Meeting the Challenges of COVID-19 by Expanding the Reach of Palliative Care: Proactive Advance Care Planning with Videos for the Elderly and all Patients with Dementia

通过扩大姑息治疗的范围来应对 COVID-19 的挑战：为老年人和所有痴呆症患者提供视频的主动预先护理计划

• 批准号: 10784057
• 负责人: Michael Paasche-Orlow
• 金额: $ 148.32万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10784057
• 关键词: Acute; Address; Administrator; Admission activity; Advance Care Planning; Alzheimer' s disease caregiver; Alzheimer' s disease patient; Alzheimer' s disease related dementia; American; Boston; COVID-19; COVID-19 pandemic; COVID-19 patient; Caregivers; Caring; Certification; Cessation of life; Cluster randomized trial; Communication; Communication Barriers; Complex; Consult; Consultations; Country; Critical Illness; Decision Aid; Decision Making; Dementia; Documentation; Effectiveness of Interventions; Elderly; Electronic Health Record; Emotional; Enrollment; Ensure; Equilibrium; Family; Family member; Future; Health system; Hospitalization; Hospitals; Infrastructure; Inpatients; Intervention; Intubation; Knowledge; Language; Learning; Limited English Proficiency; Loneliness; Mechanical ventilation; Medical; Medical center; Modeling; Natural Language Processing; Outcome; Palliative Care; Palliative Care Nursing; Patient-Centered Care; Patient-Focused Outcomes; Patients; Phase; Proxy; Quality of Care; Randomized, Controlled Trials; Recommendation; Resuscitation; Risk; Role; Services; Testing; Triage; University Hospitals; Work; aged; care systems; compare effectiveness; dementia care; end of life; end of life care; evidence base; experience; follow-up; health literacy; hospice environment; human old age (65+); implementation facilitators; implementation intervention; improved; innovation; literacy; meetings; mortality; novel coronavirus; older patient; palliative; pandemic disease; patient-clinician communication; preference; primary outcome; response; satisfaction; visual information; ward

The majority of patients aged 65 or over, and patients with Alzheimer's Disease and Related Dementias (ADRD), have never communicated their preferences to clinicians or completed advance care planning (ACP) documents. Palliative care has the potential to improve ADRD care, improve patient-clinician communication and patient-centered outcomes, while decreasing unwanted burdensome treatments and improving care at the end of life. The novel Coronavirus Disease 2019 (COVID-19) has acutely escalated the importance of integrating ACP and palliative care services into medical care. The default response to critical illness for patients with ADRD (and all others) is intubation, mechanical ventilation, and aggressive care despite having no change in mortality outcome. ADRD patients and their caregivers may prefer to avoid these interventions. To address these gaps, we have developed a COVID-19 ACP Educator-led, video-assisted palliative care intervention to improve patient-clinician communication, increase ACP documentation, and lead to more patient-centered care at the end of life. We will identify all hospitalized patients aged 65 and older, and any patient with ADRD, and then an ACP Educator will proactively proceed with primary palliative care services of ACP, leveraging certified video decision aids that we have developed. The ACP Educator to be tested in this proposal represents a new role and proactive function for the palliative care team. The ACP Educator, who will be a palliative care nurse, will work with older patients or patients with ADRD and proxy decision-makers to learn about and document patients' wishes. The overall objective is to reduce the burden of COVID-19 by expanding the reach of inpatient palliative care, especially for patients with ADRD. We propose to conduct a stepped wedge cluster randomized trial of an ACP Educator intervention among hospitalized patients aged 65 and over, or any patient with ADRD and their proxy decision-makers in the ward and ICU settings of two major hospitals: Boston Medical Center and North Shore University Hospital. Patient outcomes will be abstracted from electronic health records with Natural Language Processing. We will evaluate intervention effectiveness by comparing the following outcomes among 9,000 hospitalized patients: ACP documentation; preferences for resuscitation; palliative care consults; and, hospice use. We will characterize caregiver-centered outcomes of patients with ADRD, including: (1) knowledge, (2) confidence in future care, (3) communication satisfaction, and (4) decisional certainty in 600 caregivers of patients with ADRD admitted to the hospital. COVID-19 poses a unique dilemma for older Americans and patients with ADRD and their caregivers, who must balance their desire to live against the risk of a lonely and potentially traumatic hospital death. Video decision support is a practical, evidence- based, and innovative approach to assist patients facing such choices. If proven effective, this innovative care model can be immediately deployed across the country to improve the quality of care for millions of Americans.

大多数患者年龄在65岁或以上，以及患有阿尔茨海默病和相关痴呆的患者

项目成果

Study protocol for Video Images about Decisions to Improve Ethical Outcomes with Palliative Care Educators (VIDEO-PCE): a pragmatic stepped wedge cluster randomised trial of older patients admitted to the hospital.

• DOI: 10.1136/bmjopen-2022-065236
• 发表时间: 2022-07-25
• 期刊: BMJ open
• 影响因子: 2.9