Identifying Effective Strategies to Disclose Prognosis in Patients with ARDS

项目摘要摘要 尽管最近在治疗方面取得了进展，但30%-40%的急性肺损伤(ALI)患者无法存活。 美国30年关于临终关怀的研究表明，美国人死于 重症监护病房通常在生命的最后几天接受他们不会接受的维持生命的治疗 选择吧。其中一个原因是，作为代理决策者的家庭经常这样做 不了解病人的预后有多差。这个问题对双方都有负面影响 以病人为中心的临终关怀以及卫生保健资源的有效利用。 不幸的是，还没有实证研究指出哪些披露策略能有效地传达新闻。 对危重病人家属来说预后很差。 这项研究计划的长期目标是改善决策和沟通 高死亡风险或严重功能障碍的急性呼吸衰竭患者的预后 通过制定和测试循证干预措施。在拟议的研究中，我们 解决限制我们制定此类干预措施的能力的3个关键知识差距。目标1：实现 确定向危重病人家属有效传达预后信息的披露策略 病人。目标2：确定家庭对预后的误解程度 与生前长期使用维持生命的治疗有关。目标3：确定 医生和家庭对如何沟通预后的看法 严重疾病，以及改变医生在这方面的行为的障碍。 我们将利用ARDS临床研究网络的基础设施进行一项前瞻性队列研究 175例ALI急性呼吸衰竭患者预后沟通研究我们会 录音带医生-家庭会议和量化编码如何医生透露预后。我们 将在这些会议之后从医生和家庭那里获得定量的预后评估，以及 使用多变量方法确定有效传达预后信息的策略。我们会 与30名医生和60名家庭成员进行半结构化访谈，了解 披露预后不佳的消息。这项研究具有重要意义，因为它将提供新的信息 关于有效和可接受的沟通预后的方法以及对 关于预后的沟通不良在多大程度上与更多地使用维持生命有关 治疗。这项研究具有创新性，因为我们将定量和定性相结合， 由我们团队开发的新测量工具，以及一个多学科的研究团队来研究 关于预后的沟通。这些见解将使我们能够制定有针对性的干预措施 加强对急性呼吸衰竭患者的护理。项目叙事 在美国，20%的死亡发生在重症监护病房(ICU)或之后不久， 提供高科技、昂贵的护理服务的环境。家庭经常被要求 参与是否继续生命维持治疗的决定，但许多家庭 与临床医生沟通不足，不了解患者的预后， 使这些决定变得困难。拟议研究的结果将提供以下方面的信息 有效和可接受的策略，向危重患者家属披露预后不良的消息 生病的病人。这些见解将使我们能够开发一种干预措施，以改善关于 急性呼吸衰竭患者的预后。

Project Summary Abstract Despite recent advances in treatment, 30-40% of patients with acute lung injury (ALI) do not survive. Three decades of research on end-of-life care in the United States indicates that Americans dying in intensive care units often spend their final days receiving life sustaining treatment they would not choose. One reason for this is that family who are acting as surrogate decision-makers frequently do not understand how poor a patient's prognosis is. This problem has negative effects on both patient-centered care at the end-of-life and also on effective use of health care resources. Unfortunately, no empirical studies have addressed what disclosure strategies effectively convey news of a poor prognosis to family of critically ill patients. The long-term goal of this research program is to improve decision-making and communication about prognosis for patients with acute respiratory failure at high risk of death or severe functional impairment through the development and testing of evidence-based interventions. In the proposed research, we address 3 critical gaps in knowledge that limit our ability to develop such interventions. Aim 1: to identify disclosure strategies that effectively convey prognostic information to family of critically ill patients. Aim 2: to determine the extent to which families' misperceptions about prognosis are associated with prolonged use of life-sustaining treatments before death. Aim 3: to determine physicians' and families' perceptions about how prognosis should be communicated in the setting of critical illness, and the barriers to changing physicians' behavior in this regard. We will use the infrastructure of the ARDS Clinical Research Network to conduct a prospective cohort study of communication about prognosis for 175 patients with acute respiratory failure from ALI. We will audiotape physician-family conferences and quantitatively code how physicians disclose prognosis. We will elicit quantitative prognostic estimates from physicians and families after these conferences, and use multivariate methods to identify strategies that effectively convey prognostic information. We will conduct semi-structured interviews with 30 physicians and 60 family members regarding strategies to disclose news of a poor prognosis. The research is significant because it will provide new information about effective and acceptable methods to communicate about prognosis as well as an estimate of the extent to which poor communication about prognosis is associated with more use of life-sustaining treatment. This research is innovative because we will combine quantitative and qualitative methods, new measurement tools developed by our group, and a multidisciplinary research team to study communication about prognosis. These insights will allow us to develop a targeted intervention to improve the care of patients with acute respiratory failure. Project Narrative Twenty percent of deaths in the US occur in or shortly after a stay in an intensive care unit (ICU), a setting in which highly technological, expensive care is delivered. Families are often asked to participate in decisions about whether to continue life-sustaining treatment, but many families experience inadequate communication with clinicians and do not understand the patient's prognosis, making these decisions difficult. The results of the proposed study will provide information about effective and acceptable strategies to disclose news of a poor prognosis to family members of critically ill patients. These insights will allow us to develop an intervention to improve communication about prognosis for patients with acute respiratory failure.