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A Randomized Clinical Trial of Scenario Planning for Older Adults with Serious Injury

严重损伤老年人情景规划的随机临床试验

基本信息

批准号：
10708157
负责人：
Margaret Schwarze
金额：
$ 86.16万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-30 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10708157
关键词：
Address Admission activity Affect American College of Surgeons Award Businesses Caring Cause of Death Cessation of life Clinical Trials Cognitive Collaborations Communication Communication Tools Conflict (Psychology)Data Collection Decision Making Distress Educational process of instructing Effectiveness Elderly Emergency Situation Evaluation Event Family Family member Feasibility Studies Feeling hopeless Force of Gravity Frequencies Future Goals Government Healthcare Healthcare Systems Hospitals Injury Intensive Care Intensive Care Units Intervention Length of Stay Life Measurement Measures Mediating Military Personnel Morals Operative Surgical Procedures Outcome Outcome Study Patient Care Patients Persons Pilot Projects Positioning Attribute Procedures Process Professional Organizations Prognosis Provider Quality of life Randomized Recording of previous events Reporting Research Risk Site Surgeon Testing Training Translating Trauma Trauma Research Traumatic injury Treatment outcome Uncertainty United States burnout care delivery care outcomes communication aid design effectiveness study effectiveness testing end of life end of life care end-of-life communication experience family support implementation intervention improved injured innovation interpersonal conflict intervention effect member mortality mortality statistics multidisciplinary novel older patient pilot test primary outcome programs public health priorities randomized, clinical trials secondary outcome severe injury support tools surrogate decision maker tool trauma care trauma centers treatment group trend

项目摘要

ABSTRACT For older adults, poor communication about serious injury and life-limiting illness has consequences for patients and families, clinicians, and healthcare systems. Afflicting 500,000 older adults annually, treatment for traumatic injury frequently involves burdensome interventions (like prolonged life support), major changes in functional or cognitive status, and high mortality. Surgeons use mortality statistics to communicate about the gravity of illness, but current communication standards often lead to goal discordant care, moral distress for clinicians, and prolongation of the dying process. Given high treatment burdens and frequency of poor prognosis, seriously injured older adults would benefit from communication interventions that clarify patients' goals, alleviate conflict in the ICU, and reduce unwanted invasive procedures for dying patients. A Randomized Clinical Trial of Scenario Planning for Older Adults with Serious Injury is a 5-year R01 Clinical Trial that responds specifically to NOSI-AG-20-041 for evaluation of decision support tools and communication aids for seriously ill older patients and their surrogate decision-makers to achieve goal- concordant care. We have developed a novel communication tool called Best Case/Worst Case-ICU that uses scenario planning—narrative description of plausible futures—and a graphic aid to illustrate information about the patient's care trajectory and overall prognosis for daily use in the trauma ICU. We pilot tested this intervention and found that surgeons can use this tool to support families and it may improve quality of communication and reduce clinician moral distress. We are now ready to test the intervention in a large-scale effectiveness study. We propose a pragmatic multisite randomized clinical trial following 4,500 older adults with traumatic injury. We aim to test the effectiveness of the Best Case/Worst Case-ICU intervention on quality of communication (Aim 1), clinician moral distress (Aim 2), and length of stay in the ICU (Aim 3). This award will allow us to test an intervention that is easily scalable and can be disseminated rapidly for use with older adults with serious illness. The research is innovative because it tests scenario planning —a decision-making strategy that has been successfully applied in business and government—but is not widely used in healthcare. The research is significant because, if we demonstrate effectiveness, it has the potential to transform how surgeons and other ICU clinicians talk with patients and families about treatment and prognosis and dramatically improve care older adults receive in the trauma ICU. Our multidisciplinary team has a long history of collaboration and is well positioned to achieve our objectives. The feasibility of this study is enhanced by support from the Coalition for National Trauma Research, which comprises the major trauma professional organizations in the United States and uses the American College of Surgeons' Trauma Quality Improvement Program as a data collection platform.

摘要