Developing and piloting a multi-component technology-based care intervention to address patient symptoms and caregiver burden in home hospice

项目摘要 候选人：Veerawat Phongtankuel博士是威尔康奈尔大学医学院的助理教授， 老年医学和姑息医学。他的长期目标是改善老年人及其照顾者的护理 (CGs)通过减少痛苦，CG负担和生命末期（EoL）的繁重护理过渡， 确立了自己在老年医学和姑息医学领域的领导地位。 研究：随着临终关怀的发展，老年人有机会接受家庭护理， 减少痛苦，注重生活质量。然而，几乎一半的临终关怀出院病人 导致住院治疗，通常导致不必要和无效的护理，并增加医疗保健费用。虽然 住院的原因是复杂的，这位候选人的研究表明，患者的症状和CG 负担是重要的贡献者。目前的家庭临终关怀模式包括护理访问， 不足以解决患者的症状和CG负担，每天都可能波动。虽然使用 技术和教育视频还有待于在家庭临终关怀中得到充分的开发、结构化和评估 在护理方面，它已显示出改善其他环境中护理的希望。因此，本建议旨在发展和 评估基于多组分技术的护理干预，即，改善居家安宁疗护的管理 通过技术解决生命终结问题（I-HoME），重点是评估和解决患者症状 通过同步直播视频访问和教育视频，减轻家庭临终关怀环境中的CG负担。的 本计画的目标为：（1）以使用者为中心的设计流程，开发家用的I-HoME 临终关怀患者及其CG和（2）进行随机试点研究，评估可行性和 与常规治疗（N = 50）相比，I-HoME（N = 50）的潜在疗效。的 科学 获得的结果将提供 R 01应用的基础，以评价I-HoME在多中心RCT中的结局。 职业发展：Phongtankuel博士召集了一批杰出的跨学科导师（Drs. Reid，Czaja和Prigerson）和在医学，护理，姑息/临终关怀方面具有专业知识的合作者， 在老年人中实现以用户为中心的设计，计算机科学和技术。他的职业生涯 发展计划整合了以下领域的课程，研讨会和导师制：（1）高级 症状管理和康复培训，（2）家庭临终关怀服务，（3）干预技能 开发和临床试验，（4）导师和领导力发展，（5）赠款写作。与 从 铅 suppor 威尔康奈尔医学和访问护士服务的纽约，博士Phongtankuel是很好的定位， 纽约的姑息治疗研究计划。 不 建议的培训和支持将提供博士。 Phongtankuel拥有成为开发，实施， 并利用技术提供创新的护理模式，以改善患者和CG的护理， hospicare在家里

PROJECT SUMMARY Candidate: Dr. Veerawat Phongtankuel is an Assistant Professor at Weill Cornell Medicine with expertise in geriatrics and palliative medicine. His long-term goals are to improve care for older adults and their caregivers (CGs) by reducing suffering, CG burden, and burdensome care transitions at the end of life (EoL) while establishing himself as a leader in the field of geriatrics and palliative medicine. Research: With the growth of hospice, older adults have the opportunity to receive home-based care aimed at reducing suffering and focusing on quality of life at the EoL. However, almost half of all live hospice discharges result in a hospitalization, often leading to unwanted and futile care and increased healthcare costs. Although reasons for hospitalizations are complex, this candidate's research suggests that patient symptoms and CG burden are significant contributors. The current model of home hospice care consisting of nursing visits can be inadequate to address patient symptoms and CG burden that can fluctuate on a daily basis. While use of technology and educational videos has yet to be fully developed, structured, and evaluated in home hospice care, it has shown promise to improve care in other settings. Therefore, this proposal aims to develop and evaluate a multi-component technology-based care intervention, i.e., Improving Home hospice Management of End of life issues through technology (I-HoME), that focuses on assessing and addressing patient symptoms and CG burden in the home hospice setting through synchronous live video visits and educational videos. The aims for the project are, (1) To employ an iterative user-centered design process to develop I-HoME for home hospice patients and their CGs and (2) To conduct a randomized pilot study evaluating the feasibility and potential efficacy of I-HoME (N=50) compared to usual care (N=50). The scientific results obtained will provide the foundation for a R01 application to evaluate the outcomes of I-HoME in a multi-site RCT. Career Development: Dr. Phongtankuel has assembled a preeminent group of interdisciplinary mentors (Drs. Reid, Czaja, and Prigerson) and collaborators with expertise in medicine, nursing, palliative/hospice care, caregiving, user-centered design, computer science, and technology implementation in older adults. His career development plan integrates coursework, seminars, and mentorship in the following areas: (1) Advanced training in symptom management and caregiving, (2) Home hospice care delivery, (3) Skills in intervention development and clinical trials, (4) Mentorship and leadership development, and (5) Grant writing. With from lead suppor Weill Cornell Medicine and the Visiting Nurse Service of New York, Dr. Phongtankuel is well-positioned to palliative care research initiatives in New York. t The proposed training and support will provide Dr. Phongtankuel with the skills and experience to become a transformative leader in developing, implementing, and delivering innovative care models using technology to improve care forpatients and CGs receiving hospicecare at home.