Development of an Interactive Bioethics Training Module for Healthcare Providers Treating Patients Who Need Liver Transplant for Alcohol-associated Liver Disease

为治疗酒精相关性肝病需要肝移植的患者的医疗保健提供者开发交互式生物伦理学培训模块

• 批准号: 10785093
• 负责人: ANDREW M. CAMERON
• 金额: $ 13.29万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10785093
• 关键词: Abstinence; Address; Alcoholic Hepatitis; Alcoholic Liver Diseases; Area; Award; Bioethics; Cessation of life; Clinical; Data; Development; Distress; Education; Educational Curriculum; Educational Intervention; Educational Materials; Educational Psychology; Educational process of instructing; Ethics; Exercise; Feeling; Foundations; Future; Health Personnel; Health Professional; Instruction; Interview; Justice; Learning; Learning Module; Life; Liver; Liver diseases; Methodology; Morals; Organ Donor; Parents; Pathway interactions; Patient Care; Patient-Focused Outcomes; Patients; Positioning Attribute; Process; Provider; Psychological Theory; Qualifying; Research; Research Methodology; Resource Sharing; Resources; Series; Stigmatization; Surveys; Testing; Training Activity; Transplant Recipients; Transplantation; United States; addiction; alcohol abstinence; alcohol use disorder; clinical care; clinical practice; clinically relevant; design; education resources; health empowerment; health training; implicit bias; interest; iterative design; liver transplantation; mortality; novel; patient subsets; post-transplant; programs; promote resilience; resilience; social stigma; tool; transplant centers; trustworthiness; unconscious bias

PROJECT SUMMARY Alcohol-associated liver disease (ALD) accounts for nearly half of liver-related deaths in the United States and is the leading indication for liver transplant (LT). Historically, many transplant centers have required a 6-month alcohol abstinence period to qualify for a liver transplant. However, the subset of patients with ALD who have severe alcoholic hepatitis (SAH) are unlikely to survive 6 months, with 70-80% mortality in 3 months. A 6- month abstinence requirement limits access to LT for patients with SAH. Early liver transplantation (ELT), or the practice of proceeding with a transplant without waiting for a 6-month abstinence period, is the only life- saving treatment available for most patients with SAH. Since its introduction a decade ago, ELT for SAH has sparked debate on issues of fair and responsible allocation of scarce donor organs. Healthcare providers who treat patients with ALD have expressed conflicting feelings and moral distress about center-level ELT practices, particularly related to the selection process and post-transplant clinical care. Recent research data providing evidence of successful patient outcomes after ELT have not resolved healthcare providers’ moral distress, especially related to stigmatization of patients with alcohol use disorder and concerns about trustworthiness or deservingness. Healthcare providers’ perceptual schemas and unconscious biases are persistent barriers to the expansion and sustainment of ELT. To aid in the expansion of ELT nationally, ethics training for healthcare providers and research collaborators is needed. Bioethics educational interventions have been shown to alleviate moral distress, increase resilience, and empower healthcare workers to exercise moral agency. We will develop a novel, interactive training module that situates key bioethics concepts within real clinical practice and teaches foundations of ethical reasoning to help healthcare providers navigate moral distress related to ELT. We will use design-based research methodology to create an online training module that will include a) foundations of bioethics and ethical reasoning and their application to clinical scenarios in ELT b) self-reflexive exercises to examine unconscious biases and c) selectable instructional pathways tailored to the learner’s moral distress. The training module will be part of a larger endeavor to share resources, including an ethical framework (as outlined in the parent award) and educational materials, for transplant centers nationally. We envision this module to be the first in a series, culminating in a comprehensive and customizable online bioethics curriculum.

项目摘要 与酒精相关的肝病（ALD）占美国与肝有关的死亡的一半 是肝移植（LT）的主要指示。从历史上看，许多移植中心需要6个月 戒酒期有资格获得肝移植。但是，具有ALD患者的子集 严重的酒精性肝炎（SAH）不可能生存6个月，在3个月内死亡70-80％。一个6- SAH患者的节制要求限制了对LT的访问权限。早期肝移植（ELT）或 在不等待6个月的禁欲期的情况下进行移植的做法是唯一的生活 - 可为大多数SAH患者提供节省治疗。自十年前引入以来，SAH的ELT 就稀缺捐助者组织的公平和负责任的分配问题引发了辩论。医疗保健提供者 治疗ALD的患者对中心级ELT表示矛盾的感觉和道德困扰 实践，特别是与选择过程和移植后临床护理有关的实践。最近的研究数据 在ELT未能解决医疗保健提供者的道德之后，提供成功的患者结果的证据 困扰，尤其是与酒精使用障碍患者的污名化有关 值得信赖或应得的。医疗保健提供者的感知模式和无意识的偏见是 ELT扩张和维持的持续障碍。 为了帮助扩大全国ELT，医疗保健提供者和研究合作者的道德培训是 需要。已经证明，生物伦理学教育干预措施可以减轻道德困扰，增加韧性， 并授权医疗保健工人行使道德机构。我们将开发一种小说，互动培训 将关键生物伦理学概念定位在实际临床实践中的模块，并教授道德基础 帮助医疗保健提供者导致与ELT相关的道德困扰的推理。我们将使用基于设计的 创建在线培训模块的研究方法，其中包括a）生物伦理基础和 道德推理及其在ELT中的临床场景中的应用b）自我反射练习以检查 无意识的偏见和c）根据学习者的道德困扰量身定制的可选教学途径。这 培训模块将成为共享资源的更大努力的一部分，包括道德框架（作为 在父母奖中概述了全国移植中心的教育材料。我们设想 模块是系列中的第一个，最终达到全面且可定制的在线生物伦理学 课程。

项目成果

Transplant Center Attitudes Toward Early Liver Transplant for Alcohol-associated Liver Disease.

• DOI: 10.1097/txd.0000000000001532
• 发表时间: 2023-09
• 期刊: Transplantation direct
• 影响因子: 2.3

Patient reflections, challenges, and supports related to early liver transplant for severe alcohol-associated liver disease.

• DOI: 10.1097/lvt.0000000000000059
• 发表时间: 2023-07-01
• 期刊: LIVER TRANSPLANTATION
• 影响因子: 4.6
• 作者: Chen, Po-Hung;Sung, Hannah C.;Punchhi, Gopika;Krach, Michelle;Greenberg, Ross;Gianaris, Kevin;Teles, Mayan;Kaplow, Katya;Wheatley, Jason;Cameron, Andrew M.;Chander, Geetanjali
• 通讯作者: Chander, Geetanjali

Discovery and characterization of cross-reactive intrahepatic antibodies in severe alcoholic hepatitis.

• DOI: 10.7554/elife.86678
• 发表时间: 2023-12-06
• 期刊: eLife
• 影响因子: 7.7
• 作者: Ahmadi AR;Song G;Gao T;Ma J;Han X;Hu MW;Cameron AM;Wesson RN;Philosophe B;Ottmann S;King E;Gurakar A;Qi L;Peiffer B;Burdick J;Anders R;Zhou Z;Lu H;Feng D;Chen CS;Qian J;Gao B;Zhu H;Sun Z
• 通讯作者: Sun Z

Projected 20- and 30-Year Outcomes for Pediatric Liver Transplant Recipients in the United States.

• DOI: 10.1097/mpg.0000000000002592
• 发表时间: 2020-03
• 期刊: Journal of pediatric gastroenterology and nutrition
• 影响因子: 2.9
• 作者: Bowring MG;Massie AB;Chu NM;Bae S;Schwarz KB;Cameron AM;Bridges JFP;Segev DL;Mogul DB
• 通讯作者: Mogul DB

Survival Benefit of Split-Liver Transplantation for Pediatric and Adult Candidates.

• DOI: 10.1002/lt.26393
• 发表时间: 2022-06
• 期刊: LIVER TRANSPLANTATION
• 影响因子: 4.6
• 作者: Bowring, Mary G.;Massie, Allan B.;Schwarz, Kathleen B.;Cameron, Andrew M.;King, Elizabeth A.;Segev, Dorry L.;Mogul, Douglas B.
• 通讯作者: Mogul, Douglas B.