Conversational Agents to Improve Quality of Life in Palliative Care

对话代理可提高姑息治疗中的生活质量

• 批准号: 10117443
• 负责人: TIMOTHY W. BICKMORE
• 金额: $ 24.71万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-22 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10117443
• 关键词: Accident and Emergency department; Address; Admission activity; Adult; Advance Care Planning; Adverse event; Affective; Ambulatory Care Facilities; Anxiety; Behavior; Boston; Caregivers; Chronic; Chronic Disease; Clinical; Clinical Trials; Communication; Computer Interface; Computer Literacy; Computers; Counseling; Cues; Data Collection; Development; Elderly; Emotions; Empathy; Enrollment; European Organization for Research and Treatment of Cancer; Evaluation; Gestures; Hand; Health; Health Professional; Health Status; Health care facility; Home environment; Hospitals; Information Systems; Inpatients; Intervention; Interview; Intuition; Life; Life Expectancy; Measures; Medical center; Medication Management; Mental Depression; Methods; Monitor; Needs Assessment; Neighborhood Health Center; New England; Nurses; Outcome Measure; Palliative Care; Participant; Patient Care; Patient Care Team; Patients; Pharmaceutical Preparations; Physical activity; Population Study; Quality of life; Randomized Controlled Trials; Research; Social isolation; Stress; Surveys; Symptoms; System; Tablet Computer; Technology; Telephone; Testing; Time; Visit; Voice; advanced disease; base; cancer care; care systems; cost; cost effective; ethnic minority population; gaze; group intervention; health literacy; hospital services; improved; innovation; member; older patient; patient oriented; physical symptom; primary outcome; racial minority; randomized controlled design; randomized trial; safety net; satisfaction; screening; secondary outcome; service utilization; side effect; symptom management; tertiary care; treatment as usual; urgent care

Background: Although many interventions have now been developed to address palliative care for specific chronic diseases, little has been done to address the overall quality of life for older adults with serious illness, spanning not only the functional aspects of symptom and medication management, but the affective aspects of suffering in a scalable and cost effective manner. Over the past decade we have developed and tested embodied conversational agents (ECA) — computer characters that simulate face- to-face conversation using voice, hand gesture, gaze cues and other nonverbal conversational behavior to provide a natural and intuitive computer interface that is capable of expressing empathy and other emotions. We have successfully developed and evaluated this interface in several clinical trials involving older patients of all levels of health and computer literacy. We now propose to adapt this innovative cutting edge technology to create and test a mobile ECA for palliative care (ECA-PAL) for patients with advanced illnesses, spanning: symptom and medication tracking and management; assessment and counseling to reduce social isolation, depression and unmet spiritual needs; and, promotion of and communication about advance care planning. Design: Randomized Controlled Trial Hypotheses: In comparison to participants receiving usual care, ECA-PAL participants will: (1) have greater quality of life; (2) a higher rate of receiving of palliative care services; (3) a lower rate of hospital service utilization; and (4) lower cost per patient-month. Population Studied: Adult patients at Boston Medical Center or affiliated Health Centers with life-limiting illness, who’s clinician endorses that it would not be a surprise if the patient died within 12 months. Methods: The ECA-PAL will be assessed with a randomized controlled trial of patients getting usual care (n=182) or usual care plus ECA-PAL (n=182). Each participant will be enrolled along with a caregiver surrogate subject. Outcome Measures: The primary outcome is quality of life. Secondary outcomes will be measured in the domains of receipt of palliative care services, hospital service utilization, cost, social isolation, depression, anxiety, physical symptoms, spiritual needs, advance care planning. Caregivers will also be interviewed to measure their quality of life. Expected Results: In this project we will evaluate a scalable patient-centered intervention to improve the quality of life for people with advanced illnesses.

背景：尽管现在已经制定了许多干预措施来解决姑息治疗问题 但在改善患有特定慢性病的老年人的整体生活质量方面几乎没有采取任何措施 严重疾病，不仅涵盖症状和药物管理的功能方面，还涵盖 以可扩展且具有成本效益的方式解决痛苦的情感方面。过去十年我们 开发并测试了体现对话代理（ECA）——模拟面部的计算机角色 使用声音、手势、目光暗示和其他非语言对话行为进行面对面对话 提供自然直观的计算机界面，能够表达同理心和其他 情绪。我们已在多项临床试验中成功开发并评估了该界面，涉及 各个健康水平和计算机素养水平的老年患者。我们现在建议采用这一创新 尖端技术，为患有以下疾病的患者创建和测试用于姑息治疗的移动 ECA (ECA-PAL) 晚期疾病，涵盖：症状和药物跟踪和管理；评估和 提供咨询，以减少社会孤立、抑郁和未满足的精神需求；以及，促进和 有关预先护理计划的沟通。 设计：随机对照试验 假设：与接受常规护理的参与者相比，ECA-PAL 参与者将：(1) 更高的生活质量； (2) 姑息治疗服务接受率较高； (3)住院率较低 服务利用； (4) 每个患者每月的成本更低。 研究人群：波士顿医疗中心或附属健康中心的生命有限的成年患者 该患者的临床医生表示，如果患者在 12 个月内死亡，也就不足为奇了。 方法： ECA-PAL 将通过对恢复正常的患者进行随机对照试验进行评估 护理 (n=182) 或常规护理加 ECA-PAL (n=182)。每位参与者都将被登记并附有 照顾者替代主体。 结果测量：主要结果是生活质量。次要结果将衡量 接受姑息治疗服务、医院服务利用、成本、社会隔离等领域， 抑郁、焦虑、身体症状、精神需求、预先护理计划。护理人员也将 进行访谈以衡量他们的生活质量。 预期结果：在这个项目中，我们将评估可扩展的以患者为中心的干预措施，以改善 患有晚期疾病的人的生活质量。