Cotter Valerie T, Sloan Danetta H, Scerpella Daniel L, Smith Kelly M, Abshire Saylor Martha, Wolff Jennifer L
Johns Hopkins School of Nursing, Baltimore, MD, USA.
Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Am J Hosp Palliat Care. 2025 Aug;42(8):785-791. doi: 10.1177/10499091241282087. Epub 2024 Sep 3.
Traditional methods of fidelity monitoring are not possible in pragmatic trials in real-world clinical settings. We describe our approach to monitoring and reinforcing the fidelity to ACP conversations for a hard-to-reach subpopulation by using standardized patients in a pragmatic trial. We developed standardized patient scenarios grounded in the Respecting Choices First Steps™ Advance Care Planning curriculum to provide an opportunity to reinforce and assess ACP facilitator competency. Scenarios represented one-on-one encounters. The first case was a standardized patient with cognitive impairment and the second case involved a standardized patient with dementia and their care partner. A previously validated fidelity checklist was used to score skills and behaviors observed during simulations including encounter set-up, ACP topics, and general communication. Simulations involved voice teleconferencing to align primary modality of ACP in the pragmatic trial. Six facilitators completed two standardized patient cases each. Overall fidelity scores were moderately high (78.8% ± 11.7; 63.4 - 95.6) for the case with cognitive impairment and for the case with the patient with dementia and care partner (76.2% ± 13.0; 54.4 - 91.5). Simulation using standardized patients supported fidelity monitoring and provided coachable feedback to support facilitator competency. Our study can help inform future research and training related to advance care planning in older adults living with Alzheimer's disease and related disorders.
在现实世界临床环境中的务实试验中，传统的保真度监测方法是不可行的。我们描述了在一项务实试验中，通过使用标准化患者来监测和加强针对难以接触到的亚人群进行的预立医疗照护规划（ACP）对话保真度的方法。我们根据“尊重选择第一步”高级医疗照护规划课程开发了标准化患者场景，以提供强化和评估ACP促进者能力的机会。场景代表一对一的会面。第一个案例是一名患有认知障碍的标准化患者，第二个案例涉及一名患有痴呆症的标准化患者及其护理伙伴。使用先前验证过的保真度检查表对模拟过程中观察到的技能和行为进行评分，包括会面设置、ACP主题和一般沟通。模拟采用语音电话会议，以与务实试验中ACP的主要方式保持一致。六名促进者每人完成了两个标准化患者案例。对于认知障碍案例以及患有痴呆症的患者及其护理伙伴的案例，总体保真度得分中等偏高（分别为78.8%±11.7；63.4 - 95.6和76.2%±13.0；54.4 - 91.5）。使用标准化患者进行模拟有助于保真度监测，并提供可指导的反馈以支持促进者的能力。我们的研究可为未来与患有阿尔茨海默病及相关疾病的老年人的预立医疗照护规划相关的研究和培训提供参考。
