Interactive Decision Aid for Advance Care Planning

描述(由申请人提供)：特里·夏沃等广为人知的案例提高了人们对提前护理计划的重要性的认识。然而，虽然通过联邦法律和法规来促进，但重点是完成预先指令(AD)文件，而不是确保尊重临终关怀优先选择所必需的知情决策和沟通。事实上，几乎没有证据表明，单独患有AD会在生命结束时带来改善或首选的护理。因此，先行指令(或生前遗嘱)作为一种公共政策工具被称为失败的社会政策。最近，人们的注意力重新转向了预先护理规划的过程。作为回应，我们提出了一种创新的交互式决策辅助工具，以帮助个人不仅在生命末期做出关于首选治疗的明智决定，而且还将这些偏好和决定传达给他们的医疗保健提供者和家人。该计划将使用视频来提供几种晚期健康状态的可视描述和生命末期护理治疗的选项，并建立与卫生保健提供者和家庭关于护理偏好的有效沟通模式。完成AD和医疗代理的模板文档将立即或稍后提供完成。该程序在平板电脑上展示，具有基于网络的能力，允许将这些文件包括在电子病历中。没有其他可用的程序在便携式平台上提供所有这些功能，以最大限度地促进各种设置的使用。第一阶段的具体目标已经成功完成。第二阶段的具体目标是：1)制作关于患者与家人和保健代理人交流的最后两个戏剧性视频；2)为更多的健康状况和潜在的治疗选择制作数字视频；3)完成网页设计和文本屏幕的完整编程以及视频和音频叙述的整合；4)评估该计划的有效性；以及5)最终确定和实施商业化计划。 公共卫生相关性：提前制定护理计划不仅仅是签署一份文件。这是一个过程。这一交互式决策助手不仅将帮助个人在生命末期做出关于首选治疗的明智决定，而且还将向他们的医疗保健提供者和家人传达这些偏好和决定。该节目将使用视频呈现几种晚期健康状态和临终关怀治疗选项，并模拟与医疗保健提供者和家庭就护理偏好进行沟通。

DESCRIPTION (provided by applicant): Widely publicized cases such as Terri Schiavo have raised awareness of the importance of advance care planning. However, while promoted through federal law and regulation, emphasis is placed on the completion of an advance directive (AD) document rather than on the informed decision making and communication essential to ensuring that end of life care preferences are honored. In fact, there is little evidence that having an AD alone results in improved or preferred care at the end of life. Consequently, the advance directive (or living will) as a public policy instrument has been called a failed social policy. More recently, attention has been redirected to the process of advance care planning. In response, we propose an innovative interactive decision aid to help individuals not only to make informed decisions about preferred treatment at end of life but also to communicate these preferences and decisions to their health care providers and families. The program will use video to provide visual depiction of several advance stage health states and options for end of life care treatment and to model effective communication with health care providers and family about preferences for care. Template documents for completing an AD and health care proxy will be provided for completion immediately or at a later date. The program is presented on a tablet-PC, with the capability to be web-based allowing the inclusion of these documents in an electronic medical record. No other available program offers all of these features on a portable platform to maximize and facilitate use across a range of settings The Specific Aims of Phase I were completed successfully. The Specific Aims of Phase II are to: 1) produce the final two dramatic videos regarding patient communication with family and a health care proxy; 2) produce digital videos for additional health states and potential treatment options; 3) finalize web design and complete programming of text screens and integration of video and audio narration; 4) evaluation of the program's effectiveness; and 5) finalization and implementation of the commercialization plan. PUBLIC HEALTH RELEVANCE: Advance care planning is more than signing a document. It is a process. This interactive decision aide will help individuals not only make informed decisions about preferred treatment at end of life but also to communicate these preferences and decisions to their health care providers and families. The program will use video to present several advance stage health states and options for end of life care treatment and to model communication with health care providers and family about preferences for care.