Enhancing Parent-Provider Communication during Critical Care Decision-making

 描述（由申请人提供）：候选人的申请提供了必要的培训，以建立致力于改善家庭和危重病儿童健康的临床研究生涯，这符合NICHD的儿科创伤和危重病分支。候选人是一名重症监护和姑息医学医生，他建议接受专家小组的直接指导，并获得定量和定性分析，干预性研究设计和教学沟通技巧方面的培训。有了这个培训计划，她将开发和试点干预措施，可以很好地改善危重病儿童的父母和照顾他们的提供者（医生和护士）之间的沟通。 2010年健康人民目标中增加了健康传播，认识到传播影响到健康和疾病的各个方面。父母和供应商之间的有效沟通是至关重要的，因为沟通不足可能会导致延迟决定和增加痛苦的儿童，临床团队和父母之间的冲突，以及父母的不信任，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适。在这项为期4年的研究中，我们建议开发和试点干预措施，其中包括两个组成部分：（1）提供者的沟通技巧培训;（2）使用临床测量，“好父母工具”（GPT），以了解父母的价值观和对关键决策的偏好;然后在父母-提供者会议之前向提供者提供这些个性化的价值观，并测量它们在会议中的使用情况。在目标1中，我们将通过为重症监护提供者制定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。父母的参与将通过使用Roter互动分析系统进行录音分析来衡量。所有其他成果将通过调查加以衡量。我们将使用本研究获得的数据生成未来混合方法通信多中心干预研究的效应量。这项研究是我们长期研究目标的第一步，即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.