Development of an Interactive Bioethics Training Module for Healthcare Providers Treating Patients Who Need Liver Transplant for Alcohol-associated Liver Disease

项目摘要 酒精相关性肝病（ALD）占美国肝脏相关死亡的近一半， 是肝移植（LT）的主要适应症。从历史上看，许多移植中心需要6个月的时间 酒精戒断期才有资格进行肝脏移植然而，患有ALD的患者亚组， 重度酒精性肝炎（SAH）不太可能存活6个月，3个月内死亡率为70-80%。A 6- 一个月的禁欲要求限制了SAH患者接受LT的机会。早期肝移植（ELT），或 在没有等待6个月禁欲期的情况下进行移植的做法，是唯一的生命- 为大多数SAH患者节省治疗。自十年前推出以来，SAH的ELT已经 引发了关于公平和负责任地分配稀缺捐赠器官问题的辩论。的医疗服务提供者 治疗ALD患者表达了对中心水平ELT的矛盾感受和道德困扰 实践，特别是与选择过程和移植后临床护理有关的实践。最新研究数据 在ELT没有解决医疗保健提供者的道德问题后，提供成功的患者结局的证据 痛苦，特别是与酒精使用障碍患者的污名化有关， 值得信赖或应得。医疗保健提供者的知觉图式和无意识的偏见是 持续存在的障碍，以扩大和维持ELT。 为了帮助在全国范围内扩大ELT，对医疗保健提供者和研究合作者的伦理培训是 needed.生物伦理教育干预措施已被证明可以减轻道德压力，提高复原力， 并赋予医护人员行使道德代理权的权力。我们将开发一种新颖的互动式培训 一个模块，将关键的生物伦理学概念置于真实的临床实践中，并教授伦理学基础 推理，以帮助医疗保健提供者导航与ELT相关的道德困扰。我们将使用基于设计的 （a）生物伦理学基础， 伦理推理及其在ELT临床情景中的应用B）自我反思练习， 无意识的偏见和c）针对学习者的道德困境的可选择的教学途径。的 培训模块将是共享资源的更大奋进的一部分，包括道德框架（如 在父母奖概述）和教育材料，为全国移植中心。我们设想 模块是一个系列的第一个，最终在一个全面的和可定制的在线生物伦理学 课程。

PROJECT SUMMARY Alcohol-associated liver disease (ALD) accounts for nearly half of liver-related deaths in the United States and is the leading indication for liver transplant (LT). Historically, many transplant centers have required a 6-month alcohol abstinence period to qualify for a liver transplant. However, the subset of patients with ALD who have severe alcoholic hepatitis (SAH) are unlikely to survive 6 months, with 70-80% mortality in 3 months. A 6- month abstinence requirement limits access to LT for patients with SAH. Early liver transplantation (ELT), or the practice of proceeding with a transplant without waiting for a 6-month abstinence period, is the only life- saving treatment available for most patients with SAH. Since its introduction a decade ago, ELT for SAH has sparked debate on issues of fair and responsible allocation of scarce donor organs. Healthcare providers who treat patients with ALD have expressed conflicting feelings and moral distress about center-level ELT practices, particularly related to the selection process and post-transplant clinical care. Recent research data providing evidence of successful patient outcomes after ELT have not resolved healthcare providers’ moral distress, especially related to stigmatization of patients with alcohol use disorder and concerns about trustworthiness or deservingness. Healthcare providers’ perceptual schemas and unconscious biases are persistent barriers to the expansion and sustainment of ELT. To aid in the expansion of ELT nationally, ethics training for healthcare providers and research collaborators is needed. Bioethics educational interventions have been shown to alleviate moral distress, increase resilience, and empower healthcare workers to exercise moral agency. We will develop a novel, interactive training module that situates key bioethics concepts within real clinical practice and teaches foundations of ethical reasoning to help healthcare providers navigate moral distress related to ELT. We will use design-based research methodology to create an online training module that will include a) foundations of bioethics and ethical reasoning and their application to clinical scenarios in ELT b) self-reflexive exercises to examine unconscious biases and c) selectable instructional pathways tailored to the learner’s moral distress. The training module will be part of a larger endeavor to share resources, including an ethical framework (as outlined in the parent award) and educational materials, for transplant centers nationally. We envision this module to be the first in a series, culminating in a comprehensive and customizable online bioethics curriculum.