Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure

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ABSTRACT The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Douglas White to train, mentor, and support the career development of clinician-scientists focused on developing and testing interventions to improve surrogate decision making for incapacitated patients with advanced respiratory failure. Patients with acute respiratory failure and a poor prognosis often receive intensive, burdensome treatments near the end of life that are inconsistent with their values and preferences. This is an important public health problem because 1) patient-centered care near the end of life is a central aspect of ethical, humane care, and 2) overtreatment near the end of life contributes to the disproportionate costs of medical care near the end of life in the U.S. Although the scope of the problems is well documented, there are few evidence-based interventions to improve patient outcomes. Solving this problem will require the collaboration of scientists with expertise in decision science, organizational behavior, and health services research. Dr. White is extremely well positioned to lead these efforts. He is a midcareer investigator with a mature, NIH-funded program of research on surrogate decision making in acute respiratory failure. He has an extensive track record of successful mentoring in patient-oriented research. He has assembled a team of senior scientists and collaborators to accomplish the proposed research and mentoring plan. He will increase his skills as a mentor and expand his scientific expertise by participating in targeted career development activities in mentoring, organizational science, and the psychology of group decision making. The scientific goal of this proposal is for Dr. White and his mentees to use the existing data and infrastructure of his ongoing R01s to develop new lines of research exploring the roles of interprofessional team functioning and group decision making on outcomes for incapacitated patients with acute respiratory failure. In Aim 1 the team will conduct a mixed methods study to characterize clinicians’ attitudes and actual practices related to interprofessional team collaboration in providing decision support to surrogates of patients with advanced respiratory failure (Aim 1a), then conduct exploratory analyses examining associations between team functioning and outcomes of patients with advanced respiratory failure (Aim 1b). In Aim 2 they will use the largest dataset in existence of audiorecorded clinician-family conferences about goals of care in ICUs to determine whether and how clinicians elicit the values and preferences of incapacitated patients from surrogates (Aim 2a), then conduct exploratory analyses examining associations with patient outcomes (Aim 2b). Together, these scientific aims and career development activities will expand Dr. White’s ability to train the next generation of patient-oriented researchers in developing interventions to improve surrogate decision making for patients with advanced respiratory failure.