Chronic Obstructive lung disease (COPD) is the third leading cause of death in the United States. People over age 65 have the highest burden of COPD, especially the more advanced forms of the disease.1, 2 acute respiratory failures is a common cause of hospitalization and death in patients with severe COPD. One of the treatment choices for patients with acute respiratory failure is invasive mechanical ventilation (a "breathin machine"). However, if patients survive, this treatment has associated complications and may lead to a poor quality of life. Patients with severe COPD are often uninformed about the tradeoffs associated with invasive mechanical ventilation and therefore at risk of receiving default critical care that is not congruent with their preferences. This proposal"s hypothesizes that if that patients with severe COPD are effectively informed in advance of critical illness abou their personalized prognoses and likely tradeoffs of invasive mechanical ventilation treatment, they will be more prepared to make critical care decisions and more likely to receive preference-congruent care. The research seeks to better inform severe COPD patients and surrogate decision makers about treatment options for acute respiratory failure and personalized outcomes in advance of critical illness. The proposed method is to support doctor-patient communication and shared decision making about mechanical ventilation and advance care planning. The tool proposed is a brief, web-based decision aid, "InformedTogether". "InformedTogether" integrates comparative effectiveness research on invasive versus noninvasive mechanical ventilation for severe COPD, with patient-centered language doctors can use to communicate choices and outcomes, and to elicit patients" preferences. The "InformedTogether" decision aid targets several clinician barriers to communication and shared decision making about advance care planning which include: a lack of prognostic estimates for alternative treatment options, a lack of time, and difficulty communicating with patients, especially when prognosis is poor. It also targets several patient barriers to informed decision making which include: lack of prognostic information;lack of opportunity to consider tradeoffs &preferences, and;denial/ discomfort discussing dying. The decision aid design will adhere to the International Patient Decision Aid Standards and will be guided by principles of Human Factors Engineering (the scientific discipline used to enhance the interaction between humans and systems to optimize performance, increase learnability, minimize error, and increase safety).
The specific aims are: (1) To revise a brief, decision aid ('InformedTogether') which supports shared decision making between doctors and severe COPD patients about treatments for acute respiratory failure. (2) To test the decision aid 'InformedTogether'for quality and feasibility of implementation. This work will support communication of research results to aging and older people and aims to improve informed decision making and preference- congruent care in this population, meeting one of the missions of the National Institutes of Aging.
Artificial life support for patients with severe COPD may cause more harm than benefit and may lead to complications. This research intends to inform patients, with the help of their doctors, about their treatment choices and what may result from the treatments so that they are prepared and informed to make these decisions.