Advancing the Conversations Helpful for Awareness of Illness Trajectory (CHAT) Intervention

项目摘要 射血分数保留性心力衰竭（HFpEF）是一种老年综合征， 与高症状负担、生活质量降低和5年生存率低相关 超过50%。然而，很少有HFpEF患者了解病情，其预期轨迹和/或预后。 这有几个重要的意义，正如我们的初步数据显示的那样：（1）33%的患者有既往病史， 因HFpEF住院患者不知道他们患有某种形式的心力衰竭;（2）症状负担高， 参与症状管理的程度较低;（3）高级护理计划（ACP）的利用率极低 在这个病人群体中。症状管理和ACP是姑息治疗的关键特征，但 姑息治疗要么在疾病末期使用，要么根本不使用。为了解决迫切需要改善的问题， 症状管理和ACP早于传统的疾病，我们开发了 有助于疾病意识轨迹（CHAT）干预的对话。这次干预是基于 自我决定理论，它概述了驾驶能力，自主性和相关性的重要性 行为改变CHAT将提供知识（能力），提高患者激活和自我效能 （自主性），并通过结合在线 面向患者的基于视频的模块，使用患者激活学习系统（帕尔斯）平台和健康 教练将通过在线模块指导患者，以促进积极参与。这一目标 建议是：（1）通过半 对患者、护理人员和医生进行结构化定性访谈，以及（2）对CHAT干预进行试点测试 可行性、可接受性和初步疗效通过一个试点随机对照试验。MPI Goyal和 Shen在HFpEF，实施科学，通信基础等专业领域具有互补性 干预措施和社会心理框架。研究人员团队还包括一个初级保健 一位在干预开发方面具有专业知识的医生，他还创建了帕尔斯，一位在以下方面具有专业知识的护士科学家： 心力衰竭自我护理和患者报告的结局，以及具有专业知识的老年病学家/姑息治疗专家 心力衰竭的决策和实施科学。长期目标是建立一个模型， 用于传达疾病轨迹，以促进患者积极参与症状管理（以及 改善生活质量）和参与ACP。该提案旨在超越传统的孤立做法， 护理，以解决需要“纳入姑息治疗的方法，对老龄化相关的条件，由医疗保健 不是姑息治疗专家的医生。”

PROJECT SUMMARY Heart failure with preserved ejection fraction (HFpEF) is a geriatric syndrome that disproportionately impacts older adults and is associated with high symptom burden, reduced quality of life, and a 5-year survival rate less than 50%. Yet, few patients with HFpEF understand the condition, its anticipated trajectory, and/or prognosis. This has several important implications, as our preliminary data show: (1) 33% of patients with a prior hospitalization for HFpEF are unaware that they have a form of heart failure; (2) symptom burden is high and engagement in symptom management is low; and (3) advanced care planning (ACP) is vastly underutilized among this patient population. Symptom management and ACP are key features of palliative care, but palliative care is either utilized at terminal disease stages or not at all. To address the urgent need to improve symptom management and ACP earlier in the disease than has traditionally been done, we developed the Conversations Helpful for Awareness of Illness Trajectory (CHAT) intervention. This intervention is grounded in self-determination theory, which outlines the importance of competence, autonomy, and relatedness in driving behavior change. CHAT will provide knowledge (competence), improve patient activation and self-efficacy (autonomy), and strengthen the patient-physician relationship (relatedness) through a combination of online patient-facing video-based modules using the Patient Activated Learning System (PALS) platform and a health coach who will guide patients through the online modules to promote active engagement. The objectives of this proposal are to: (1) refine the CHAT intervention by incorporating key stakeholders’ feedback through semi- structured qualitative interviews of patients, caregivers, and physicians, and (2) pilot test the CHAT intervention for feasibility, acceptability, and preliminary efficacy through a pilot randomized controlled trial. MPIs Goyal and Shen have complementary areas of expertise in HFpEF, implementation science, communication-based interventions, and social psychological frameworks. The investigator team also includes a primary care physician with expertise in intervention development who also created PALS, a nurse scientist with expertise in heart failure self-care and patient-reported outcomes, and a geriatrician/palliative care specialist with expertise in decision-making in heart failure and implementation science. The long-term objective is to develop a model for communicating illness trajectory to promote proactive patient engagement in managing symptoms (and improve QOL), and engagement in ACP. This proposal seeks to move beyond traditional siloed approaches of care to address the need to “incorporate palliative care approaches for aging-related conditions by healthcare practitioners who are not palliative care specialists.”