A communication tool to assist severely injured older adults

摘要 每年有近50万老年人因创伤入院。对于许多严重 对于受伤的患者，跌倒或车祸造成的伤害是导致20%住院和40%住院的终末事件， 年死亡率。严重的创伤性损伤会给老年患者带来他们不想要的积极治疗的负担 因为这些治疗方法在延长患者生存期或恢复患者生活质量方面的能力有限 他们受伤前的情况考虑到治疗负担和预后不良，严重受伤的老年人 将受益于决策支持干预，促进抢先体验姑息治疗，这可以 减少不必要的侵入性手术，解决症状并明确目标。这一建议有助于长期- 改善与家人一起面临决策的老年人沟通的长期目标 因此他们的治疗选择反映了个人的偏好和目标。 “一个帮助严重受伤的老年人的沟通工具”是一个为期两年的R21， 特别是PA-13-355，“开发和评估用于重病患者的创新决策辅助工具” 老年患者和/或他们的代理决策者。我们的研究团队开发了一种新的 一种称为“最佳情况/最坏情况”的交流工具，采用叙述和图形辅助来说明选项， 表达不确定性，并在患者基础健康的背景下描述结果。我们有 证明外科医生可以学习使用该工具，并且在急性护理环境中患者可以接受， 我们现在需要调整并测试这个工具，以便与最有可能受益的患者群体一起使用 抢先体验姑息治疗。该项目有两个目标：目标1，适应最佳情况/最差情况 目的2，测试教导创伤护理提供者使用 最佳/最差情况工具。 该奖项将产生一个决策干预用于创伤设置，知识， 干预对沟通的影响，以及未来大规模疗效研究的初步数据。的 这项研究是创新的，因为它测试了一种新颖的、有理论基础的干预措施， 家庭最有可能受益。这项研究意义重大，因为如果干预有效， 提供了一种低成本的策略，以改善与老年创伤患者家属的沟通。我们 我们有能力在这个奖项的范围内实现我们的目标，因为我们正在调整现有的 干预和评估一个重要的中间成果-沟通质量- 可能影响下游的健康结果。

ABSTRACT Nearly 500,000 older adults are admitted to the hospital annually with traumatic injury. For many severely injured patients, injury from a fall or car crash is a terminal event leading to a 20% in-hospital and 40% one- year mortality. Severe traumatic injury can burden older patients with aggressive treatments they do not want because these treatments often have limited ability to prolong survival or return patients to the quality of life they had before their injury. Given the burdens of treatment and poor prognosis, severely injured older adults would benefit from decision support interventions that facilitate early access to palliative care, which can reduce unwanted invasive procedures, address symptoms and clarify goals. This proposal serves the long- term goal of improving communication for older adults who, together with their family, are facing decisions about invasive treatments—so that their treatment choices reflect personal preferences and goals. “A communication tool to assist severely injured older adults” is a two-year R21 that responds specifically to PA-13-355 for “development and evaluation of innovative decision aids for seriously ill older patients and/or their proxy decision makers.” Our research team has developed a novel communication tool called “best case/worst case” that employs narrative and a graphic aid to illustrate options, express uncertainty and describe outcomes within the context of the patient's underlying health. We have demonstrated that surgeons can learn to use the tool and it is acceptable to patients in the acute care setting, we now need to adapt and test this tool for use with a cohort of patients who are most likely to benefit from early access to palliative care. This project has two aims: Aim 1, to adapt the best case/worst case communication tool to the trauma setting; Aim 2, to test the effect of teaching trauma care providers to use the best case/worst case tool on the quality of communication. This award will produce a decision-making intervention for use in the trauma setting, knowledge about the effect of the intervention on communication, and preliminary data for a future large-scale efficacy study. The research is innovative because it tests a novel, theoretically grounded intervention in a setting where patients and families are most likely to benefit. The research is significant because if the intervention is effective, it offers a low-cost strategy to improve communication with families of older patients with traumatic injury. We are well positioned to achieve our objectives within the scope of this award because we are adapting an existing intervention and evaluating an important intermediate outcome —quality of communication— with high potential to impact downstream health outcomes.