Involving Family to Improve Primary Care Visits for Cognitively Impaired Patients

让家人参与改善认知障碍患者的初级保健就诊

• 批准号: 9134674
• 负责人: Jennifer L. Wolff
• 金额: $ 24.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9134674
• 关键词: Address; Affect; Audiotape; Behavioral Symptoms; Caring; Characteristics; Chronic; Communication; Companions; Dementia; Detection; Diagnosis; Elderly; Family; Family Caregiver; Family member; Feedback; Future; Health; Healthcare; Impaired cognition; Intervention; Interview; Knowledge; Medical; Patients; Persons; Pharmaceutical Preparations; Phase; Play; Preparation; Primary Health Care; Process; Protocols documentation; Provider; Randomized; Role; Self-Administered; Social Work; Structure; Surveys; Symptoms; Testing; Time; To specify; Visit; Work; brief intervention; cost; dementia care; design; evidence base; health care service utilization; improved; meetings; multi-site trial; older patient; patient oriented; patient population; preference; randomized trial; treatment as usual; user centered design; work-study

 DESCRIPTION (provided by applicant): Dementia is among the most profoundly disabling and costly health conditions. With devastating impacts and no known cure, health care is nevertheless pivotal to detection and treatment of behavioral symptoms, initiation of social service referrals, and planning for future needs. Dementia poses special communication challenges in primary care, where most persons are initially treated. As persons with dementia have a high burden of chronic medical conditions, communication challenges also affect the care of co-occurring medical conditions, resulting in excessively burdensome treatments, inappropriate medication use, and potentially avoidable health care utilization. Family caregivers play a vital role in dementia care, and are typically present and actively involved in medical visits. Patients and providers strongly endorse involving family to meet the communication needs of patients who lack the capacity to obtain, process, and understand basic health information to make appropriate health decisions. However, knowledge of how to involve family caregivers in medical visits is lacking. This study will refine a brief intervention to effectivelyand purposely involve family caregivers ("companions") who accompany persons with cognitive impairment to primary care visits. The study team has developed a checklist to be used by patients and their companions prior to medical visits. The checklist is designed to elicit and alig patient and companion perspectives concerning health concerns to discuss with the doctor, and to clarify the role of the companion in the visit. The checklist was well received in a recent proo-of-concept randomized study. Communication was significantly more patient-centered in visits of patient-companion dyads who completed the checklist versus those who received usual care and did not complete the checklist. However, people with moderate and severe cognitive impairment were excluded from this early phase study. Therefore, building from our preliminary work, the overall objective of this study is to refine and evaluate a patient- companion checklist to address the communication needs of primary care patients with a range of cognitive impairment and their companions. First, we will undertake a user-centered design process to refine and enhance the checklist for older adults with mild, moderate, or severe cognitive impairment. We will incorporate feedback regarding checklist content and delivery characteristics (timing and mode of administration) by undertaking in-depth interviews with older patients with cognitive impairment (n=20) and their companions (n=20; 20 dyads in total). Second, we will conduct a two-group pilot randomized trial to evaluate the feasibility of delivering the refined checklist older primary care patients with cognitive impairment and their companions and to compare the checklist protocol to usual care with respect to medical communication (from audiotapes). The intervention has the potential to advance a low cost and practical approach to improving medical communication for a highly prevalent, vulnerable, and costly patient population whose care is especially challenging. Study activities will pave the way for a larger multi-site trial in primary care.

 描述（由适用提供）：痴呆症是最严重残疾和昂贵的健​​康状况之一。尽管有破坏性的影响，也没有已知的治疗方法，但医疗保健对于对行为症状的检测和治疗，社会服务转诊的倡议以及未来需求的计划仍然是关键的。痴呆症在初级保健中面临特殊的沟通挑战，大多数人最初受到治疗。由于患有痴呆症患者的慢性医疗状况很高，沟通挑战也会影响同时发生的医疗状况的护理，从而极度耐磨，不适当的药物使用以及可能避免的医疗保健利用。家庭护理人员在痴呆症护理中起着至关重要的作用，通常在医疗访问中就存在并积极参与。患者和提供者强烈认可家庭，以满足缺乏获得，处理和理解基本健康信息以做出适当健康决定的患者的沟通需求。但是，缺乏有关如何让家庭护理人员参与医疗访问的知识。这项研究将简要干预以有效且故意涉及家庭护理人员（“同伴”），他们协助认知障碍者对初级保健访问。研究团队已制定了一份清单，可在医疗访问之前使用患者及其同伴使用。该清单旨在引起和艾丽格患者以及有关与医生讨论健康问题的观点，并阐明同伴在访问中的作用。在最近的概念验证随机研究中，该清单受到了良好的接收。沟通在访问患者班的二元组中的访问中，沟通更为以患者为中心，他们完成了检查清单，而那些接受了通常的护理且未完成清单的沟通。然而，从这项早期研究中排除了中度和严重认知障碍的人。因此，根据我们的初步工作，这项研究的总体目的是完善和评估患者企业的清单，以满足具有一系列认知障碍及其同伴的初级保健患者的沟通需求。首先，我们将进行以用户为中心的设计过程，以完善和增强对患有轻度，中度或严重认知障碍的老年人的清单。我们将通过对老年认知障碍患者（n = 20）及其同伴（n = 20;总共20个二元组）进行深入的访谈，从而结合有关清单内容和交付特征（时机和给药方式）的反馈。其次，我们将进行一项两组飞行员随机试验，以评估提供认知障碍及其同伴的精制清单较旧的初级保健患者的可行性，并将清单方案与医疗通信（来自录音带）的常规护理进行比较。该干预措施有可能提高低成本和实用方法，以改善医疗沟通，以使高度普遍，脆弱且昂贵的患者人群特别具有挑战性。研究活动将为初级保健的更大多站点试验铺平道路。