ENABLING ADVANCE DIRECTIVE COMPLETION BY RURAL ALABAMA VETERANS: A PILOT STUDY

描述（由申请人提供）： 使农村亚拉巴马退伍军人提前完成指令：试点研究的目的：这项试点研究的主要目的是收集有关护士支持的提前护理计划干预措施的未来大型全面疗效试验的可行性和完善方法的信息。该应用程序的第二个具体目标是发展护士首席研究员的研究技能，并推动她在VA内的独立护士调查员职业生涯。 目的：试点研究的目的是（1）测试招募、随机化和保留的可行性;（2）测试标准化护士支持的预先护理计划干预的可行性;（3）评估评估过程和数据收集程序的可行性;（4）评估退伍军人对干预及其预先指令决策的满意度;（5）评估护理人员支持的预先护理计划干预的初步效果。 背景资料：VHA的使命是为美国退伍军人的医疗保健需求服务，它采取了以退伍军人为中心的方法--这种方法不仅从医疗团队的需求评估开始，而且特别是从退伍军人对自己需求的评估开始。来自亚拉巴马退伍军人农村健康倡议研究的初步数据表明，大约30%的农村亚拉巴马退伍军人没有预先指示，并希望帮助完成一个。农村亚拉巴马退伍军人生活在非裔美国少数民族比例较高的县，教育水平较低，家庭贫困率高于美国人口的平均水平。先前的研究表明，提前指令完成率的差异可能与种族，收入水平和教育水平有关。VHA的研究重点包括解决少数民族医疗保健需求的挑战和医疗保健服务中出现的差距。虽然许多研究证明了教育和咨询在促进提前完成指令方面的有效性，但缺乏数据表明资源保守的干预措施对使农村和南部少数民族能够完成提前指令的有效性。 方法：一项前瞻性、随机、对照的初步研究。在塔斯卡卢萨退伍军人医疗中心接受护理的50名亚拉巴马退伍军人将被前瞻性地随机分配到护士支持的高级护理计划干预或护理。护士支持的预先护理计划干预是由注册护士提供的手动教育，支持和指导课程，包括有关风险，益处和特定选择的替代方案的信息。护理是与社会工作者的一次会议，他解释了什么是预先指令，并指导退伍军人完成预先指令文件的过程，而不提供有关风险，收益和特定选择的替代品的信息。将收集、分析和评价与招募、随机化和保留相关的数据;受试者完成研究;数据收集的完整性;退伍军人的满意度;以及干预的初步效果。 意义：本研究支持VHA提供以退伍军人为中心的护理的使命。它奠定了基础，以解决与提前完成指令有关的医疗保健差距。它提供了计划全面研究一个 具体的护士支持的提前护理计划干预，以促进农村亚拉巴马退伍军人提前完成指令。

DESCRIPTION (provided by applicant): Enabling Advance Directive Completion by Rural Alabama Veterans: A Pilot Study Aims: The primary aim of this pilot study is to gather information on the feasibility of and refine the methos relative to a future large full-scale efficacy trial of a Nurse-Supported Advance Care Planning Intervention. The secondary specific aim of this application is to develop the nurse principal investigator's research skills and advance her towards an independent nurse investigator career within VA. Objectives: The objectives of the pilot study are to (1) test the feasibility of recruitment, randomization, and retention; (2) test the feasibility of a standardized Nurse-Supported Advance Care Planning Intervention; (3) evaluate the feasibility of the assessment process and data collection procedures; (4) evaluate the Veterans' satisfaction with the intervention and their Advance Directive decisions; and (5) evaluate preliminary effects of the Nurse-Supported Advance Care Planning Intervention. Background: The VHA mission to serve the health care needs of America's veterans assumes a veteran-centered approach - one that evolves not only from the health team's assessment of needs, but especially one that begins with the veteran's assessment of his or her own needs. Preliminary data from the Alabama Veterans Rural Health Initiative study suggest that approximately 30% of rural Alabama veterans do not have an Advance Directive and want help completing one. Rural Alabama veterans live in counties with a higher percent of African American minorities, lower levels of education, and higher family poverty rates, than the average for the US population at large. Prior studies have demonstrated that disparities in Advance Directive completion rates may be related to race, level of income, and level of education. VHA research priorities include addressing the challenges of minority health care needs and the disparities that arise in healthcare delivery. Although many studies evidence the effectiveness of education and counseling in facilitating Advance Directive completion, data are lacking that demonstrate the efficacy of resource- conservative interventions to enable Advance Directive completion by rural, southern minorities. Methods: A prospective, randomized, controlled pilot study. Fifty rura Alabama veterans who receive care at the Tuscaloosa VA Medical Center will be prospectively randomized to either the Nurse-Supported Advance Care Planning Intervention or Care-as-Usual. The Nurse-Supported Advance Care Planning Intervention is a manualized education, support, and guidance session provided by a Registered Nurse that includes information about risks, benefits, and alternatives of specific choices. The Care-as-Usual is a session with the social worker who explains what the Advance Directive is, and guides the Veteran regarding the process of completing the Advance Directive document, without providing information about risks, benefits, and alternatives of specific choices. Data related to recruitment, randomization, and retention; study completion by subjects; completeness of data collection; Veterans' satisfaction; and preliminary effects of the intervention will be collected, analyzed, and evaluated. Significance: This study supports the VHA mission to provide Veteran-centered care. It lays the groundwork to address a health care disparity related to Advance Directive completion. It provides important information needed to plan a full study of the effectiveness of a specific Nurse-Supported Advance Care Planning Intervention to facilitate Advance Directive completion by rural Alabama Veterans.