 在重病护理中。

Communication surrounding serious illness 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 palliative and hospice care services. Numerous studies have suggested that improved ACP rates better align health care delivery with patient preferences. Despite expansion of ACP services in the health care system, Native Hawaiians (NHs) consistently have negligible rates of ACP and low use of palliative and hospice care services. To address these shortcomings, our multi-disciplinary community and research group has partnered to create the I kua na'u "Let Me Carry Out Your Last Wishes" ACP video intervention. Our Community-Based Collaborative Approach will create, develop and test the I kua na'u comprehensive video-based ACP program honoring the history, opinions, and culture of NHs. Indeed, NH culture is primarily an oral tradition in which the spoken word permeates the life of NHs and is the normal way of interacting with neighbors, including in its most recent adaptation with the use of video media. The I kua na'u program will include videos tailored for the different settings in which older NHs live and get medical care. The videos will explain the importance of ACP, empower NHs to tell their story ('olelo Kama'ilio; "Talk Story") by allowing the recording of personal video declarations of ACP wishes, and the ability to share the personal video declaration with family, friends and clinicians. The overall objective is to conduct a five-year program that includes two years of development of the I kua na'u ACP video program with focus group testing, and then three years of implementation in the NH community. Demonstrating the effectiveness of using the video program in NHs represents an essential step to implement this tool in practice. The Specific Aims are: (1) To conduct focus groups and group interviews of NH elders, their families, and their providers to inform the creation and pilot-testing of NH ACP videos that would embrace the NH concept of I kua naʻu - "Let me help carry out your last wishes" among three different types of organizations serving NH elders and their families (NH Homestead, Group Assisted Living, and Ambulatory Care). (2) To compare the ACP engagement, knowledge, decisional conflict, and ACP completion rates in 220 NHs over the age of 55 in: (a) a pre-post study design in 110 people living on Homestead or Assisted Living using the video intervention, and (b) a randomized trial of 110 people recruited from Ambulatory Clinics. (3) To conduct a qualitative assessment of personal video declarations from 165 NHs using the intervention. (4) To compare ACP documentation and end-of-life health care utilization of NHs compared to non-NHs living in Hawaiʻi before and after the intervention program using electronic health records and/or insurance data. Conventional ACP programs do not meet the unique needs of NHs. Creating and implementing a unique video-based intervention for NHs can help support decision making in this community and decrease disparities in serious illness care.