Communication quality during family meetings in the intensive care unit: how does quality impact health outcomes?

重症监护病房家庭会议期间的沟通质量：质量如何影响健康结果？

• 批准号: 10718011
• 负责人: Allison M Scott
• 金额: $ 65.53万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-16 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10718011
• 关键词: Address; Affect; Anxiety; Attention; Black race; COVID-19 pandemic; Caring; Clinical; Communication; Data; Decision Making; Disparity; Economic Conditions; Economics; Education; Environment; Family; Family member; Future; Goals; Health; Health Professional; Health education; Healthcare; Individual; Intensive Care Units; Intervention; Intrinsic factor; Knowledge; Length of Stay; Longitudinal, observational study; Measures; Mediating; Mediation; Mental Depression; Modeling; Neighborhoods; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Perception; Personality Traits; Post-Traumatic Stress Disorders; Protocols documentation; Psychological Stress; Questionnaires; Research; Risk; Rural; Rural Community; Severity of illness; Social Conditions; Stress; Testing; Therapeutic; Trust; Underrepresented Populations; Ventilator; Work; demographics; design; distrust; experience; health care availability; hispanic community; improved; innovation; meetings; outcome disparities; pandemic disease; patient oriented; post-pandemic; post-traumatic symptoms; programs; psychological outcomes; rural underrepresented; shared decision making; social health determinants; trait; trial design; underserved community

ABSTRACT When poor communication between clinicians and family members of ICU patients, disparities related to social determinants of health (SDOH), and a heightened distrust of healthcare professionals all coalesced during the COVID-19 pandemic, “the perfect storm” emerged. Improving communication and trust in healthcare professionals is critical in high-stakes ICU environments where the need for shared decision-making demands that clinicians rapidly establish rapport and therapeutic alliance with family members of non-capacitated patients. Many well-designed trials testing ICU communication interventions have had negative or minimally impactful results, perhaps in part because we have only a rudimentary understanding of how SDOH impact communication in the ICU, a clinical context where underrepresented individuals also suffer from disparities. The goals of this R01 are to conduct a mediation analysis that will: 1) examine SDOH’s impact on communication between family members and ICU clinicians; 2) identify mechanisms of action related to how communication quality affects distrust of healthcare professionals and therapeutic alliance; and 3) determine how these factors contribute to or mediate outcomes for family members of ICU patients. This longitudinal, observational study will collect data from 320 family members from 5 ICUs serving underrepresented rural, Black, and Hispanic communities in 3 states. Our primary health outcome is the provision of family-centered care (as measured by the Patient Perceptions of Patient Centeredness questionnaire- Family Version). Secondary health outcomes include family members’ psychological stress (anxiety, depression, symptoms of post-traumatic stress disorder) and measures of patient ICU utilization (e.g., ICU LOS, ventilator days). Mediating factors to be examined include communication quality, healthcare distrust, and therapeutic alliance. Moderating factors include family members’ intrinsic traits (e.g., personality traits and decision-making style). We hypothesize that: 1) poor SDOH yield poor outcomes and result in less attention to family-centered care and worse ICU patient utilization outcomes; and 2) higher communication quality will improve the therapeutic relationship and healthcare trust and result in improved attention to family-centered care and improved ICU patient utilization outcomes among all patients regardless of SDOH. Using our results, we will adapt a prominent conceptual model of communication to address the high-stakes communication needs of families from underserved communities. Completing this work will advance the field by providing data to allow new understanding of how SDOH and other factors (e.g., communication quality, trust) relate to provision of patient- and family-centered care in the post-pandemic context. The knowledge gained will inform new content and concrete communication strategies for future ICU interventions aiming to facilitate high-quality communication, help to restore trust in healthcare, and improve therapeutic alliances in pursuit of achieving patient- and family- centered ICU care.

摘要 当临床医生和ICU患者家属之间沟通不畅时，差异与社会 健康决定因素(SDOH)和对医疗保健专业人员更高的不信任都在 新冠肺炎大流行，《完美风暴》横空出世改善医疗保健领域的沟通和信任 在需要共享决策的高风险ICU环境中，专业人员至关重要 临床医生迅速与无行为能力的家庭成员建立融洽的关系和治疗联盟 病人。许多精心设计的测试ICU沟通干预的试验都有负面的或最低限度的影响 有影响力的结果，可能部分是因为我们对SDOH如何影响只有一个初步的了解 ICU中的沟通，这是一种临床环境，代表不足的个人也存在差异。 本R01的目标是进行调解分析，该分析将：1)检查SDOH对 家庭成员和ICU临床医生之间的沟通；2)确定与以下方面有关的行动机制 沟通质量影响对医疗专业人员和治疗联盟的不信任；以及3)决定 这些因素如何影响或调节ICU患者家属的预后。这个纵向的， 观察性研究将收集来自5个ICU的320名家庭成员的数据，这些ICU服务的农村人口比例偏低， 黑人和西班牙裔社区分布在3个州。我们的主要健康成果是提供以家庭为中心的 护理(通过患者对以患者为中心的看法问卷-家庭版)衡量。 次要健康后果包括家庭成员的心理压力(焦虑、抑郁、 创伤后应激障碍)和患者ICU利用率的衡量标准(如ICU损失、呼吸机使用天数)。 要检查的中介因素包括沟通质量、医疗不信任和治疗联盟。 调节因素包括家庭成员的内在特征(如个性特征和决策风格)。 我们假设：1)糟糕的SDOH会产生糟糕的结果，并导致对以家庭为中心的护理的关注较少 和更差的ICU患者利用结果；2)更高的沟通质量将改善治疗 关系和医疗信任，并导致对以家庭为中心的护理和改善ICU的更多关注 所有患者的患者利用结果与SDOH无关。利用我们的结果，我们将改编一个 突出的通信概念模型，以满足家庭的高风险通信需求 来自服务不足的社区。完成这项工作将通过提供数据来推进该领域，从而允许新的 了解SDOH和其他因素(例如，沟通质量、信任)如何与提供患者- 以及在大流行后的背景下以家庭为中心的护理。所获得的知识将为新的内容和 未来ICU干预的具体沟通战略，旨在促进高质量的沟通， 帮助恢复对医疗保健的信任，并改善治疗联盟，以追求实现患者和家庭- 以重症监护室为中心。