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

项目摘要/摘要 本NHLBI K23导师以患者为导向的研究职业发展奖(PA-18-374)由 医学博士Anuj B.Mehta将使他能够实现他的首要职业目标--提高共同决策能力 通过将定性研究方法与“大数据”相结合，在重症监护病房(ICU)开展了一项研究。Dr。 梅塔是国家犹太人健康中心的肺部和重症监护内科医生。该奖项将建立在Dr。 Mehta以前在分娩科学方面的卫生服务研究，并为他提供受保护的研究时间和 支持开展1)定性研究2)高级统计方面的高级教育和培训 卫生服务研究的方法论，3)SDM，和4)决策辅助开发。有了这项建议，我们 通过开发和试用个性化决策辅助工具(AIM 3)寻求改进气管切开术的SDM 通过对代理决策者的半结构化访谈(AIM)进行定性决策需求评估 1)和定制气管切开预测模型的建立(AIM 2)。的戏剧性增长 我们之前报道的气管切开术的使用对个人和社会都有很大的影响。病人 接受气管切开术的人绝大多数需要长期住院，发病率很高， 死亡率、长期护理需求和照顾者压力。有证据表明，有大量的病人 在决策过程中存在重大决策冲突、关怀错位的代理挫折感 根据患者价值提供，以及代孕者的期望和实际结果之间的不协调。这些 研究结果增加了患者可能正在接受不受欢迎的、侵入性的和昂贵的治疗的可能性 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SDM的关键工具。SDM和决策已被证明 改善以患者为中心的护理，提高患者对治疗方案和可能的治疗方案的了解 结果，更好地使选择的治疗方法与患者价值保持一致，并减少决策遗憾和冲突。 多个社会现在建议将SDM作为ICU BIT ITS以患者为中心的护理的基石 渗透和吸收是有限的。我们假设个性化的基于Web的决策辅助工具 气管切开术将改善共同的决策过程。梅塔博士得到了来自 国家犹太人健康中心。梅塔博士已经组建了一支非常适合确保他成功的导师团队 在这个由艾弗·道格拉斯博士和丹尼尔·马特洛克博士领导的职业发展奖期间。梅塔博士的工作将 作为ICU中SDM工具开发的典范。梅塔博士提出的培训和研究将直接 通过改进SDM影响与气管切开相关的患者护理，并更好地将接受的护理与 病人和代孕者的价值观。

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.