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.

项目总结 在美国，酒精相关性肝病(ALD)占肝脏相关死亡的近一半， 是肝移植(LT)的主要适应症。从历史上看，许多移植中心需要6个月的时间 戒酒期，才有资格接受肝脏移植。然而，患有ALD的患者中，有 重度酒精性肝炎(SAH)不太可能存活6个月，3个月内死亡率为70%-80%。A 6- 月禁欲要求限制了SAH患者接受LT的机会。早期肝移植，或 在没有等待6个月禁欲的情况下进行移植的做法，是唯一的生命- 为大多数SAH患者提供节省治疗的方法。自十年前引入以来，SAH的ELT已经 引发了关于公平和负责任地分配稀缺捐赠器官问题的辩论。医疗保健提供者 治疗ALD的患者对中心水平的英语教学表达了相互矛盾的感觉和精神痛苦 实践，特别是与选择过程和移植后临床护理有关的做法。最新研究数据 提供ELT后患者成功结局的证据并未解决医疗保健提供者的道德问题 痛苦，特别是与对酒精使用障碍患者的污名化和对 值得信赖或值得信赖。医疗保健提供者的感知图式和无意识偏见是 持续存在的障碍阻碍英语教学的扩展和维持。 为了帮助ELT在全国范围内的扩展，针对医疗保健提供者和研究合作者的道德培训是 需要的。生命伦理学教育干预已被证明可以缓解精神痛苦，增强韧性， 并赋予医护人员行使道德代理的权力。我们将开发一种新颖的、互动的培训 该模块将关键的生物伦理学概念置于实际的临床实践中，并教授伦理学基础 帮助医疗保健提供者克服与英语教学相关的精神困扰的推理。我们将使用基于设计的 研究方法，以创建一个在线培训模块，其中将包括a)生物伦理基础和 伦理推理及其在英语教学中的临床应用b)自我反身练习 无意识的偏见和c)为学习者的精神痛苦量身定做的可选择的教学路径。这个 培训模块将是共享资源的更大努力的一部分，包括道德框架(AS 父母奖中概述的)和教育材料，用于全国移植中心。我们预见到了这一点 作为一系列的第一个模块，最终形成了一个全面的、可定制的在线生物伦理 课程设置。

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.