Adapting Advance Care Planning Tools for Permanent Supportive Housing Residents

项目摘要 背景：无家可归的人口正在老龄化，50岁以上的比例越来越大。人经历 慢性无家可归，定义为长期或多次无家可归的残疾状况， 加速老化和高死亡率。由于与卫生保健系统的相互作用支离破碎， 社会孤立，长期无家可归的老年人有很高的风险没有他们的愿望，医疗保健 记录或跟踪。先进的护理计划（ACP）旨在引起患者的医疗愿望;然而，老年人 无家可归的成年人患ACP的比率很低。长期以来，政府在政策上一直关注安置问题， 无家可归者进入永久支持性住房（PSH）。虽然PSH代表一种独特的设置， ACP，目前尚无ACP在PSH中的研究。我们的团队已经创建了易于使用、基于证据的ACP工具， 例如易于阅读预先指示（AD）和带有视频故事的基于网络的教育节目 （PrepareForYourCare.org）用于团体访问或与一对一的主持人。然而，这些ACP 干预措施需要适应PSH环境。该提案的目标是调整、试点和 证明基于证据的ACP干预措施对独特人群（以前为慢性 无家可归的老年人）在一个新的设置（PSH）。目标：我们将采用易于阅读的广告（目标1）， 参观指南（目标2）和一对一的辅导员指南（目标3），以满足老年人（≥ 50岁）的需求 PSH居民。然后，我们会试行经修改的机场核心计划措施，以评估推行机场核心计划的可行性 在PSH设置的干预措施，并获得有关干预和过程的反馈。(Aim 4）。方法：对 针对目标1-3，我们将为每个目标开展三个焦点小组，每个焦点小组有6-10名老年（≥ 50岁）PSH居民。我们将 应用行为改变轮（BCW）框架，该框架使用能力机会动机 行为（COM-B）模型来理解目标行为（即，非加太国家的参与）的背景下， 使用非加太干预措施，以及克服这些措施的战略。我们将进行主题内容分析， 确定克服这些障碍所需的调整，并创建其他材料以满足PSH 居民的需要。我们将根据这些输入调整材料和工艺。在目标4中，我们将评估 我们的招聘程序的可行性，我们的调查材料，以及小组访问和协调员干预。 我们将使用经过验证的问卷来评估满意度，并获得有关 干预措施和我们在PSH环境中的研究程序。由主要PSH领导人组成的社区咨询委员会， 住院医生和工作人员将与研究人员合作，指导研究。与NIH和公共卫生的相关性： 拟议的项目将开发ACP干预措施用于PSH，我们将在未来的R 01资助的 疗效随机试验。这些干预措施可能会减少ACP中以前慢性 无家可归的老年人

PROJECT ABSTRACT Background: The homeless population is aging, with increasing proportions over age 50. People experiencing chronic homelessness, defined as prolonged or multiple homeless episodes with a disabling condition, have accelerated aging and high rates of mortality. Due to fragmented interactions with the health care system and social isolation, chronically homeless older adults are at high risk of not having their wishes for medical care documented or followed. Advance care planning (ACP) aims to elicit patients' medical wishes; yet, older homeless adults have low rates of ACP. Significant policy attention has focused on rehousing chronically homeless people into Permanent Supportive Housing (PSH). While PSH represents a unique setting to initiate ACP, there are no studies of ACP in PSH. Our team has created easy-to-use, evidenced-based ACP tools, such as an easy-to-read advance directive (AD) and a web-based educational program with video stories (PrepareForYourCare.org) to be used in group visits or with a one-on-one facilitator. However, these ACP interventions require adaptation for PSH settings. The objective of this proposal is to adapt, pilot, and demonstrate the feasibility of evidenced-based ACP interventions for a unique population (formerly chronically homeless older adults) in a novel setting (PSH). Aims: We will adapt the easy-to-read AD (Aim 1), the group visit guide (Aim 2), and the one-on-one facilitator guide (Aim 3) to meet the needs of older (≥ 50 years of age) PSH residents. Then, we will pilot the adapted ACP interventions to assess the feasibility of delivering the ACP interventions in the PSH setting and obtain feedback on the intervention and processes. (Aim 4). Methods: In Aims 1-3, we will conduct three focus groups for each Aim, with 6-10 older (≥ 50) PSH residents each. We will apply the Behavior Change Wheel (BCW) framework, which uses the Capability Opportunity Motivation Behavior (COM-B) model to understand targeted behaviors (i.e., ACP engagement) in context, the barriers to use of the ACP interventions, and strategies to overcome them. We will conduct thematic content analysis to determine needed adaptations to overcome these barriers and create additional material to meet PSH residents' needs. We will adapt both materials and processes based on this input. In Aim 4, we will assess the feasibility of our recruitment procedures, our survey materials, and the group visit and facilitator interventions. We will assess satisfaction using validated questionnaires and obtain feedback about feasibility of the interventions and our study procedures in the PSH setting. A Community Advisory Board of key PSH leaders, residents and staff will work with the investigators to guide the study. Relevance to NIH and public health: The proposed project will develop ACP interventions for use in PSH, which we will test in a future R01-funded efficacy randomized trial. These interventions may reduce health disparities in ACP among formerly chronically homeless older adults.