Adapting Advance Care Planning Tools for Permanent Supportive Housing Residents

项目摘要 背景：无家可归人口正在老龄化，50岁以上的比例越来越大。人们正在经历 慢性无家可归，定义为长期或多次无家可归，并伴有致残状态， 加速衰老和高死亡率。由于与医疗保健系统的互动支离破碎， 与世隔绝，长期无家可归的老年人有很高的风险得不到医疗保健的愿望 记录在案或遵循。高级护理计划(ACP)旨在激发患者的医疗意愿；然而，老年人 无家可归的成年人患非典的比率很低。重大的政策关注集中在长期的安置上 无家可归者进入永久支持性住房(PSH)。而PSH表示要启动的唯一设置 ACP，但目前尚无ACP在PSH中的研究。我们的团队已经创建了易于使用、基于证据的ACP工具， 例如易于阅读高级指令(AD)和带有视频故事的基于网络的教育计划 (PrepareForYourCare.org)，用于小组访问或与一对一主持人一起使用。然而，这些机场核心工程 干预措施需要适应PSH环境。该提案的目标是适应、试行和 展示针对特定人群(以前为慢性人群)实施循证的非典干预措施的可行性 无家可归的老年人)在一个新的环境(PSH)。目标：我们将改编易读的广告(目标1)，小组 访问指南(目标2)和一对一主持人指南(目标3)，以满足老年人(≥50岁)的需求 PSH居民。然后，我们将试行调整后的机场核心计划干预措施，以评估交付机场核心计划的可行性 在PSH环境中进行干预，并获得关于干预和流程的反馈。(目标4)。方法：In 目标1-3，我们将为每个目标组织三个焦点小组，每个小组由6-10名年长(≥50)的PSH居民组成。我们会 应用行为改变轮(BCW)框架，该框架使用能力机会激励 行为(COM-B)模型，以了解上下文中的目标行为(即ACP参与)、 非加太项目干预措施的使用，以及克服这些干预措施的战略。我们将进行专题内容分析，以 确定克服这些障碍所需的适应并创建满足PSH要求的其他材料 居民的需求。我们将根据这一投入调整材料和工艺。在目标4中，我们将评估 我们的招聘程序、我们的调查材料以及小组访问和主持人干预的可行性。 我们将使用经过验证的问卷来评估满意度，并获得有关可行性的反馈 PSH环境中的干预措施和我们的研究程序。由PSH主要领导人组成的社区咨询委员会， 居民和工作人员将与调查人员合作指导这项研究。与美国国立卫生研究院和公共卫生的相关性： 拟议的项目将开发用于PSH的ACP干预措施，我们将在未来由R01资助的测试中进行测试 疗效随机试验。这些干预措施可能会减少既往慢性病患者中ACP的健康差距 无家可归的老年人。

PROJECT ABSTRACT Background: The homeless population is aging, with increasing proportions over age 50. People experiencing chronic homelessness, defined as prolonged or multiple homeless episodes with a disabling condition, have accelerated aging and high rates of mortality. Due to fragmented interactions with the health care system and social isolation, chronically homeless older adults are at high risk of not having their wishes for medical care documented or followed. Advance care planning (ACP) aims to elicit patients' medical wishes; yet, older homeless adults have low rates of ACP. Significant policy attention has focused on rehousing chronically homeless people into Permanent Supportive Housing (PSH). While PSH represents a unique setting to initiate ACP, there are no studies of ACP in PSH. Our team has created easy-to-use, evidenced-based ACP tools, such as an easy-to-read advance directive (AD) and a web-based educational program with video stories (PrepareForYourCare.org) to be used in group visits or with a one-on-one facilitator. However, these ACP interventions require adaptation for PSH settings. The objective of this proposal is to adapt, pilot, and demonstrate the feasibility of evidenced-based ACP interventions for a unique population (formerly chronically homeless older adults) in a novel setting (PSH). Aims: We will adapt the easy-to-read AD (Aim 1), the group visit guide (Aim 2), and the one-on-one facilitator guide (Aim 3) to meet the needs of older (≥ 50 years of age) PSH residents. Then, we will pilot the adapted ACP interventions to assess the feasibility of delivering the ACP interventions in the PSH setting and obtain feedback on the intervention and processes. (Aim 4). Methods: In Aims 1-3, we will conduct three focus groups for each Aim, with 6-10 older (≥ 50) PSH residents each. We will apply the Behavior Change Wheel (BCW) framework, which uses the Capability Opportunity Motivation Behavior (COM-B) model to understand targeted behaviors (i.e., ACP engagement) in context, the barriers to use of the ACP interventions, and strategies to overcome them. We will conduct thematic content analysis to determine needed adaptations to overcome these barriers and create additional material to meet PSH residents' needs. We will adapt both materials and processes based on this input. In Aim 4, we will assess the feasibility of our recruitment procedures, our survey materials, and the group visit and facilitator interventions. We will assess satisfaction using validated questionnaires and obtain feedback about feasibility of the interventions and our study procedures in the PSH setting. A Community Advisory Board of key PSH leaders, residents and staff will work with the investigators to guide the study. Relevance to NIH and public health: The proposed project will develop ACP interventions for use in PSH, which we will test in a future R01-funded efficacy randomized trial. These interventions may reduce health disparities in ACP among formerly chronically homeless older adults.