Interactive Decision Aid for Advance Care Planning

描述（由申请人提供）：像Terri Schiavo这样被广泛报道的病例提高了人们对提前护理计划重要性的认识。然而，虽然通过联邦法律和法规促进，但重点放在完成预先指示（AD）文件上，而不是在知情的决策和沟通上，这对确保临终关怀的偏好得到尊重至关重要。事实上，几乎没有证据表明单独患有阿尔茨海默病会在生命结束时改善或优选护理。因此，作为公共政策工具的事前指示（生前遗嘱）被称为失败的社会政策。最近，人们的注意力已经转向了预先护理计划的过程。因此，我们提出了一种创新的交互式决策辅助工具，帮助个人不仅在生命结束时对首选治疗做出知情决定，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。该项目将使用视频提供几个晚期健康状态的视觉描述和临终关怀治疗的选择，并模拟与医疗保健提供者和家庭关于护理偏好的有效沟通。将提供用于填写AD和医疗保健代理的模板文档，以便立即或稍后完成。该程序在平板电脑上呈现，具有基于网络的功能，允许将这些文件包含在电子病历中。没有其他可用的程序在便携式平台上提供所有这些功能，以最大限度地提高和促进在一系列设置中的使用。第二阶段的具体目标是：1)制作关于患者与家人和医疗保健代理沟通的最后两个戏剧性视频；2)制作关于其他健康状况和潜在治疗方案的数字视频；3)完成网页设计，完成文字画面的编程和音视频叙事的整合；4)项目有效性评价；5)商业化计划的确定与实施。

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.