Developing and piloting a multi-component technology-based care intervention to address patient symptoms and caregiver burden in home hospice

项目总结 候选人：Veerawat Phongtankuel博士是威尔·康奈尔医学院的助理教授，擅长于 老年病学和姑息医学。他的长期目标是改善对老年人及其照顾者的护理 (CGS)通过减少痛苦、CG负担和繁重的临终关怀过渡(EoL)，同时 确立了自己在老年医学和姑息医学领域的领先地位。 研究：随着临终关怀的发展，老年人有机会接受旨在 减少痛苦，关注EoL的生活质量。然而，几乎一半的活人临终关怀出院 导致住院，通常导致不想要的和徒劳的护理，并增加医疗成本。虽然 住院的原因很复杂，这位候选人的研究表明，患者的症状和CG 负担是重要的贡献者。目前由护理探视组成的家庭临终关怀模式可以 不足以处理可能每天波动的患者症状和CG负担。在使用时 技术和教育视频尚未在家庭临终关怀中得到充分开发、组织和评估 在医疗保健方面，它已经显示出在其他环境中改善保健的前景。因此，这项建议旨在发展和 评估基于技术的多组件护理干预，即改善家庭临终关怀管理 通过技术(i-home)解决生命终结问题，侧重于评估和解决患者症状 通过同步的现场视频访问和教育视频，家庭临终关怀环境中的CG负担。这个 该项目的目标是(1)采用迭代的以用户为中心的设计过程来开发面向家庭的i-home (2)进行一项随机先导研究，以评估 I-home(N=50)与常规护理(N=50)的潜在疗效比较。这个 科学 所获得的结果将为 为R01应用程序奠定基础，以评估i-home在多站点RCT中的结果。 职业发展：Phongtankuel博士组建了一支卓越的跨学科导师团队(Dr. 里德、查贾和普里格森)和具有医学、护理、姑息/临终关怀专业知识的合作者， 护理，以用户为中心的设计，计算机科学，以及老年人的技术实施。他的职业生涯 发展计划在以下方面整合了课程、研讨会和指导：(1)高级 症状管理和护理方面的培训，(2)家庭临终关怀服务，(3)干预技能 开发和临床试验，(4)指导和领导力发展，以及(5)赠款写作。使用 从… 铅 支持 威尔·康奈尔医学和纽约访问护士服务，Phongtankuel博士非常适合 纽约的姑息治疗研究计划。 T 拟议的培训和支持将为Dr。 Phongtankuel拥有技能和经验，可以成为开发、实施 提供创新的护理模式，利用技术改善对患者和CGs的护理 在家里做临终关怀。

PROJECT SUMMARY Candidate: Dr. Veerawat Phongtankuel is an Assistant Professor at Weill Cornell Medicine with expertise in geriatrics and palliative medicine. His long-term goals are to improve care for older adults and their caregivers (CGs) by reducing suffering, CG burden, and burdensome care transitions at the end of life (EoL) while establishing himself as a leader in the field of geriatrics and palliative medicine. Research: With the growth of hospice, older adults have the opportunity to receive home-based care aimed at reducing suffering and focusing on quality of life at the EoL. However, almost half of all live hospice discharges result in a hospitalization, often leading to unwanted and futile care and increased healthcare costs. Although reasons for hospitalizations are complex, this candidate's research suggests that patient symptoms and CG burden are significant contributors. The current model of home hospice care consisting of nursing visits can be inadequate to address patient symptoms and CG burden that can fluctuate on a daily basis. While use of technology and educational videos has yet to be fully developed, structured, and evaluated in home hospice care, it has shown promise to improve care in other settings. Therefore, this proposal aims to develop and evaluate a multi-component technology-based care intervention, i.e., Improving Home hospice Management of End of life issues through technology (I-HoME), that focuses on assessing and addressing patient symptoms and CG burden in the home hospice setting through synchronous live video visits and educational videos. The aims for the project are, (1) To employ an iterative user-centered design process to develop I-HoME for home hospice patients and their CGs and (2) To conduct a randomized pilot study evaluating the feasibility and potential efficacy of I-HoME (N=50) compared to usual care (N=50). The scientific results obtained will provide the foundation for a R01 application to evaluate the outcomes of I-HoME in a multi-site RCT. Career Development: Dr. Phongtankuel has assembled a preeminent group of interdisciplinary mentors (Drs. Reid, Czaja, and Prigerson) and collaborators with expertise in medicine, nursing, palliative/hospice care, caregiving, user-centered design, computer science, and technology implementation in older adults. His career development plan integrates coursework, seminars, and mentorship in the following areas: (1) Advanced training in symptom management and caregiving, (2) Home hospice care delivery, (3) Skills in intervention development and clinical trials, (4) Mentorship and leadership development, and (5) Grant writing. With from lead suppor Weill Cornell Medicine and the Visiting Nurse Service of New York, Dr. Phongtankuel is well-positioned to palliative care research initiatives in New York. t The proposed training and support will provide Dr. Phongtankuel with the skills and experience to become a transformative leader in developing, implementing, and delivering innovative care models using technology to improve care forpatients and CGs receiving hospicecare at home.