视频游戏干预措施，以增加老年病医生与老年人之间的预先护理计划对话：一项阶梯式临床试验的研究方案。

Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial.

机构信息

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.

出版信息

BMJ Open. 2021 Mar 22;11(3):e045084. doi: 10.1136/bmjopen-2020-045084.

DOI:10.1136/bmjopen-2020-045084

PMID:33753443

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7986882/

Abstract

INTRODUCTION

Fewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.

METHODS AND ANALYSIS

We developed , a theory-based adventure video game, to modify physicians' attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy of for increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playing for at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.

ETHICS AND DISSEMINATION

Dartmouth's Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website. will be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.

TRIAL REGISTRATION NUMBER

NCT04557930.

摘要

简介

在美国，只有不到一半的人有书面的预先护理计划（ACP）。住院为医生提供了启动 ACP 对话的机会。尽管有专家建议，但医院内的医生（医院医生）并没有常规地进行这些对话，而是将其保留给重症患者。本研究的目的是测试一种新的行为干预措施对在从 220 家美国急症护理医院中抽取的分层随机样本中的医院医生进行 ACP 对话的发生率的影响，这些医院由一家全国性的急症护理医师实践机构提供人员支持，该机构正在进行 ACP 质量改进计划。

方法和分析

我们开发了一款基于理论的冒险视频游戏，以改变医生对 ACP 对话的态度，并提高他们进行对话的积极性。计划中的研究是一项实用的分步楔形交叉 III 期试验，测试的功效，以增加 ACP 对话。我们将随机将 40 家医院分配到他们接受干预的月份（步骤）。我们旨在从每个步骤中的最多 8 家医院中招募 30 名医院医生来完成干预，至少玩 2 小时。主要结果是由参与的医院医生管理的 65 岁及以上患者的 ACP 计费。我们假设该干预措施将在传播后的季度内增加 ACP 计费，并有 80%的能力检测到 1%的绝对增加，有 99%的能力检测到 3.5%的绝对增加。