Evaluating effectiveness of a communication facilitator to reduce distress and improve goal concordant care for critically ill patients and their families

评估沟通促进者在减轻危重患者及其家人的痛苦和改善目标一致护理方面的有效性

• 批准号: 9794765
• 负责人: J Randall Curtis
• 金额: $ 66.01万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-27 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9794765
• 关键词: Accounting; Acute; Address; Anxiety; Behavioral; Caring; Clinical; Communication; Communities; Conflict (Psychology); Confusion; Critical Care; Critical Illness; Distress; Effectiveness; Effectiveness of Interventions; Emotional; Ensure; Family; Family member; Feedback; Future; Goals; Health Care Costs; Healthcare; Home environment; Hospital Costs; Hospitalization; Hybrids; Individual; Intervention; Intervention Trial; Knowledge; Lead; Length of Stay; Life; Long-Term Care; Measures; Mediating; Mediation; Medical; Mental Depression; Methodology; Modeling; Multicenter Trials; Nurses; Outcome; Patient-Focused Outcomes; Patients; Penetration; Physicians; Positioning Attribute; Process; Provider; Qualitative Methods; Quality of life; Quality-of-Life Assessment; Randomized; Resources; Science; Secure; Self Efficacy; Skilled Nursing Facilities; Testing; Time; Training; Work; aging population; attentional control; base; care costs; cost; depressive symptoms; expectation; experience; high risk; hospital readmission; implementation trial; improved; improved outcome; innovation; intervention cost; novel; phase 2 study; phase II trial; post-traumatic stress; primary outcome; psychological distress; randomized trial; reduce symptoms; skills; social cognitive theory; theories

PROJECT SUMMARY The impact of critical illness is increasing due to our aging population as well as advances in effectiveness and availability of critical care. Critically ill patients and their families suffer a high burden of symptoms of depression, anxiety, and post-traumatic stress due, in part, to fragmented medical care that is often poorly aligned with their goals. Fragmented care includes numerous transitions for patients and families across clinicians and across settings, starting in the ICU and extending to acute care, skilled nursing facilities, or home. As illness progresses, patients and families struggle to navigate the spectrum of goals of care, to match their values and goals with treatments, to communicate their goals to their clinicians, and to make difficult medical decisions without letting unmet emotional needs interfere. Poor communication exacerbated by these transitions compounds an already stressful experience, causing distress to patients and their families. Taken together, these issues lead to ineffective communication during and after the ICU which can often result in high intensity “default” care that may be unwanted. Using a randomized trial, this application proposes to evaluate an innovative model of care in which ICU nurse facilitators support, model, and teach communication strategies that enable patients and families to secure care in line with their goals over an illness trajectory, beginning in the ICU and continuing into the community. Facilitators will use communication skills, attachment theory, and mediation to improve: 1) patients' and families' self-efficacy to communicate with clinicians within and across settings; 2) patients' and families' outcome expectation that communication with clinicians can improve their care; and 3) patients' and families' behavioral capability through skill building to resolve barriers to effective communication and mediate conflict. Facilitators will work with seriously ill patients (n=376) and their families (n=564) beginning with a critical care unit stay and following them over the course of 3 months. The intervention's effectiveness will be measured with patient- and family-centered outcomes including symptoms of depression, anxiety, and post-traumatic stress, as well as quality of life and assessments of goal- concordant care, at 1, 3, and 6 months post-randomization. The primary outcome will be family members' burden of symptoms of depression over the 6 months. We will also evaluate whether the intervention improves the value of healthcare by reducing healthcare costs while improving patient and family outcomes. Finally, we will use qualitative methods to explore implementation factors (intervention, settings, individuals, processes) associated with improved implementation outcomes (acceptability, fidelity, penetration) to inform dissemination of this type of intervention to support patients and their families. This application will address key knowledge gaps while evaluating a methodologically rigorous intervention to improve outcomes for patients with serious illness and their families across the trajectory of care and the spectrum of goals of care.

项目总结