Enhancing Parent-Provider Communication during Critical Care Decision-making

 描述(由申请人提供)：应聘者的申请提供了必要的培训，以建立致力于改善家庭和危重疾病儿童健康的临床研究生涯，这与NICHD的儿科创伤和危重疾病分支是一致的。应聘者是一名重症监护和姑息医学内科医生，他建议接受专家小组的直接指导，并接受定量和定性分析、干预性研究设计和教学沟通技能方面的培训。通过这项培训计划，她将制定并试行一项干预措施，很好地改善危重儿童的父母与护理他们的提供者(医生和护士)之间的沟通。健康传播被添加到2010年健康人目标中，承认传播影响到健康和疾病的方方面面。在儿童罹患危重疾病期间，父母和提供者之间的有效沟通至关重要，因为沟通不充分可能导致延迟作出决定，增加儿童的痛苦，导致临床团队与父母之间的冲突，以及父母的不信任、不满和心理社会痛苦。重症监护中最佳沟通的一些主要障碍是缺乏提供者沟通技能培训、时间限制和提供者 对引发家庭价值观和偏好感到不适。在这项为期4年的研究中，我们建议开发和试行一项干预措施，其中包括两个组成部分：(1)为提供者提供沟通技能培训；(2)使用临床测量工具--“好父母工具”(GPT)来引出父母围绕关键决策的价值观和偏好；然后在家长-提供者会议之前将这些个性化的价值观提供给提供者，并在会议上衡量它们的使用情况。在目标1中，我们将通过调整针对重症护理提供者的有效沟通技能培训计划来制定干预措施。在目标2中，我们将评估父母参与干预对提供者结果的影响，而在目标3中，我们将评估干预对父母结果的影响。家长参与度将通过使用Roter互动分析系统的录音分析来衡量。所有其他结果将通过调查来衡量。我们将使用从这项研究中获得的数据来为未来的混合方法传播多中心干预研究产生效果大小。这项研究是朝着我们的长期研究目标迈出的第一步，我们的研究目标是了解提供者指导的沟通干预对父母结果的影响。

 DESCRIPTION (provided by applicant): The candidate's application provides the requisite training to establish a clinical research career committed to improving the health of families and children with critical illness, which is in line with the Pediatric Trauma and Critical Illness brach of NICHD. The candidate is a critical care and palliative medicine physician who is proposing to receive direct mentorship from a panel of experts and obtain training in quantitative and qualitative analyses, interventional study design and teaching communication skills. With this training plan she will develop and pilot an intervention that could very well improve communication between parents of children with critical illness and providers (physicians and nurse practitioners) who care for them. Health communication was added to the Healthy People 2010 objectives, recognizing that communication affects every aspect of health and disease. Effective communication between parents and providers is crucial during critical illness of children because inadequate communication can lead to delayed decisions and increased suffering for the child, conflict between the clinical team and parents, and parental distrust, dissatisfaction and psychosocial distress. Some of the major barriers to optimal communication in critical care are lack of provider communication skills training, time constraints, and provider discomfort with eliciting family values and preferences. In this 4-year study, we propose to develop and pilot an intervention which includes two components: (1) communication skills training for providers; and (2) use of a clinical measure, the "Good Parent Tool" (GPT) to elicit parental values and preferences around critical decision- making; then provide these individualized values to providers prior to a parent-provider conference and measure their use in the conference. In Aim 1, we will develop the intervention by adapting a validated communication skills training program for critical care providers. In Aim 2 we will assess the impact of the parental engagement intervention on provider's outcomes, while in Aim 3 we will assess the impact of the intervention on parent's outcomes. Parental engagement will be measured by audio-taped analysis using the Roter Interaction Analysis System. All other outcomes will be measured by surveys. We will use the data obtained from this study to generate effect sizes for future mixed methods communication multi-center intervention studies. This study constitutes a first step towards our long term research goal of understanding the impact of provider-directed communication interventions on parent outcomes.