Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
School of Nursing, George Washington University, Washington, DC, USA.
BMC Palliat Care. 2022 Jul 16;21(1):129. doi: 10.1186/s12904-022-01011-5.
Patients undergoing hemodialysis have a high mortality rate and yet underutilize palliative care and hospice resources. The Shared Decision Making-Renal Supportive Care (SDM-RSC) intervention focused on goals of care conversations between patients and family members with the nephrologist and social worker. The intervention targeted deficiencies in communication, estimating prognosis, and transition planning for seriously ill dialysis patients. The intervention showed capacity to increase substantially completion of advance care directives. The HIGHway Project, adapted from the previous SDM-RSC, scale up training social workers or nurses in dialysis center in advance care planning (ACP), and then support them for a subsequent 9-month action period, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care.
We will train between 50-60 dialysis teams, led by social workers or nurses, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. This implementation project uses the Knowledge to Action (KTA) Framework within the Consolidated Framework for Implementation Research (CFIR) to increase adoption and sustainability in the participating dialysis centers. This includes a curriculum about how to hold ACP conversation and coaching with monthly teleconferences through case discussion and mentoring. An application software will guide on the process and provide resources for holding ACP conversations. Our project will focus on implementation outcomes. Success will be determined by adoption and effective use of the ACP approach. Patient and provider outcomes will be measured by the number of ACP conversations held and documented; the quality and fidelity of ACP conversations to the HIGHway process as taught during education sessions; impact on knowledge and skills; content, relevance, and significance of ACP intervention for patients, and Supportive Kidney Care (SKC) App usage. Currently HIGHway is in the recruitment stage.
Effective changes to advance care planning processes in dialysis centers can lead to institutional policy and protocol changes, providing a model for patients receiving dialysis treatment in the US. The result will be a widespread improvement in advance care planning, thereby remedying one of the current barriers to patient-centered, goal-concordant care for dialysis patients.
The George Washington University Protocol Record NCR213481, Honoring Individual Goals and Hopes: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis, is registered in ClinicalTrials.gov Identifier: NCT05324878 on April 11, 2022.
接受血液透析的患者死亡率很高，但姑息治疗和临终关怀资源的利用率却很低。共享决策-肾脏支持性护理（SDM-RSC）干预措施侧重于患者及其家属与肾脏病医生和社会工作者之间的护理目标对话。该干预措施针对的是沟通、预后估计和重症透析患者的过渡计划方面的缺陷。该干预措施显示出大大提高预先护理指令完成率的能力。HIGHway 项目是对之前的 SDM-RSC 的改编，培训透析中心的社会工作者或护士进行预先护理计划（ACP），然后在接下来的 9 个月的行动期间为他们提供支持，与患者在透析中心进行关于他们对生命末期护理的偏好的 ACP 对话。
我们将培训 50-60 个由社会工作者或护士领导的透析团队，与透析中心的患者进行关于他们对生命末期护理偏好的 ACP 对话。这个实施项目使用知识到行动（KTA）框架内的整合实施研究（CFIR）框架来增加参与的透析中心的采用率和可持续性。这包括一个关于如何进行 ACP 对话的课程，并通过案例讨论和指导进行每月的电话会议进行辅导。一个应用软件将指导该过程并为进行 ACP 对话提供资源。我们的项目将侧重于实施结果。成功将通过 ACP 方法的采用和有效使用来确定。患者和提供者的结果将通过进行和记录的 ACP 对话数量来衡量；ACP 对话的质量和与 HIGHway 过程的一致性，如在教育课程中教授的；对知识和技能的影响；ACP 干预对患者的内容、相关性和意义，以及支持性肾脏护理（SKC）应用程序的使用情况。目前 HIGHway 正处于招募阶段。
在透析中心有效改变预先护理计划流程可以导致机构政策和协议的改变，为美国接受透析治疗的患者提供一个模式。其结果将是广泛改善预先护理计划，从而纠正当前阻碍透析患者以患者为中心、目标一致的护理的一个障碍。
乔治华盛顿大学方案记录 NCR213481，尊重个人目标和希望：对接受透析治疗的肾脏疾病患者实施预先护理计划，在 ClinicalTrials.gov 注册，标识符：NCT05324878，于 2022 年 4 月 11 日注册。
