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Using the Emergency Department Visit to Promote Advance Care Planning

利用急诊科就诊促进预先护理计划

基本信息

批准号：
10052762
负责人：
Jane Brice
金额：
$ 64.59万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
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：
2020-09-15 至 2021-02-25
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10052762
关键词：
Accident and Emergency department Address Adult Advance Care Planning Agreement American Americas Caring Cessation of life Clinical Clinical Trials Cognitive Communication Consensus Data Decision Aid Documentation Effectiveness of Interventions Elderly Electronic Health Record Electronic Mail Emergency Care Emergency Department patient Emergency Department-based Intervention Emergency Situation Emergency department visit Ethnic Origin Event Family Fright Goals Health Expenditures Health Personnel Health Status Hispanics Hospital Nursing Institute of Medicine (U.S.)Instruction Intervention Length of Stay Life Measures Medical Modeling Not Hispanic or Latino Nursing Homes Outcome Patient Preferences Patients Physicians Positioning Attribute Process Provider Race Randomized Randomized Controlled Trials Reporting Research Secure Social Workers Structure Subgroup Testing Time Treatment Efficacy Update Visit Work advanced disease aged base care preference care providers efficacy trial empowered end of life end of life care ethnic minority population health care service utilization health literacy high risk population hospital utilization implementation strategy improved intervention effect loved ones older patient preference racial minority satisfaction secondary outcome shared decision making treatment as usual

项目摘要

1 Project Summary 2 3 During the last few months of life, many older adults receive care that is discordant with their preferences, 4 increases suffering, and disrupts closure and grieving. The process of advance care planning (ACP) helps 5 patients have control over their end-of-life care by empowering patients to define and document what care they 6 would like to receive while they still have the cognitive and physical abilities to consider and express these 7 preferences. ACP improves patient and family satisfaction with the dying process, increases the likelihood that 8 patients receive the care they want, and reduces healthcare expenditures. Unfortunately, few older adults have 9 completed ACP and even fewer have documented their end-of-life care preferences in a way that is accessible 10 in a timely manner to medical providers. In a recent Institute of Medicine report on Death and Dying in America, 11 increasing ACP among older adults was identified as a major public priority. Primary care providers, who typically 12 have long-term relationships with patients and understand the details of their medical condition, are well 13 positioned to have end-of-life care conversations. Unfortunately, for several reasons these conversations often 14 do not occur: primary providers don’t want patients to think they’ve given up hope; patients think they are too 15 healthy to benefit from these conversations; and educating patients about end-of-life options takes time. U.S. 16 emergency department (ED) visits provide access to a large number of older adults with advanced illness who 17 are likely to benefit from ACP and provide a unique and important opportunity to overcome these barriers to 18 ACP. Specifically, emergency providers are unlikely to fear undermining a long-term relationship with the patient, 19 older adults who are receiving ED care are unlikely to think they are too healthy to benefit from ACP, and there 20 is ample opportunity during the ED visit to educate patients and initiate a conversation about end-of-life care 21 preferences. The overarching goal of this project is to develop evidence to support the use of an ED-based 22 intervention to promote ACP. We propose a randomized controlled trial of 900 older adults receiving care at 23 three U.S. EDs. Patients receiving the intervention will watch a 5-minute certified video decision aid about ACP 24 and have a structured conversation with a social worker about their values and preferences. The social worker 25 will then send a secure electronic message to the patient’s primary provider sharing with them the patient’s initial 26 preferences and providing instructions as to how to document the patient’s preferences in a manner that is widely 27 accessible to the patient’s medical providers. Following the clinical model of shared decision making, patients 28 will be encouraged by the social worker to deliberate further on their preferences and then have an informed 29 conversation with their primary provider or admitting physician regarding care preferences. Outcomes will include 30 documentation of ACP conversations and preferences, agreement between expressed and documented 31 preferences, and hospital days assessed 3 and 6 months after the ED visit. The results of this study will establish 32 the efficacy of this intervention and provide information to support and inform implementation.

1 项目概要 2 3 在生命的最后几个月，许多老年人接受的护理与其偏好不符， 4 会增加痛苦，扰乱封闭和悲伤。预先护理计划 (ACP) 流程有助于 5 名患者可以通过授权患者定义和记录他们的临终护理来控制他们的临终护理 6 人希望在他们仍然有认知和身体能力来考虑和表达这些内容时接受 7 偏好。 ACP 提高了患者和家属对临终过程的满意度，增加了死亡的可能性 8 名患者得到了他们想要的护理，并减少了医疗支出。不幸的是，很少有老年人能够 9 人完成了 ACP，更少的人以易于理解的方式记录了他们的临终护理偏好 10.及时向医疗机构提供帮助。在医学研究所最近一份关于美国死亡和临终的报告中， 11 增加老年人的 ACP 被确定为主要的公共优先事项。初级保健提供者通常 12 与患者有长期关系，了解其医疗状况的详细情况，状况良好 13 负责进行临终关怀对话。不幸的是，由于多种原因，这些对话经常 14 不会发生：主要医疗服务提供者不希望患者认为他们已经放弃了希望；患者也认为自己也是 15 身体健康，可以从这些对话中受益；对患者进行有关临终选择的教育需要时间。我们。 16 次急诊科 (ED) 就诊为大量患有晚期疾病的老年人提供了接触机会 17 可能会从 ACP 中受益，并提供独特而重要的机会来克服这些障碍 18 非加太。具体来说，急救人员不太可能担心破坏与患者的长期关系， 19 名接受 ED 护理的老年人不太可能认为自己太健康而无法从 ACP 中受益，并且 20 在急诊室就诊期间有充足的机会教育患者并发起有关临终关怀的对话 21 项偏好。该项目的总体目标是开发证据来支持基于 ED 的使用 22 干预促进 ACP。我们建议对 900 名接受护理的老年人进行一项随机对照试验 23 三份美国ED。接受干预的患者将观看一段 5 分钟的有关 ACP 的认证视频决策辅助 24 并与社会工作者就他们的价值观和偏好进行结构化对话。社会工作者然后，25 将向患者的主要医疗服务提供者发送一条安全电子消息，与他们分享患者的姓名首字母 26 种偏好，并提供有关如何以广泛应用的方式记录患者偏好的说明 27 患者的医疗服务提供者可以访问。遵循共同决策的临床模型，患者 28 社会工作者将鼓励他们进一步考虑他们的偏好，然后获得知情的信息 29 与他们的主要医疗服务提供者或入院医生讨论护理偏好。结果将包括 30 ACP 对话和偏好的文档，表达和记录之间的协议 31 项偏好以及急诊就诊后 3 个月和 6 个月评估的住院天数。这项研究的结果将确定 32 该干预措施的有效性，并提供支持和指导实施的信息。