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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：
10251332
负责人：
Angelo Volandes
金额：
$ 64.87万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
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 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10251332
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 在生命的最后几个月，许多老年人接受的护理与他们的偏好不一致， 4增加痛苦，破坏关闭和悲伤。提前护理计划（ACP）的过程有助于 5.通过授权患者定义和记录他们需要的护理，患者可以控制他们的临终护理。 6.当他们仍然有认知和身体能力来考虑和表达这些想法时， 7个偏好ACP提高了患者和家属对死亡过程的满意度， 8患者得到他们想要的护理，并减少医疗费用。不幸的是，很少有老年人 9人完成了ACP，更少的人以可访问的方式记录了他们的临终护理偏好 10、及时就医。在最近的一份关于美国死亡和临终的医学研究所报告中， 11增加老年人的ACP被确定为一个主要的公共优先事项。初级保健提供者通常 12与患者有长期的关系，并了解他们的医疗状况的细节， 13人被定位为进行临终关怀谈话。不幸的是，由于几个原因，这些对话往往 14不发生：主要提供者不希望患者认为他们已经放弃希望;患者认为他们也是如此 15健康从这些对话中受益;教育患者关于生命终结的选择需要时间。美国 16急诊科（艾德）访问提供了访问大量的老年人与先进的疾病， 17个国家可能受益于非加太，并为克服这些障碍提供了独特而重要的机会， 18 ACP。具体来说，急救服务提供者不太可能担心破坏与病人的长期关系，接受艾德护理的老年人不太可能认为他们太健康而不能从ACP中受益， 20是在艾德访问期间教育患者并启动关于临终关怀的对话的充足机会 21个偏好。该项目的总体目标是开发证据以支持使用基于ED的 22个国家参与促进非加太国家方案。我们提出了一项随机对照试验，900名老年人接受护理， 23美国ED接受干预的患者将观看5分钟的关于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。社工 25然后将向患者的主要提供者发送安全电子消息，与他们共享患者的初始信息。 26个偏好，并提供如何以广泛适用的方式记录患者偏好的说明。 27、患者的医疗服务。在共享决策的临床模式下，患者社会工作者将鼓励28人进一步考虑他们的偏好，然后在知情的情况下， 29与他们的主要提供者或承认医生关于护理偏好的谈话。成果将包括 30份非加太对话和偏好的文件，表达和记录之间的协议 31项偏好，以及在艾德访视后3个月和6个月评估的住院天数。这项研究的结果将建立 32.评估这种干预措施的有效性，并提供信息，以支持和宣传实施工作。