Interactive Decision Aid for Advance Care Planning

描述(由申请人提供)：特里·夏沃等广为人知的案例提高了人们对提前护理计划的重要性的认识。然而，虽然通过联邦法律和法规来促进，但重点是完成预先指令(AD)文件，而不是确保尊重临终关怀优先选择所必需的知情决策和沟通。事实上，几乎没有证据表明，单独患有AD会在生命结束时带来改善或首选的护理。因此，先行指令(或生前遗嘱)作为一种公共政策工具被称为失败的社会政策。最近，人们的注意力重新转向了提前护理计划的过程。作为回应，我们提出了一种创新的交互式决策辅助工具，不仅可以帮助个人在生命末期做出关于首选治疗的明智决定，而且还可以将这些偏好和决定传达给他们的医疗保健提供者和家人。该计划将使用视频来提供几种晚期健康状态的可视描述和生命末期护理治疗的选项，并建立与卫生保健提供者和家庭关于护理偏好的有效沟通模式。完成AD和医疗代理的模板文档将立即或稍后提供完成。该程序将在平板电脑上展示，具有基于网络的能力，允许将这些文件包括在电子病历中。没有其他可用的程序在便携式平台上提供所有这些功能，以最大限度地提高和促进在各种环境中的使用。第一阶段的具体目标是：1)为整个程序开发内容大纲；2)开发程序的设计和格式；3)为一个部分程序模块开发脚本和故事板；4)开发这一部分(原型)以在平板电脑上交付；5)对原型进行可行性评估；以及6)在第二阶段为完整程序的生产制定计划和时间表。项目叙事高级护理计划不仅仅是签署文档。这是一个过程。这一交互式决策助手不仅将帮助个人在生命末期做出关于首选治疗的明智决定，而且还将向他们的医疗保健提供者和家人传达这些偏好和决定。该节目将使用视频呈现几种晚期健康状态和临终关怀治疗选项，并模拟与医疗保健提供者和家庭就护理偏好进行沟通。

DESCRIPTION (provided by applicant): Widely publicized cases such as Terri Schiavo have raised awareness of the importance of advance care planning. However, while promoted through federal law and regulation, emphasis is placed on the completion of an advance directive (AD) document rather than on the informed decision making and communication essential to ensuring that end of life care preferences are honored. In fact, there is little evidence that having an AD alone results in improved or preferred care at the end of life. Consequently, the advance directive (or living will) as a public policy instrument has been called a failed social policy. Recently attention has been redirected to the process of advance care planning. In response, we propose an innovative interactive decision aid to help individuals not only make informed decisions about preferred treatment at end of life but also to communicate these preferences and decisions to their health care providers and families. The program will use video to provide visual depiction of several advance stage health states and options for end of life care treatment and to model effective communication with health care providers and family about preferences for care. Template documents for completing an AD and health care proxy will be provided for completion immediately or at a later date. The program will be presented on a tablet-PC, with the capability to be web-based allowing the inclusion of these documents in an electronic medical record. No other available program offers all of these features on a portable platform to maximize and facilitate use across a range of settings The Specific Aims of Phase I are to: 1) develop a content outline for the full program; 2) develop the design and format of the program; 3) develop a script and storyboard for one partial program module; 4) develop this section (prototype) for delivery on a tablet PC; 5) conduct a feasibility evaluation of the prototype; and 6) develop a plan and schedule for production of the full-length program in Phase II. PROJECT NARRATIVE Advance care planning is more than signing a document. It is a process. This interactive decision aide will help individuals not only make informed decisions about preferred treatment at end of life but also to communicate these preferences and decisions to their health care providers and families. The program will use video to present several advance stage health states and options for end of life care treatment and to model communication with health care providers and family about preferences for care.