Improving Surrogate/Clinician Communication: Validation of the Family Inpatient C

描述（由申请人提供）：随着人口老龄化，越来越多的住院老年人将需要家庭成员和其他代理人的帮助，为他们做出医疗决定。有证据表明，临床医生和代理人之间的沟通往往很差，代理决策者在住院期间和住院后经历了高度的痛苦，患者有时接受无效或不必要的护理。我们的研究小组提出，临床医生和代理人之间的沟通质量提高了患者及其代理人的决策质量和结果。然而，我们不知道哪些沟通要素对代理人最重要，因此应该成为未来干预的重点，我们对沟通影响患者和代理人结果的机制了解有限。为了更好地了解这些问题，我们需要一个高质量的工具来评估代理/临床医生在医院环境中的沟通和决策。据我们所知，没有经过充分验证的仪器可用于此目的。目前的R 01提案将验证一种新的工具，以衡量医院环境中代理决策者和临床医生之间的沟通质量，并将检查该措施与决策质量、代理痛苦和患者结局之间的关系。这项新的措施，家庭住院沟通调查，检查沟通的几个要素，我们已经确定在我们的早期工作是特别重要的决策，如情感支持和频繁的沟通。我们已经起草了该工具，进行了专家评审并进行了试点测试。拟议的R 01研究将进行重要的下一步，与来自印第安纳波利斯地区3家不同医院的代理决策者一起验证该工具，包括一家城市公立医院，一家三级转诊中心， 和一家郊区社区医院我们还将管理决策质量，替代结果（如痛苦和抑郁）和患者护理结果的其他有效措施，并将研究沟通质量，决策质量和患者与替代结果之间的关系。我们已经召集了一批具有老年医学、伦理学、护理学和心理测量学专业知识的多元化调查人员。研究小组将由临床医生顾问小组（包括ICU医生、社会工作者和护士）提供建议，以就临床环境中研究的实施提供建议。从目前的研究结果将是至关重要的干预措施，以改善沟通和决策在医院的发展。这项研究议程的长期目标是提高住院患者的决策质量，并改善必须为患者做出艰难选择的代理人的痛苦。

DESCRIPTION (provided by applicant): As the population ages, a growing number of hospitalized older adults will require the assistance of family members and other surrogates to make medical decisions for them. There is evidence that communication between clinicians and surrogates is often poor, that surrogate decision makers experience high degrees of distress during and after hospitalization, and that patients sometimes receive care that is ineffective or unwanted. Our research group has proposed that the quality of communication between clinicians and surrogates improves both the quality of decision making and outcomes for both patients and their surrogates. However, we do not know which elements of communication are most important to the surrogates and should therefore be the focus of future intervention and we have a limited understanding of the mechanisms by which communication impacts outcomes for patients and surrogates. To gain a better understanding of these issues, we need a high quality instrument to assess surrogate/clinician communication and decision making in the hospital setting. To our knowledge, there is no well-validated instrument for this purpose. The current R01 proposal will validate a new instrument to measure the quality of communication between surrogate decision makers and clinicians in the hospital setting and will examine relationships between this measure and decision quality, surrogate distress and patient outcomes. This new measure, the Family Inpatient Communication Survey, examines several elements of communication that we have identified in our earlier work to be especially important for decision making, such as emotional support and frequent communication. We have drafted the instrument, conducted expert review and pilot tested it. The proposed R01 study will conduct the essential next step, validating the instrument with surrogate decision makers from 3 diverse hospitals in the Indianapolis area, including an urban public hospital, a tertiary referral center, and a suburban community hospital. We will also administer other well-validated measures of decision quality, surrogate outcomes (such as distress and depression), and patient care outcomes and will examine the relationships between communication quality, decision making quality, and patient and surrogate outcomes. We have assembled a diverse group of investigators with expertise in geriatrics, ethics, nursing and psychometrics. The research team will be advised by a Clinician Advisory Panel, including ICU physicians, a social worker and a nurse, to advise on the implementation of the study in the clinical setting. Findings from the current research will be crucial in the development of an intervention to improve communication and decision making in the hospital. The long term goal of this research agenda is to improve the quality of decisions for hospitalized patients and to improve the distress of surrogates who must make difficult choices for patients.