Building Resilience In SKilled nursing facilities (BRISK): Development and Pilot Testing of a Dyadic Intervention for Psychological Distress in Post-Acute Skilled Nursing Care

背景：两名患者在熟练护理机构(SNF)停留的时间都面临着巨大的心理压力。 和家庭护理伙伴(CP)，这可能对康复以及长期健康和心理产生负面影响 结果。这些后果可能在社会经济上处于不利地位的患者(即双重资格患者)中放大 受益者)和他们的CP，他们经历了多种健康差距。二元心理干预促进应对 改善患者和CP的短期痛苦和降低慢性心理症状风险的技能，但 未在SNF中进行测试。为了解决这一局限，并使该领域朝着改善SNF的心理护理的方向发展，我 将开发并试行“在熟练护理设施中建立复原力”(BRISK)，这是一项旨在减少 社会经济困难患者和CP在急性三叉神经痛后住院期间的心理困扰。特定的 目标和研究设计：(1)通过进行半结构化，迭代地开发具有多层次利益相关者投入的快速开发 采访多达20名患者-CP二元组和4个焦点小组与SNF临床和领导人员(NIH模型1a阶段)； (2)通过对5个患者-CP二元组和退出访谈进行单臂开放试点研究，细化和优化BRISK 与5名SNF员工一起(NIH模型1a阶段)；以及(3)通过进行 先导组随机对照试验，患者-CP双联完成快速(N=30个双联)或最小增强 常规护理(N=20个二联体)在3个SNF(NIH阶段模型1b)。一个多元化的利益相关者咨询委员会将在 获奖期用于协作指导干预措施的开发和改进，以增强相关性和现实世界 采用潜力旺盛。培训：我已经制定了一个严格的培训计划，旨在支持研究目标 和这项建议的最终目标，以及帮助我开始我的职业生涯作为一名独立的以患者为中心的调查员 长期的职业目标，改善对社会经济弱势患者和家庭的心理护理。 具体的培训目标是：(1)发展干预措施发展和优化的技能；(2)获得以下技能 临床试验研究，包括统计分析，在SNF中使用DUAD；以及(3)获得研究技能，使用 在社会经济上处于不利地位的老年人和家庭，其目标是促进健康公平。这项研究 马萨诸塞州总医院和哈佛医学院的环境以及我的多学科指导团队 拥有不同和互补的专门知识领域将有助于确保成功实现培训目标。影响： 我是一名临床老年心理学家，在住院、急诊和长期护理环境中拥有专业知识。我的终极使命是 开发一种可行的、可扩展的、可持续的心理干预措施，以改善符合双重条件的患者的护理 和他们的CP接受急性SNF后护理。这份K23提案中概述的研究和培训目标将提供 为未来的临床试验奠定基础，以测试其疗效--有效性，并最终推广和实施 社会经济上处于不利地位的患者-CP二人组在SNF接受急性后护理，这是一种高度需要和不足的- 研究了人口。这项工作与NIA提高应对能力和减少照顾者、家庭、 和患者压力(战略目标C；目标C-4)和NIA优先人群。

Background: The timing of a skilled nursing facility (SNF) stay is met with significant psychological stress for both patients and family care-partners (CPs), which can negatively impact recovery as well as long-term health and psychological outcomes. These consequences may be magnified among socioeconomically disadvantaged patients (i.e., dual-eligible beneficiaries) and their CPs, who experience multiple health disparities. Dyadic psychological interventions promote coping skills to improve short-term distress and reduce the risk of chronic psychological symptoms for both patients and CPs, but are untested in SNFs. To address this limitation and to progress the field toward improving psychological care in SNFs, I will develop and pilot “Building Resilience In SKilled nursing facilities” (BRISK), a dyadic intervention designed to reduce psychological distress among socioeconomically disadvantaged patients and CPs during a post-acute SNF stay. Specific aims and research design: (1) iteratively develop BRISK with multi-level stakeholder input by conducting semi-structured interviews with up to 20 patient-CP dyads and 4 focus groups with SNF clinical and leadership staff (NIH Model Stage 1a); (2) refine and optimize BRISK by conducting a single-arm open pilot study with 5 patient-CP dyads and exit interviews with 5 SNF staff (NIH Model Stage 1a); and (3) test the feasibility, acceptability, and fidelity of BRISK by conducting a pilot cluster randomized controlled trial with patient-CP dyads completing BRISK (N=30 dyads) or minimally enhanced usual care (N=20 dyads) in 3 SNFs (NIH Stage Model 1b). A diverse stakeholder advisory council will convene throughout the award period to collaboratively guide intervention development and refinements to enhance the relevance and real-world adoption potential of BRISK. Training: I have developed a rigorous training plan designed to support the research aims and end goal of this proposal, as well as help me launch my career as an independent patient-oriented investigator with the long-term career goal of improving psychological care for socioeconomically disadvantaged patients and families in SNFs. The specific training goals are to: (1) develop skills in intervention development and optimization; (2) acquire skills for clinical trials research, including statistical analysis, with dyads in SNFs; and (3) acquire skills for research with socioeconomically disadvantaged older adults and families, with the goal of promoting health equity. The research environments at Massachusetts General Hospital and Harvard Medical as well as my multidisciplinary mentorship team with distinct and complementary areas of expertise will help ensure the successful achievement of training goals. Impact: I am a clinical geropsychologist with expertise in residential post-acute and long-term care settings. My ultimate mission is to develop a feasible, scalable, and sustainable psychological intervention that improve care among dual-eligible patients and their CPs receiving post-acute SNF care. The research and training goals outlined in this K23 proposal will provide the foundation for future clinical trials to test the efficacy-effectiveness and, eventually, dissemination and implementation of BRISK with socioeconomically disadvantaged patient-CP dyads receiving post-acute care in SNFs, a high-need and under- studied population. This work is well aligned with NIA's goal of improving coping ability and reducing caregiver, family, and patient stress (Strategic Goal C; Objective C-4) with a NIA priority population.