Avatar-Based Decision Support Technology for Surrogate Decision Makers

描述(由申请人提供)：任何家庭成员面临的最沉重的责任之一就是为受到决定性损害的亲人做出医疗保健决定。鉴于人口老龄化和治疗急性疾病的选择越来越多，大多数美国人将发现自己面临着承担亲属或朋友的代理决策者角色的巨大挑战。尽管家庭成员经常面临这种繁重的责任，但我们尚未找到有效的方法来支持他们的决策。该项目建立在已建立的决策支持框架和该团队先前在卫生技术方面的经验的基础上。我们的目标是使用严肃的游戏技术创建一种基于虚拟化身的交互式干预措施，为代理决策者提供决策支持，为出院后有关患者复苏和重新住院状态的决策做准备。这项研究的目的是开发和评估一种新的决策支持战略，如果被证明是有效的，可以广泛传播并提供给代理决策者，这些决策者面临着在他们认知受损的亲人的急性和慢性护理中所需的许多重要的卫生保健决策。该项目计划分两个阶段：第一阶段将包括创建、开发和设计一个互动的、基于化身的、个性化的电子程序，该程序将吸引家庭成员并为扮演代孕决策者的角色做好准备。第二阶段将是一项三臂随机临床试验，比较定制的、基于虚拟化身的模拟系统“电子代孕决策者资源和定制培训”(ESMARTT)与非定制的被动教育项目“电子护理家庭决策辅助”(ENHDA)和常规护理(UC)。通过聘请代理决策者作为决策支持策略的联合设计者和评估者，这一应用程序将生成将对临床实践和该领域未来研究方向产生重大影响的数据。

DESCRIPTION (provided by applicant): One of the most burdensome responsibilities faced by any family member is making health care decisions for a loved one who is decisionally impaired. Given the aging of the population and increasing options for treatment of acute illnesses, most Americans will find themselves facing this tremendous challenge of assuming the surrogate decision maker role for a relative or friend. Despite the frequency with which family members face this taxing responsibility, we have yet to identify effective ways to support them in decision making. This project builds on an established decision support framework and the team's prior experience with health technology. We aim to create an interactive, avatar-based, tailored intervention using serious gaming technology to deliver decision support to surrogate decision makers in preparation for post-discharge decisions about a patient's resuscitation and rehospitalization status. The purpose of this study is the development and evaluation of a novel decision support strategy that, if shown to be effective, can be widely disseminated and offered to surrogate decision makers facing the many significant health care decisions required in the acute and chronic care of their cognitively impaired loved one. The project is planned in two phases: Phase 1 will consist of the creation, development, and design of an interactive, avatar-based, individually tailored electronic program that will engage and prepare family members for the role of surrogate decision maker. Phase 2 will be a three-arm, randomized, clinical trial comparing the tailored, avatar-based simulation system, "electronic Surrogate Decision Maker Resources and Tailored Training" (eSMARTT) with a non-tailored passive educational program, "electronic Nursing Home Decision Aid" (eNHDA), and with usual care (UC). By engaging surrogate decision makers as co-designers and evaluators of decision support strategies, this application will generate data that will have a significant impact on clinical practice and the future direction of research in this area.