Shared Decision Making to Improve Palliative Care in the Nursing Home

 描述(由申请人提供)：改善养老院姑息治疗的共同决策摘要65岁以上的美国人中有28%死于养老院。研究发现，养老院临终关怀的护理质量面临许多挑战。还有记录表明，家庭成员，特别是那些居住在远处的家庭成员，希望参与对其居民的照顾，家庭支持可以使居民受益。家庭成员在养老院环境中的决策参与改善了患有限制生命的疾病的居民的结局。共享决策是一个过程，其中医疗保健选择由医疗保健提供者和居民或居民的代理人(14，15)共同做出，通常是家庭成员。这项建议旨在促进家庭成员、患有限制生命的疾病的居民(他们没有参加临终关怀)和疗养院护理团队之间的SDM。我们的总体研究问题(RQ)问：在疗养院通过网络会议与SDM相关的家庭成员和患有生命限制性疾病的居民的结果在多大程度上？我们的总体假设(H)是，家庭成员、居民(如果可能)和熟练的疗养院工作人员通过网络会议进行的SDM将改善家庭成员和患有限制生命的疾病的居民的结局。我们提出探索性的混合方法，随机临床试验试点，以检验基于网络会议的共享决策对家庭成员的抑郁和负担以及养老院居民的痛苦的影响。我们寻求通过网络会议和共享决策将我们的临终关怀经验转化为适合姑息治疗的老年住院医生的疗养院环境。

 DESCRIPTION (provided by applicant): Shared Decision Making to Improve Palliative Care in the Nursing Home Abstract Twenty-eight percent of Americans over the age of 65 die in a nursing home. Research has found the quality of care of end-of-life care in nursing homes to have many challenges. It has also been documented that family members, especially those living at a distance, want to be involved in the care of their resident and family support can be beneficial to residents. Family members' involvement in decision-making in the nursing home setting improves outcomes for residents with life-limiting illnesses. Shared decision-making is a process wherein a healthcare choice is jointly made by a healthcare provider and a resident or resident's proxy (14, 15), often a family member. This proposal seeks to facilitate SDM among family members, residents with life- limiting illnesses (who are not enrolled in hospice), and the nursing home care team. Our overall research question (RQ) asks: To what extent are outcomes for family member and residents with life limiting illnesses associated with SDM via web-conferencing in the nursing home? Our overall hypothesis (H) is that SDM among family members, residents (when possible), and skilled nursing home staff via web- conferencing will improve outcomes for family members and residents with life-limiting illnesses. We propose exploratory mixed methods randomized clinical trial pilot to test the effect of shared decision making using web-based conferencing on the depression and burden of family members and the pain of nursing home residents. We seek to translate our hospice experience with web-conferencing and shared decision making into the nursing home setting with geriatric residents appropriate for palliative care.