Improving Surrogate/Clinician Communication: Validation of the Family Inpatient C

描述(申请人提供)：随着人口老龄化，越来越多的住院老年人将需要家庭成员和其他代理人的帮助来为他们做出医疗决定。有证据表明，临床医生和代孕医生之间的沟通往往很差，代孕决策者在住院期间和之后经历了高度的痛苦，患者有时接受的治疗无效或不受欢迎。我们的研究小组提出，临床医生和代理人之间的沟通质量提高了患者和他们的代理人的决策质量和结果。然而，我们不知道哪些沟通因素对代孕者最重要，因此应该成为未来干预的重点，我们对沟通影响患者和代孕者结局的机制了解有限。为了更好地了解这些问题，我们需要一种高质量的工具来评估医院环境中代理医生/临床医生的沟通和决策。据我们所知，目前还没有经过充分验证的工具来实现这一目的。目前的R01提案将验证一种新的工具，以衡量医院环境中代理决策者和临床医生之间的沟通质量，并将检查这一衡量标准与决策质量、代理痛苦和患者结果之间的关系。这项名为家庭住院患者沟通调查的新措施考察了我们在早期工作中发现的几个沟通元素，这些元素对决策特别重要，例如情感支持和频繁的沟通。我们已经起草了该文书，进行了专家审查并进行了初步试验。拟议的R01研究将进行关键的下一步，与印第安纳波利斯地区3家不同医院的代理决策者一起验证该工具，包括一家城市公立医院、一家三级转诊中心和一家郊区社区医院。我们还将管理决策质量、代孕结果(如痛苦和抑郁)和患者护理结果的其他经过充分验证的衡量标准，并将检查沟通质量、决策质量以及患者和代孕结果之间的关系。我们汇集了一批在老年病学、伦理学、护理和心理测量学方面具有专业知识的不同研究人员。研究小组将由临床医生咨询小组提供建议，其中包括ICU医生、一名社会工作者和一名护士，以就研究在临床环境中的实施提供建议。目前的研究结果将对制定干预措施以改善医院的沟通和决策至关重要。这项研究议程的长期目标是提高住院患者的决策质量，并改善必须为患者做出艰难选择的代理人的痛苦。

DESCRIPTION (provided by applicant): As the population ages, a growing number of hospitalized older adults will require the assistance of family members and other surrogates to make medical decisions for them. There is evidence that communication between clinicians and surrogates is often poor, that surrogate decision makers experience high degrees of distress during and after hospitalization, and that patients sometimes receive care that is ineffective or unwanted. Our research group has proposed that the quality of communication between clinicians and surrogates improves both the quality of decision making and outcomes for both patients and their surrogates. However, we do not know which elements of communication are most important to the surrogates and should therefore be the focus of future intervention and we have a limited understanding of the mechanisms by which communication impacts outcomes for patients and surrogates. To gain a better understanding of these issues, we need a high quality instrument to assess surrogate/clinician communication and decision making in the hospital setting. To our knowledge, there is no well-validated instrument for this purpose. The current R01 proposal will validate a new instrument to measure the quality of communication between surrogate decision makers and clinicians in the hospital setting and will examine relationships between this measure and decision quality, surrogate distress and patient outcomes. This new measure, the Family Inpatient Communication Survey, examines several elements of communication that we have identified in our earlier work to be especially important for decision making, such as emotional support and frequent communication. We have drafted the instrument, conducted expert review and pilot tested it. The proposed R01 study will conduct the essential next step, validating the instrument with surrogate decision makers from 3 diverse hospitals in the Indianapolis area, including an urban public hospital, a tertiary referral center, and a suburban community hospital. We will also administer other well-validated measures of decision quality, surrogate outcomes (such as distress and depression), and patient care outcomes and will examine the relationships between communication quality, decision making quality, and patient and surrogate outcomes. We have assembled a diverse group of investigators with expertise in geriatrics, ethics, nursing and psychometrics. The research team will be advised by a Clinician Advisory Panel, including ICU physicians, a social worker and a nurse, to advise on the implementation of the study in the clinical setting. Findings from the current research will be crucial in the development of an intervention to improve communication and decision making in the hospital. The long term goal of this research agenda is to improve the quality of decisions for hospitalized patients and to improve the distress of surrogates who must make difficult choices for patients.