End-of-life Care for Chronic Lung Disease and Acute Respiratory Failure

描述（由申请人提供）：此K24续期申请为Curtis博士提供工资支持，使他有机会将40%的时间用于指导肺部和重症监护研究员，初级教师和其他学员进行以患者为导向的慢性肺病和急性呼吸衰竭患者研究。该K24奖项由华盛顿大学肺部和重症监护医学部奖学金培训计划的临床研究培训轨道支持。博士-。Curtis是该培训课程的负责人。这两个项目旨在提高急性呼吸衰竭（项目1）和慢性肺病（项目2）患者的临终护理质量。具体目标是：项目11。通过对12家医院的随机试验，评估多方面跨学科干预的有效性，以提高在ICU死亡或入住ICU后不久死亡的患者的护理质量。干预措施将通过患者层面的结果进行评估，控制医院内患者的聚集，包括：a）临终和死亡的质量（家属和护士的调查）; B）对护理的满意度（家属和护士的调查）;以及c）临终护理的质量（护士的调查和病历审查）。2.检查社区ICU中临终关怀和临终关怀质量的变化和预测因素，目的是确定非大学环境中临终关怀的当前质量以及与这种护理质量相关的机构，临床医生和患者因素。3.评估干预措施的成功和不成功的组成部分，并描述机构和临床医生的促进者和干预措施的实施障碍，重点是告知干预措施，以改善护理垂死的其他网站。第21章.评估跨学科干预的有效性，以提高患者和家属对重度COPD或转移性癌症患者的希望和预后的沟通评级。2.评价这种跨学科干预对患者和家庭抑郁和焦虑、焦虑、患者-临床医生对患者治疗偏好的一致性的有效性，并评价重度COPD或转移性癌症患者的临终关怀。3.评价3个月内上述结局变化的稳定性。4.评价干预措施对改善医护合作的效果。

DESCRIPTION (provided by applicant): This K24 renewal application provides for salary support for Dr. Curtis to provide him the opportunity to spend 40% of his time mentoring pulmonary and critical care fellows, junior faculty, and other trainees in patient-oriented studies concerning chronic lung disease and patients with acute respiratory failure. This K24 award is supported by the Clinical Research Training Track of the fellowship training program of the Division of Pulmonary and Critical Care Medicine at the University of Washington. Dr-. Curtis is Director of this Training Track. The two projects are designed to improve the quality of end-of-life care for patients with acute respiratory failure (Project 1) and chronic lung disease (Project 2). The specific aims are: Project 1 1. Evaluate the effectiveness of a multi-faceted interdisciplinary intervention to improve the quality of care for patients dying in, or shortly after a stay in, the ICU with a randomized trial of 12 hospitals. The intervention will be evaluated with patient-level outcomes, controlling for clustering of patients within hospitals, including: a) the quality of dying and death (surveys by family and nurses); b) satisfaction with care (surveys by family and nurses); and c) the quality of end-of-life care (surveys by nurses and medical record review). 2. Examine the variability in, and predictors of, the quality of dying and end-of-life care in community ICUs with the purpose of identifying the current quality of end-of-life care in non-University settings and the institutional, clinician, and patient factors associated with the quality of this care. 3. Evaluate the successful and unsuccessful components of the intervention and describe the institutional and clinician facilitators and barriers to the intervention's implementation, with a focus on informing interventions to improve care for the dying at other sites. Project 2 1. Evaluate the efficacy of an interdisciplinary intervention to enhance patients' and families' ratings of communication about hope and prognosis for patients with severe COPD or metastatic cancer. 2. Evaluate the efficacy of this interdisciplinary intervention on patient and family depression and anxiety, hopefulness, patient-clinician concordance on patient treatment preferences, and evaluations of end-of-life care for patients with severe COPD or metastatic cancer. 3. Evaluate the stability of changes in the above outcomes over a 3 month period. 4. Evaluate the efficacy of the intervention for improving physician-nurse collaboration.