Developing a Novel Decision Aid for Tracheostomy to Support Shared Decision- Making in the Intensive Care Unit

项目总结/摘要 这个NHLBI K23指导以患者为导向的研究职业发展奖（PA-18-374）提交由 Anuj B.梅塔，医学博士将使他能够实现他的首要职业目标，提高共同决策 (SDM)通过将定性研究方法与“大数据”相结合，博士 Mehta是National Jewish Health的肺部和重症监护医生。该奖项将建立在博士。 梅塔先前的健康服务研究在交付科学，并为他提供受保护的研究时间， 支持在1）定性研究2）高级统计方面进行高级教育和培训 卫生服务研究方法，3）SDM，4）决策辅助开发。通过这一提议，我们 通过开发和试用个性化决策辅助工具（AIM 3），寻求改进的气管造口术SDM， 通过对代理决策者的半结构化访谈进行定性决策需求评估（AIM 1)和定制气管造口术预测模型（AIM 2）的开发。急剧增加的 我们先前报道的气管造口术的使用具有很大的个人和社会影响。患者 接受气管切开术的患者绝大多数需要长期住院治疗并具有显著的发病率， 死亡率、长期护理需求和护理人员压力。有证据表明，有大量的病人和 代理人对决策过程的挫折感，有重大的决策冲突， 与患者价值观一起交付，以及代理人的期望与实际结果之间的不一致。这些 研究结果提出了这样一种可能性，即患者可能正在接受不必要的、侵入性的和昂贵的护理， 与他们的基本价值观相一致。SDM是患者、代理人和 医疗保健提供者就与患者一致的治疗达成知情的集体协议 价值观决策辅助工具是促进“可持续发展机制”的一个关键工具。SDM和决策已被证明， 改善以病人为中心的护理，提高病人对治疗方案的认识， 结果，更好地调整选择的治疗与病人的价值观，并减少决策的遗憾和冲突。 多个协会现在建议SDM成为ICU以患者为中心的护理的基石， 渗透和吸收有限。我们假设，个性化的基于Web的决策辅助， 气管切开术将改善共同决策过程。Mehta博士得到了以下机构的大力支持： 国家犹太人健康梅塔博士已经组建了一个导师团队， 在艾弗道格拉斯博士和丹尼尔马特洛克博士领导的职业发展奖。梅塔医生的工作 作为ICU开发SDM工具的模型。Mehta博士提出的培训和研究将直接 通过改进SDM影响与气管造口术相关的患者护理，并更好地将所接受的护理与 患者和替代值。

PROJECT SUMMARY/ABSTRACT This NHLBI K23 Mentored Patient-Oriented Research Career Development Award (PA-18-374) submission by Anuj B. Mehta, MD will enable him to achieve his overarching career goal of improving shared decision-making (SDM) in the intensive care unit (ICU) by combining qualitative research methodologies with ‘big data’. Dr. Mehta is a Pulmonary and Critical Care Physician at National Jewish Health. This award will build on Dr. Mehta’s prior health services research in delivery science and provide him with protected research time and support to pursue advanced education and training in 1) qualitative research 2) advanced statistical methodologies in health services research, 3) SDM, and 4) decision aid development. With this proposal, we seek improve SDM for tracheostomy by developing and piloting a personalized decision aid (AIM 3) with a qualitative decisional needs assessment through semi-structured interviews of surrogate decision-makers (AIM 1) and development of tailored tracheostomy prediction models (AIM 2). The dramatic increases in tracheostomy utilization that we have previously reported has large personal and societal implications. Patients who receive a tracheostomy overwhelmingly require long-term hospitalization with significant morbidity, mortality, long-term care needs, and caregiver stress. Evidence suggests that there is large patient and surrogate frustration with the decision-making process with significant decision conflict, misalignment of care delivered with patient values, and discordance between surrogates’ expectations and actual outcomes. These findings raise the possibility that patients may be receiving unwanted, invasive, and expensive care not consistent with their underlying values. SDM is the collaborative process of patients, surrogates, and healthcare providers reaching an informed, collective agreement on the treatments consistent with patient’s values. Decision aids are a key tool with which to facilitate SDM. SDM and decisions have been shown to improve the patient-centeredness of care, improve patient knowledge of treatment options and possible outcomes, better align chosen treatments with patient values, and reduce decisional regret and conflict. Multiple societies now recommend that SDM be a cornerstone of patient centered care in the ICU bit its penetration and uptake are limited. We hypothesize that a personalized web based decision aid for tracheostomy will improve the shared decision making process. Dr. Mehta has strong institutional support from National Jewish Health. Dr. Mehta has assembled a team of mentors well suited to ensuring his success during this Career Development Award led by Dr. Ivor Douglas and Dr. Daniel Matlock. Dr. Mehta’s work will serve as model for developing SDM tools in the ICU. Dr. Mehta’s proposed training and research will directly impact patient care related to tracheostomy by improving SDM, and better aligning the care received with patient and surrogate values.