Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory Failure

摘要 在以患者为导向的研究中，这个职业中期研究者奖的目标是提高以下能力： 博士道格拉斯白色培训，指导和支持临床科学家的职业发展，重点是 开发和测试干预措施，以改善残疾患者的替代决策， 晚期呼吸衰竭急性呼吸衰竭和预后不良的患者经常接受 接近生命末期的密集、繁重的治疗与其价值观不一致， 喜好这是一个重要的公共卫生问题，因为1）以病人为中心的护理接近年底， 生命是伦理和人道关怀的一个核心方面，2）在生命即将结束时的过度治疗有助于 在美国，接近生命尽头的医疗费用不成比例。 虽然这些问题有充分的文献记载，但很少有基于证据的干预措施来改善患者的预后。 解决这一问题需要具有决策科学专门知识的科学家的合作， 组织行为学和卫生服务研究。白色医生非常适合领导 这些努力他是一名职业中期的研究人员，拥有一个成熟的、由NIH资助的代孕研究项目。 急性呼吸衰竭的诊断他在以下方面有着广泛的成功指导记录： 以病人为中心的研究。他组建了一个由资深科学家和合作者组成的团队， 建议的研究和指导计划。他将提高他作为导师的技能， 通过参加有针对性的职业发展活动， 科学和群体决策心理学。这个提案的科学目的是为了白色博士 和他的学员使用现有的数据和基础设施，他正在进行的R01开发新的线， 研究探索跨专业团队运作和群体决策的作用， 急性呼吸衰竭患者的预后。在目标1中，团队将进行混合 方法研究，以表征临床医生的态度和实际做法有关的跨专业团队 合作为晚期呼吸衰竭患者的代理人提供决策支持（Aim 1a），然后进行探索性分析，检查团队运作和结果之间的关联 晚期呼吸衰竭患者（目标1b）。在目标2中，他们将使用 存在关于ICU护理目标的录音临床医生家庭会议，以确定是否 以及临床医生如何从代理人那里引出无行为能力患者的价值观和偏好（目标2a）， 然后进行探索性分析，检查与患者结局的相关性（目标2b）。在一起， 这些科学目标和职业发展活动将扩大白色博士的能力，培养下一个 培养以患者为导向的研究人员，制定干预措施，以改善替代决策 对于晚期呼吸衰竭的病人来说

ABSTRACT The goal of this Midcareer Investigator Award in Patient-Oriented Research is to enhance the ability of Dr. Douglas White to train, mentor, and support the career development of clinician-scientists focused on developing and testing interventions to improve surrogate decision making for incapacitated patients with advanced respiratory failure. Patients with acute respiratory failure and a poor prognosis often receive intensive, burdensome treatments near the end of life that are inconsistent with their values and preferences. This is an important public health problem because 1) patient-centered care near the end of life is a central aspect of ethical, humane care, and 2) overtreatment near the end of life contributes to the disproportionate costs of medical care near the end of life in the U.S. Although the scope of the problems is well documented, there are few evidence-based interventions to improve patient outcomes. Solving this problem will require the collaboration of scientists with expertise in decision science, organizational behavior, and health services research. Dr. White is extremely well positioned to lead these efforts. He is a midcareer investigator with a mature, NIH-funded program of research on surrogate decision making in acute respiratory failure. He has an extensive track record of successful mentoring in patient-oriented research. He has assembled a team of senior scientists and collaborators to accomplish the proposed research and mentoring plan. He will increase his skills as a mentor and expand his scientific expertise by participating in targeted career development activities in mentoring, organizational science, and the psychology of group decision making. The scientific goal of this proposal is for Dr. White and his mentees to use the existing data and infrastructure of his ongoing R01s to develop new lines of research exploring the roles of interprofessional team functioning and group decision making on outcomes for incapacitated patients with acute respiratory failure. In Aim 1 the team will conduct a mixed methods study to characterize clinicians’ attitudes and actual practices related to interprofessional team collaboration in providing decision support to surrogates of patients with advanced respiratory failure (Aim 1a), then conduct exploratory analyses examining associations between team functioning and outcomes of patients with advanced respiratory failure (Aim 1b). In Aim 2 they will use the largest dataset in existence of audiorecorded clinician-family conferences about goals of care in ICUs to determine whether and how clinicians elicit the values and preferences of incapacitated patients from surrogates (Aim 2a), then conduct exploratory analyses examining associations with patient outcomes (Aim 2b). Together, these scientific aims and career development activities will expand Dr. White’s ability to train the next generation of patient-oriented researchers in developing interventions to improve surrogate decision making for patients with advanced respiratory failure.