Enhancing Parent-Provider Communication during Critical Care Decision-making

在重症监护决策过程中加强家长与提供者的沟通

• 批准号: 9041645
• 负责人: TESSIE W. OCTOBER
• 金额: $ 12.47万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9041645
• 关键词: Adopted; Affect; Caring; Child; Child Rearing; Childhood; Clinical; Clinical Research; Communication; Communication Methods; Conflict (Psychology); Critical Care; Critical Illness; Critically ill children; Data; Decision Making; Disease; Distress; Educational Curriculum; Educational process of instructing; Emotional; Equilibrium; Experimental Designs; Family; Family health status; Future; Goals; Health; Health Communication; Health Personnel; Healthcare; Healthy People 2010; Institutes; Institution; Internist; Intervention; Intervention Studies; Lead; Life; Measures; Medical; Mentorship; National Institute of Child Health and Human Development; Nurse Practitioners; Oncologist; Outcome; Palliative Medicine; Parents; Patient Self-Report; Patients; Pediatric Intensive Care Units; Physicians; Provider; Psychosocial Influences; Randomized Controlled Trials; Regrets; Reporting; Research; Roter; Scientist; Surveys; Systems Analysis; Testing; Time; Training; Training Programs; Trust; United States; base; career; design; improved; intervention effect; parental role; pediatric trauma; preference; psychosocial; satisfaction; skills; skills training; symposium; tool

 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.

 描述（由申请人提供）：候选人的申请提供必要的培训，以建立致力于改善患有危重疾病的家庭和儿童的健康的临床研究职业，这符合 NICHD 的儿科创伤和危重疾病分支。该候选人是一名重症监护和姑息医学医生，建议接受专家小组的直接指导，并接受定量和定性分析、介入研究设计和教学沟通技巧方面的培训。通过这个培训计划，她将制定并试点一项干预措施，可以很好地改善患有危重疾病的儿童的父母与照顾他们的提供者（医生和护士）之间的沟通。 认识到沟通影响健康和疾病的各个方面，健康沟通被添加到“健康人民 2010”目标中。在儿童危重疾病期间，家长和提供者之间的有效沟通至关重要，因为沟通不充分可能会导致决策延迟、增加孩子的痛苦、临床团队和家长之间的冲突以及家长的不信任、不满和心理困扰。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 对引出家庭价值观和偏好感到不安。在这项为期 4 年的研究中，我们建议开发和试点一项干预措施，其中包括两个部分：(1) 提供者的沟通技巧培训； (2) 使用临床措施“好父母工具”(GPT) 来了解父母对关键决策的价值观和偏好；然后在家长提供者会议之前向提供者提供这些个性化的价值观，并衡量它们在会议中的使用情况。在目标 1 中，我们将通过针对重症监护提供者采用经过验证的沟通技能培训计划来制定干预措施。在目标 2 中，我们将评估家长参与干预对提供者结果的影响，而在目标 3 中，我们将评估干预对家长结果的影响。家长参与度将通过 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。我们将利用从本研究中获得的数据来生成未来混合方法沟通多中心干预研究的效应量。这项研究是我们实现长期研究目标的第一步，即了解提供者主导的沟通干预对家长结果的影响。