Improving the Quality of Communication about End-of-Life

描述（由申请人提供）： 这份申请是为了在K24机制下为柯蒂斯博士提供工资支持。这种支持将使他从临床和行政职责中解脱出来，并使他能够将他的研究计划重新定向到以患者为导向的研究和指导新的临床研究者。该K24奖将得到华盛顿大学肺部和重症监护医学部以及该部门的奖学金培训计划的支持。这些项目旨在衡量和改善与患者和家属就慢性阻塞性肺疾病和呼吸衰竭危重病患者的临终护理进行沟通的质量。具体目标是： 项目1：衡量和改善关于重度COPD患者临终关怀的沟通质量。 1)制定并验证重度COPD患者临终关怀患者-医生沟通质量的衡量标准。 2)确定沟通质量的提高是否与临终关怀质量的提高相关。 3)评估文化和种族在临终关怀沟通中的作用。 4)制定和评估文化敏感的干预措施，以提高重症COPD患者临终关怀的医患沟通质量。 项目2：测量和改善ICU家庭会议的沟通质量。 1)运用基于扎根理论的定性分析，描述ICU家庭会议中医生与家属就临终关怀进行沟通的内容和过程。2)使用定性和调查相结合的方法，评价ICU家庭会议中临床医生与家庭就临终关怀进行沟通的质量。3)检查问卷的可靠性和有效性，该问卷评估了ICU家庭会议中发生的关于临终关怀的临床医生与家庭沟通的质量。 4)评估跨文化ICU家庭会议中文化能力的关键组成部分。 5)制定和评估文化敏感的干预措施，以提高临床医生家庭沟通的质量。

DESCRIPTION (provided by applicant): This application is for salary support for Dr. Curtis under the K24 mechanism. This support will relieve him from clinical and administrative duties and allow him to redirect his research program to patient-oriented studies and the mentoring of new clinical investigators. This K24 award will have the support of the Division of Pulmonary and Critical Care Medicine at the University of Washington and the fellowship-training program of this Division. The projects are designed to measure and improve the quality of communication with patients and families about end-of-life care for patients with COPD and critical illness with respiratory failure. The specific aims are: Project 1: Measuring and improving the quality of communication about end-of-life care in severe COPD. 1) Develop and validate a measure of the quality of patient-physician communication about end-of-life care for persons with severe COPD. 2) Determine whether increased quality of communication is associated with increased quality of end-of-life care. 3) Assess the role of culture and ethnicity in communication about end-of-life care. 4) Develop and evaluate culturally-sensitive interventions to improve the quality of patient-physician communication about end-of-life care for patients with severe COPD. Project 2: Measuring and improving the quality of communication in the ICU family conference. 1)Describe the content and process of clinician-family communication about end-of-life care occurring as part of ICU family conferences using qualitative analysis based on grounded theory. 2) Evaluate the quality of clinician-family communication about end-of-life care occurring as part of ICU family conferences using a combination of qualitative and survey methods. 3) Examine the reliability and validity of a questionnaire assessing the quality of clinician-family communication about end-of-life care occurring as part of ICU family conferences. 4) Assess key components of cultural competence in cross-cultural ICU family conferences. 5) Develop and evaluate culturally-sensitive interventions to improve the quality of clinician-family communication.