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（由申请人提供）：痴呆症是最严重的残疾和昂贵的健康状况之一。由于具有破坏性的影响，并且没有已知的治疗方法，卫生保健对于检测和治疗行为症状，启动社会服务转介以及规划未来需求至关重要。痴呆症在初级保健中构成特殊的沟通挑战，大多数人最初接受治疗。由于痴呆症患者的慢性疾病负担很重，沟通方面的挑战也影响了对并发疾病的护理，导致治疗负担过重，药物使用不当，以及可能避免的医疗保健利用。家庭照顾者在痴呆症护理中发挥着至关重要的作用，通常会出席并积极参与医疗访问。患者和医疗服务提供者强烈支持让家人参与进来，以满足缺乏获取、处理和理解基本健康信息以做出适当健康决策的能力的患者的沟通需求。然而，缺乏如何让家庭照顾者参与医疗探访的知识。这项研究将完善一个简短的干预，以有效地和有目的地涉及家庭照顾者（“同伴”）谁陪同认知障碍的人到初级保健访问。研究小组已经制定了一份清单，供患者及其同伴在医疗访问之前使用。检查表的目的是引出和alig病人和同伴的观点有关的健康问题，讨论与医生，并澄清在访问中的伴侣的作用。该清单在最近的一项概念验证随机研究中受到好评。与接受常规护理但未完成检查表的患者相比，完成检查表的患者-伴侣配对访视中的沟通更以患者为中心。然而，中度和重度认知障碍的人被排除在这项早期研究之外。因此，从我们的初步工作的建设，本研究的总体目标是完善和评估病人的同伴检查表，以解决初级保健患者的沟通需求与一系列的认知障碍和他们的同伴。首先，我们将进行以用户为中心的设计过程，以完善和增强轻度，中度或重度认知障碍的老年人的检查表。我们将通过对认知障碍老年患者（n=20）及其同伴（n = 20;共20对）进行深入访谈，纳入有关检查表内容和交付特征（给药时间和方式）的反馈。第二，我们将进行两组试点随机试验，以评估的可行性，提供完善的检查表老年初级保健患者认知障碍和他们的同伴，并比较检查表协议，以常规护理方面的医疗通信（从录音带）。该干预措施有可能推进一种低成本和实用的方法，以改善高度流行，脆弱和昂贵的患者群体的医疗沟通，他们的护理特别具有挑战性。研究活动将为在初级保健中进行更大规模的多中心试验铺平道路。