Transitions in care during early critical illness: improving communication and facilitating goal-concordant care for older adults during Emergency Medical Services response
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PROJECT SUMMARY / ABSTRACT Emergency Medical Services (EMS) providers, including Emergency Medical Technicians (EMTs) and paramedics, are often first to respond to sudden health crises among older adults with chronic life-limiting illness. Innovations in resuscitation science and technology have transformed the delivery of pre-hospital critical care aimed at prolonging patients’ lives. However, some older adults with chronic life-limiting illnesses such as dementia prioritize comfort and quality of life over longevity. Recent efforts have been made to integrate palliative care and geriatrics principles into critical care medicine, with a predominant focus on hospital and Emergency Department settings. Despite the fact that EMS units provide critical care, and play a crucial role in establishing treatment intensity at illness onset, little is known regarding barriers and facilitators of goal-concordant care for critically ill older adults during 911 EMS response. Few EMS systems have training programs or protocols addressing communication with surrogate decision-makers or end-of-life care, and advance directives such as Physician Orders for Life-Sustaining Treatment have notable limitations. Improving end-of-life care is a national priority, with federal funding recently allocated towards a national palliative care research consortium led by the National Institute on Aging. The objective of this proposal is to identify and address barriers to communication about treatment preferences and goal-concordant care for older adults during 911 EMS response. Specific aims include: (1) Using quantitative methods, characterize the incidence of and risk factors for EMS-reported communication barriers while caring for older adults, (2) Using qualitative methods, understand EMS provider perspectives on barriers to eliciting treatment preferences for older adults with dementia and other chronic life-limiting illnesses, and (3) Using human-centered design, develop a tool for use by EMS providers to support rapid elicitation of patients’ treatment preferences and high-quality communication. The tool may consist of concise strategies for crisis communication with surrogate decision- makers and best practices for communicating care preferences to subsequent providers. This award will prepare Dr. Pollack for a career as an independent investigator focused on developing and testing strategies to align critical care with the values and preferences of older adults and their families. Through this award, she will receive training in (1) emergency systems of care and data sources, (2) human-centered intervention design, (3) pragmatic trial design in preparation for a subsequent R01 proposal, and (3) geriatrics and aging research with a focus on transitions in care. Her research and training activities will take place at University of Washington and will be supervised by a team of national leaders in geriatrics, emergency care, palliative care, and critical care medicine who are highly invested in her career development and the success of this proposal.
