Feasibility of Using Simulation to Evaluate Implementation Fidelity in an Advance Care Planning Pragmatic Trial.

Valerie T Cotter, Danetta H Sloan, Daniel L Scerpella, Kelly M Smith, Martha Abshire Saylor, Jennifer L Wolff
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Abstract

Background and Objectives: 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. Research Design and Methods: 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. Results: 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). Discussion and Implications: 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.

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在预先护理规划实用性试验中使用模拟来评估实施忠实性的可行性。
背景与目标:在真实世界的临床环境中进行实用性试验时,无法采用传统的忠实性监测方法。我们介绍了在实用性试验中使用标准化患者对难以接触到的亚人群进行 ACP 对话的忠实性监控和强化的方法。研究设计和方法:我们根据 "尊重选择的第一步"(Respecting Choices First Steps™)预先护理规划课程开发了标准化患者情景,为加强和评估 ACP 主持人的能力提供了机会。情景模拟代表一对一的接触。第一个案例是一名患有认知障碍的标准化患者,第二个案例是一名患有痴呆症的标准化患者及其护理伙伴。模拟过程中观察到的技能和行为,包括会诊设置、ACP 主题和一般交流等,均采用先前验证过的 "忠实性核对表 "进行评分。模拟涉及语音远程会议,以便与实用试验中 ACP 的主要方式保持一致。结果:六名主持人每人完成了两个标准化病例。认知障碍病例以及痴呆症患者和护理伙伴病例的总体忠实度得分中等偏上(78.8% ± 11.7;63.4 - 95.6)(76.2% ± 13.0;54.4 - 91.5)。讨论和启示:使用标准化患者进行模拟训练有助于进行真实性监测,并提供可指导的反馈,以提高指导者的能力。我们的研究有助于为今后有关阿尔茨海默病及相关疾病老年人预先护理计划的研究和培训提供信息。
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