Feasibility testing of a decision aid to support shared decision making about inv

描述(申请人提供)：慢性阻塞性肺疾病(COPD)是美国第三大死因。65岁以上的人患慢性阻塞性肺病的负担最重，尤其是病情更严重的人。2急性呼吸衰竭是重症慢性阻塞性肺疾病患者住院和死亡的常见原因。急性呼吸衰竭患者的治疗选择之一是有创机械通气(“呼吸机”)。然而，如果患者存活下来，这种治疗会出现相关的并发症，并可能导致较差的生活质量。患有严重COPD的患者通常不知道与有创机械通气相关的权衡，因此面临接受与他们的偏好不一致的默认危重护理的风险。S假设，如果重症慢性阻塞性肺疾病患者在危重疾病发生前就被有效地告知了他们的个性化预后和有创机械通气治疗的可能权衡，他们将更有准备地做出危重护理决策，并且更有可能接受符合偏好的护理。这项研究旨在更好地向重症COPD患者和替代决策者通报急性呼吸衰竭的治疗选择和危重疾病之前的个性化结果。建议的方法是支持医患沟通和共享关于机械通气的决策和提前护理计划。建议的工具是一个简短的、基于网络的决策辅助工具--“InformmedTogether”。“Informmed Together”整合了有创和无创机械通气治疗重症COPD的有效性比较研究，以及以患者为中心的语言，医生可以使用这些语言来传达选择和结果，并引出患者的偏好。“Informmed Together”决策援助针对的是临床医生在高级护理计划方面的沟通和共享决策障碍，其中包括：缺乏对替代治疗方案的预后估计，缺乏时间，以及与患者沟通困难，特别是在预后不佳的情况下。它还针对患者做出明智决策的几个障碍，包括：缺乏预后信息；缺乏考虑权衡和偏好的机会；以及拒绝/不适讨论死亡。决策辅助设计将遵循国际患者决策辅助标准，并将遵循人为因素工程原则(用于加强人与系统之间的交互，以优化性能、提高易学性、将错误降至最低并提高安全性的科学学科)。具体目标是：(1)修订一份简短的决策辅助文件(“InformmedTogether”)，该文件支持医生和严重COPD患者就急性呼吸衰竭的治疗共同决策。(2)测试决策辅助工具“信息融合”的质量和可行性。 实施。这项工作将支持将研究结果传达给老龄和老年人，旨在改善这一群体的知情决策和符合偏好的护理，实现国家老龄研究所的使命之一。

DESCRIPTION (provided by applicant): Chronic Obstructive lung disease (COPD) is the third leading cause of death in the United States. People over age 65 have the highest burden of COPD, especially the more advanced forms of the disease.1, 2 acute respiratory failures is a common cause of hospitalization and death in patients with severe COPD. One of the treatment choices for patients with acute respiratory failure is invasive mechanical ventilation (a "breathin machine"). However, if patients survive, this treatment has associated complications and may lead to a poor quality of life. Patients with severe COPD are often uninformed about the tradeoffs associated with invasive mechanical ventilation and therefore at risk of receiving default critical care that is not congruent with their preferences. This proposal"s hypothesizes that if that patients with severe COPD are effectively informed in advance of critical illness abou their personalized prognoses and likely tradeoffs of invasive mechanical ventilation treatment, they will be more prepared to make critical care decisions and more likely to receive preference-congruent care. The research seeks to better inform severe COPD patients and surrogate decision makers about treatment options for acute respiratory failure and personalized outcomes in advance of critical illness. The proposed method is to support doctor-patient communication and shared decision making about mechanical ventilation and advance care planning. The tool proposed is a brief, web-based decision aid, "InformedTogether". "InformedTogether" integrates comparative effectiveness research on invasive versus noninvasive mechanical ventilation for severe COPD, with patient-centered language doctors can use to communicate choices and outcomes, and to elicit patients" preferences. The "InformedTogether" decision aid targets several clinician barriers to communication and shared decision making about advance care planning which include: a lack of prognostic estimates for alternative treatment options, a lack of time, and difficulty communicating with patients, especially when prognosis is poor. It also targets several patient barriers to informed decision making which include: lack of prognostic information; lack of opportunity to consider tradeoffs & preferences, and; denial/ discomfort discussing dying. The decision aid design will adhere to the International Patient Decision Aid Standards and will be guided by principles of Human Factors Engineering (the scientific discipline used to enhance the interaction between humans and systems to optimize performance, increase learnability, minimize error, and increase safety). The specific aims are: (1) To revise a brief, decision aid ('InformedTogether') which supports shared decision making between doctors and severe COPD patients about treatments for acute respiratory failure. (2) To test the decision aid 'InformedTogether' for quality and feasibility of implementation. This work will support communication of research results to aging and older people and aims to improve informed decision making and preference- congruent care in this population, meeting one of the missions of the National Institutes of Aging.