Interactive Decision Aid for Advance Care Planning

描述（由申请人提供）：广泛宣传的情况下，如特丽夏沃提高了对提前护理规划的重要性的认识。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令（AD）文件上，而不是在确保尊重临终关怀偏好所必需的知情决策和沟通上。事实上，很少有证据表明，单独患有AD会在生命结束时改善或首选护理。因此，作为公共政策工具的预嘱（或生前遗嘱）被称为失败的社会政策。最近，注意力已转向预先护理规划过程。作为回应，我们提出了一个创新的交互式决策援助，以帮助个人不仅作出明智的决定，首选的治疗在生命的尽头，但也传达这些偏好和决定，他们的医疗保健提供者和家人。该计划将使用视频提供几个高级阶段的健康状态和临终关怀治疗的选择的视觉描述，并与医疗保健提供者和家庭关于护理偏好的有效沟通模型。将提供用于填写AD和医疗保健代理的模板文件，以便立即或稍后完成。该程序在平板电脑上呈现，具有基于网络的能力，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）制作最后两个关于患者与家人和医疗保健代理人沟通的戏剧性视频; 2）制作其他健康状态和潜在治疗选择的数字视频; 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;（五）商业化计划的确定和实施。 公共卫生相关性：预先护理计划不仅仅是签署一份文件。这是一个过程。这种交互式决策辅助工具不仅可以帮助个人在生命结束时对首选治疗做出明智的决定，还可以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呈现几个高级阶段的健康状态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.