Planning Advance Care Together (PACT) to Improve Engagement in Advance Care Planning among Advanced Cancer Patients
共同规划预先护理 (PACT) 以提高晚期癌症患者对预先护理规划的参与度
基本信息
- 批准号:10693114
- 负责人:
- 金额:$ 32.83万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-09-08 至 2025-08-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAdvance Care PlanningAdvance DirectivesAdvanced Malignant NeoplasmBenchmarkingCancer PatientCaregiversCaringCollaborationsControl GroupsDecision MakingDecision TheoryDevelopmentDocumentationExerciseFamilyFamily CaregiverFamily memberFeedbackFundingGoalsHealth TechnologyHealthcareIndividualInterventionInterviewLiving WillsMalignant NeoplasmsMobile Health ApplicationOncologistOutcome AssessmentParticipantPatient CarePatient EducationPatient PreferencesPatientsProcessProcess MeasureProtocols documentationProviderProxyPublic HealthQuality of CareQuality of lifeRandomizedReportingResearchResearch PersonnelScienceShapesSocial EnvironmentSocial NetworkSocial PlanningSocial WorkersSocial supportStructureSurgeonTechnologyTestingTreatment EfficacyUnited States Centers for Medicare and Medicaid ServicesWorkcare preferencecohortcollegecopingdesigneffective interventionend of lifeend of life carefield studygroup interventionhealth goalsimprovedinformantintervention refinementiterative designloved onesmHealthmeetingsmobile applicationneglectnovel strategiespatient engagementpatient subsetspilot testpilot trialpost interventionpreferenceprimary outcomeprototypesatisfactionsecondary outcomesocialsocial relationshipsstandard caretreatment as usualusability
项目摘要
PROJECT SUMMARY/ABSTRACT
Engagement in advance care planning (ACP), which includes having end-of-life (EoL) conversations and
completing advance directives (ADs) (e.g., living will, health care proxy), has been shown to improve the
quality of care and reduce suffering at the end of life. However, less than half of advanced cancer patients
engage in ACP or complete ADs. One commonly overlooked barrier to ACP engagement and AD completion is
a lack of acknowledgment that the majority of cancer patients report ACP as a social process in which they
want to engage multiple loved ones and family members in their decision-making process. Dr. Shen’s work, in
collaboration with her Co-Investigator Dr. Prigerson, suggests that patients frequently report involvement of
family members as a critical concern and need for engaging in ACP and that 70.7% report their EoL care
treatment preferences being shaped around concerns about their family members. Based on this pilot work
and prior work indicating a patient preference to engage in ACP as a social process, this study aims to develop
and pilot test a mobile application [Planning Advance Care Together (PACT)] designed to improve advanced
cancer patients’ and caregivers’ engagement in patients’ ACP, presence of ACP discussions, completion of
ADs, and receipt of goal-concordant care. The goals of this study are to: (1) refine and field-test a mobile
application intervention (PACT) using an iterative design approach, “Think Aloud” exercises, and usability
protocols; (2) evaluate the feasibility, acceptability, usability, satisfaction, and user engagement of the
intervention among advanced cancer patients and their caregivers; (3) test the preliminary efficacy of the
intervention on patients’ and caregivers’ level of engagement in ACP, documented ACP conversations, and
patients’ completion of ADs (primary outcomes); and patients’ and caregivers’ perceived social support and
family functioning as well as patients’ receipt of goal-concordant care (secondary outcomes); and (4) evaluate
process measures in a post-intervention interview. To meet these goals, we will collect feedback from
advanced cancer patients (n=10), caregivers (n=10), and providers (n=10) to improve and refine the
intervention prototype. Next, we will conduct iterative field-testing with two sets of patient-caregiver dyads
(n=15 per group) to refine the mobile application. Then, we will randomize n=100 patient-caregiver dyads to
the intervention group and n=100 dyads to the control group (usual care) and assess outcomes at baseline
and 3 and 6 months post-intervention to determine the feasibility, acceptability, usability, satisfaction, user
engagement, and preliminary efficacy of the intervention. Finally, we will conduct a brief post-intervention
interview with a subset of patients (n=15) and caregivers (n=15) to understand processes of using the PACT
application. Grounded in established theories of decision-making science, the proposed project takes the novel
approach of utilizing mobile health technology to integrate loved ones into patients’ ACP decision-making.
项目总结/摘要
参与预先护理计划(ACP),包括进行临终(EoL)对话,
完成预先指示(AD)(例如,生活意愿,医疗保健代理),已被证明可以改善
提高护理质量,减少生命结束时的痛苦。然而,不到一半的晚期癌症患者
参与ACP或完成AD。ACP参与和AD完成的一个通常被忽视的障碍是
缺乏对大多数癌症患者报告ACP是一个社会过程的认识,
希望让多个亲人和家庭成员参与决策过程。沈博士的工作,在
与她的合作研究者Prigerson博士的合作表明,患者经常报告涉及
家庭成员是参与ACP的关键问题和需求,70.7%的人报告他们的EoL护理
治疗偏好是围绕着对家庭成员的关注而形成的。在试点工作的基础上,
和先前的工作表明,患者偏好从事ACP作为一个社会过程,这项研究的目的是发展
并试点测试一个移动的应用程序[共同规划高级护理(PACT)],旨在提高高级
癌症患者和护理人员参与患者ACP,参与ACP讨论,完成
“安”与“安”,就是“安”与“安”。本研究的目的是:(1)完善和实地测试一个移动的
使用迭代设计方法、“大声思考”练习和可用性的应用干预(PACT)
协议;(2)评估的可行性,可接受性,可用性,满意度和用户参与度
在晚期癌症患者及其照顾者中进行干预;(3)测试
对患者和护理人员参与ACP的水平进行干预,记录ACP对话,以及
患者完成AD(主要结局);患者和护理人员感知的社会支持,
家庭功能以及患者接受目标一致性护理(次要结局);(4)评估
在干预后访谈中进行过程测量。为了实现这些目标,我们将收集以下方面的反馈:
晚期癌症患者(n=10),护理人员(n=10)和供应商(n=10),以改善和完善
干预原型。接下来,我们将对两组患者-护理人员配对进行迭代现场测试
(每组n=15),以完善移动的应用程序。然后,我们将随机分配n=100名患者-护理人员配对,
干预组和对照组(常规护理)的n=100对,并评估基线结果
以及干预后3个月和6个月,以确定可行性、可接受性、可用性、满意度、用户
参与和干预的初步效果。最后,我们将进行简短的事后干预
与患者(n=15)和护理人员(n=15)的子集进行访谈,以了解使用PACT的过程
应用程序.立足于决策科学的既定理论,拟议的项目采取了新颖的
利用移动的医疗技术将亲人纳入患者的ACP决策的方法。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Megan Johnson Shen其他文献
P3.05-017 Survivor Guilt: The Secret Burden of Lung Cancer Survivorship: Topic: Symptoms, Therapeutic Interventions
- DOI:
10.1016/j.jtho.2016.11.2179 - 发表时间:
2017-01-01 - 期刊:
- 影响因子:
- 作者:
Tara Perloff;Megan Johnson Shen;Kate Abramson;Jennifer King;Kay Bayne - 通讯作者:
Kay Bayne
Megan Johnson Shen的其他文献
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{{ truncateString('Megan Johnson Shen', 18)}}的其他基金
Planning Advance Care Together (PACT) to Improve Engagement in Advance Care Planning among Advanced Cancer Patients
共同规划预先护理 (PACT) 以提高晚期癌症患者对预先护理规划的参与度
- 批准号:
10469922 - 财政年份:2020
- 资助金额:
$ 32.83万 - 项目类别:
Planning Advance Care Together (PACT) to Improve Engagement in Advance Care Planning among Advanced Cancer Patients
共同规划预先护理 (PACT) 以提高晚期癌症患者对预先护理规划的参与度
- 批准号:
10601423 - 财政年份:2020
- 资助金额:
$ 32.83万 - 项目类别:
Planning Advance Care Together (PACT) to Improve Engagement in Advance Care Planning among Advanced Cancer Patients
共同规划预先护理 (PACT) 以提高晚期癌症患者对预先护理规划的参与度
- 批准号:
10057200 - 财政年份:2020
- 资助金额:
$ 32.83万 - 项目类别:
Culturally Competent Communication Intervention to Improve Latinos' Engagement in Advance Care Planning
具有文化能力的沟通干预可提高拉丁美洲人对预先护理计划的参与
- 批准号:
10531352 - 财政年份:2017
- 资助金额:
$ 32.83万 - 项目类别:
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