Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Clinically Ill Older Adults at High Risk of Death or Severe Disability - Supplement

摘要 美国国家医学研究院已确定改善临床医生的严重疾病 沟通技能(SICS)作为一个优先领域，在接近尾声时改善患者和家庭结果 生活的一部分。对于中到重度阿尔茨海默病住院患者来说，SICS尤其重要 疾病或相关痴呆症(ADRD)，因为：1)患者的偏好在以下方面存在很大差异 在这种情况下的护理目标；以及2)住院通常预示着健康轨迹的恶化 级联再入院和功能衰退，因此提供了一个参与 护理对话的强大目标。然而，实现广泛的 在这方面对住院的ADRD患者的护理的改善是缺乏可扩展的、 经验验证的方法，帮助临床医生获得所需的复杂沟通技能 让患者和家属参与医院环境中护理目标的讨论。 这种补充剂建立在父母R01的基础上，是危重老年患者的随机对照试验 评估由姑息疗法提供的护理目标对话的干预效果 护理(PC)专家，以改善患者和家庭护理人员的结果。这两个国家的广泛关注焦点 Parent R01和这份ADRD补充资料是关于照顾者支持和以患者为中心的护理，通过 增强了临床医生-患者-护理人员的沟通。鉴于个人电脑的劳动力短缺 专家，提高非个人计算机专家的技能，这是补充提案的目标， 是提高住院ADRD患者护理质量的关键战略。 我们的目标是创建和传播一种技术增强的干预措施，既 可扩展和经验式验证，可帮助医院医生和高级实践 提供商(应用程序)获得有效开展护理目标对话所需的技能 住院的ADRD患者及其家属。因此，在目标1中，我们将使用名义群 让不同利益攸关方小组参与构建技术增强型安全倡议的进程 临床医生对ADRD患者的干预。在目标2中，我们将进行单臂试验 评估SICS的可行性、可接受性和有效性(即，技能获得)的试验 干预。 拟议的工作将产生很大的影响，因为它将产生所需的初步数据 对于成功的R01应用程序，执行RCT以确定可扩展SICS的影响 ADRD住院患者及其照顾者结局的干预。该项目是 创新，因为它寻求为临床医生开发第一个经经验验证的SICS干预 利用技术实现高可伸缩性的ADRD患者。这项工作在中国是可行的 因为我们是一支由资深调查人员组成的团队，他们坚定地致力于 改善ADRD患者和照顾者的结局。

ABSTRACT The National Academy of Medicine has identified improving clinicians’ serious illness communication skills (SICS) as a priority area to improve patient and family outcomes near the end of life. SICS are particularly important for hospitalized patients with moderate-to-severe Alzheimer’s disease or related dementias (ADRD) because: 1) patients’ preferences vary substantially regarding goals of care in this context; and 2) hospitalization often signals a worsening health trajectory with cascading readmissions and functional decline, and therefore presents an opportunity to engage in robust goals of care conversations. However, a critical barrier to achieving widespread improvements in this aspect of care for hospitalized ADRD patients is the absence of a scalable, empirically-validated way to help clinicians acquire the complex communication skills needed to engage patients and families in goals of care discussions in the hospital setting. The parent R01 on which this supplement builds is an RCT among critically ill older patients assessing the efficacy of an intervention involving goals-of-care conversations delivered by palliative care (PC) specialists to improve patient and family caregiver outcomes. The broad focus of both the parent R01 and this ADRD supplement is on caregiver support and patient-centered care through enhanced clinician-patient-caregiver communication. In light of the workforce shortages for PC specialists, improving the skills of non-PC specialists, which is the goal of the supplement proposal, is a critical strategy to increase care quality for hospitalized ADRD patients. Our goal is to create and disseminate a technology-enhanced intervention that is both scalable and empirically-validated to help hospital-based physicians and advanced practice providers (APPs) acquire the skills needed to effectively conduct goals-of-care conversations for hospitalized patients with ADRD and their families. Therefore, in Aim 1, we will use a nominal group process to engage a diverse stakeholder panel in the construction of the technology-enhanced SICS intervention for clinicians treating patients with ADRD. In Aim 2, we will conduct a single-arm pilot trial to evaluate the feasibility, acceptability, and efficacy (i.e., skills acquisition) of the SICS intervention. The proposed work will have high impact because it will yield the preliminary data needed for a successful R01 application to conduct an RCT to determine the impact of the scalable SICS intervention on the outcomes of hospitalized patients with ADRD and their caregivers. The project is innovative because it seeks to develop the first empirically-validated SICS intervention for clinicians of patients with ADRD that leverages technology to achieve high scalability. The work is feasible in our hands because we are a team of established investigators with a strong commitment to improving patient and caregiver outcomes in ADRD.