Personalized Experiences to Inform Improved Communication for Minorities With Life Limiting Illness

Study Overview
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Brief Summary
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The purpose of this research is to develop patient-centered palliative care interventions to improve patient-provider communication and Quality of Life (QoL) of ethnic and racial minority patients living with life-limiting illnesses. Eliciting personal experiences is an effective way for patients to communicate their cultural values and beliefs. This study will assess how to integrate the patients' personal experience narratives into the electronic health record (EHR). The primary hypothesis is that the implementation of a patient-centered intervention to elicit personal experiences that are included in the EHR will improve patient-provider communication and patients' QoL.

Detailed Description
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Racial and ethnic minority patients with a Life Limiting Illnes (LLI) in the United States are underserved in many ways, including quality of palliative care. Specific disparities have been reported in palliative care for minority patients, including sub-optimal patient-provider communication and resulting lower QoL. A potential approach to improve communication is to elicit patients' personal narratives that address their cultural or spiritual values and beliefs, and include them in the EHR. The objective of this observational study is to assess the feasibility and efficacy of a palliative care nursing intervention designed to 1) identify barriers and facilitators for eliciting and recording relevant narratives from the perspectives of the key stakeholders: minority patients with LLI; 2) to conduct usability testing, applying a user-system-environment evaluation process to determine essential requirements for integration of the patient-centered narratives into the EHR; and 3) identify barriers and facilitators of integration of the patient's narrative into daily workflow from the perspectives of key stakeholders: acute care bedside nurse.

Official Title
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Personalized Experiences to Inform Improved Communication for Minorities With Life Limiting Illness

Conditions
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COPD, Heart Failure, Cancer

Intervention / Treatment
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* Behavioral: Storytelling Intervention for Patient Participants
* Behavioral: Storytelling Intervention for Nurse Participants


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients 18 years of age or older able to read English capable of giving informed consent self-identifying as part of a racial or ethnic minority diagnosed with at least one LLI. The operational definition of LLI eligible for this study includes the following diagnoses: metastatic solid cancer or inoperable lung cancer; COPD with FEV1 values < 35% predicted or oxygen dependence; New York Heart Association Class III or IV heart failure (CHF). Inclusion criteria: Nurse 18 years of age or older Confirm verbally that they were involved in the care of a patient who is participating in the storytelling intervention

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Inpatient Participants<br>Patients admitted to University of Colorado Hospital with at least one of the following diagnoses: Heart Failure COPD Cancer | Behavioral: Storytelling Intervention for Patient Participants<br>* The storytelling intervention consists of an audio-recorded interview with each patient participant prompted the participant to share their story with questions such as: tell me about your illness, tell me how your illness has affected your emotions, relationships, and spirituality. The interview transcripts will be used to co-create a 1 page patient story using these criteria:1) written in the first person; 2) nonjudgmental; 3) captures the participant's voice; 4) accurately reflects content of the interview; and 5) non-labeling. Once the story has been approved by the participant, I will upload it to the EHR.<br>|
| Nurse Participants<br>Bedside nurses who provide care at the inpatient level for the following diseases: Heart Failure COPD Cancer | Behavioral: Storytelling Intervention for Nurse Participants<br>* Once the patient's story is uploaded to the EHR, automatic alerts will be sent to the participant's EHR-assigned nurses. For usability testing, nurse participants will 1) provide content expertise of the workflow processes, and 2) put the storytelling intervention through in-house usability testing to check the strength of EHR features and user-friendliness. Data will be collected with exit interviews and completion of a questionnaire: the System Usability Scale which asks them to rank their satisfaction with specific elements such as: how the story is labeled and presented in the EHR, any technical navigation EHR difficulties, and use of the material.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Completed Exit Interviews From Patients on Feasibility of Their Use of Their Narrative Integrated Into EHR | Using an observational design, this measure (exit interviews) were completed with 20 inpatient participants and 18 nurse participants. The qualitative data from the interviews were used to define and refine the storytelling intervention. The data collected from the exit interview is qualitative in nature and therefore does not have a numerical value. | 1-2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Psychosocial, Underserved, Palliative, Electronic Health Record, Narrative