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）：痴呆症是最严重致残且代价最高的健康状况之一。尽管造成了毁灭性的影响，而且没有已知的治疗方法，但医疗保健对于行为症状的检测和治疗、社会服务转诊的启动以及未来需求的规划至关重要。痴呆症给初级保健带来了特殊的沟通挑战，大多数人都是在初级保健中接受治疗的。由于痴呆症患者承受着沉重的慢性疾病负担，因此沟通困难也会影响对并发疾病的护理，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。家庭护理人员在痴呆症护理中发挥着至关重要的作用，通常会在场并积极参与医疗就诊。患者和提供者强烈支持让家人参与，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能力的患者的沟通需求。然而，人们缺乏如何让家庭护理人员参与医疗就诊的知识。这项研究将完善一项简短的干预措施，以有效且有目的地让陪同认知障碍患者去初级保健就诊的家庭护理人员（“同伴”）参与其中。研究小组制定了一份清单，供患者及其同伴在就诊前使用。该清单旨在引出并调整患者和同伴对健康问题的看法，以便与医生讨论，并澄清同伴在就诊中的角色。该清单在最近的一项概念验证随机研究中受到好评。与那些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-同伴二人组的访视中，沟通明显更加以患者为中心。然而，患有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，在我们的初步工作的基础上，本研究的总体目标是完善和评估患者-同伴清单，以满足患有一系列认知障碍的初级保健患者及其同伴的沟通需求。首先，我们将进行以用户为中心的设计过程，以完善和增强针对患有轻度、中度或重度认知障碍的老年人的清单。我们将通过对患有认知障碍的老年患者 (n=20) 及其同伴 (n=20；总共 20 人) 进行深入访谈，纳入有关清单内容和交付特征（给药时间和给药方式）的反馈。其次，我们将进行一项两组试点随机试验，以评估向患有认知障碍的老年初级保健患者及其同伴提供完善的清单的可行性，并将清单协议与医疗沟通（来自录音带）方面的常规护理进行比较。该干预措施有可能提出一种低成本且实用的方法，以改善高度流行、脆弱且昂贵的患者群体的医疗沟通，这些患者的护理尤其具有挑战性。研究活动将为初级保健领域更大规模的多中心试验铺平道路。