Peer-Narrated Video Decision Aid for Alcohol Treatment After Critical Illness - Alcohol use disorder (AUD) affects up to 2 million adults admitted to intensive care units (ICUs) in the United States each year. Hospitalization for critical illness can serve as a “teachable moment” when many ICU survivors are motivated to change their drinking. Yet most patients are discharged without structured treatment planning, and few engage in evidence-based alcohol treatment. Prior research supported by Dr. Kelsey Hills-Dunlap's NIAAA F32 award found that ICU survivors with AUD often make uninformed and uncertain treatment decisions. This represents a modifiable barrier to care and highlights the need for accessible, structured decision support. To address this gap, Dr. Hills-Dunlap has developed a novel, peer-narrated, video-based alcohol treatment decision aid tailored to ICU survivors with AUD. This K23 Career Development Award will support a five-year training and research plan to rigorously test and refine the decision aid, prepare for future implementation, and launch Dr. Hills-Dunlap's career as an independent academic clinical investigator at the intersection of alcohol health services and critical care research. Her training will be guided by a multidisciplinary mentorship team led by Dr. Ellen Burnham, an expert in alcohol and critical care clinical research, and Dr. Dan Matlock, a national leader in decision aid development and implementation science. Dr. Hills-Dunlap will also complete a Master of Science in Clinical Science with relevant coursework in dissemination and implementation. This cohesive training program will help Dr. Hills-Dunlap develop foundational knowledge in addiction science, advance her skills in mixed methods and missing data analysis, and acquire experience in the design and conduct of pragmatic clinical trials involving ICU survivors with AUD. The overall research goal of this proposal is to improve alcohol treatment decision-making and engagement among ICU survivors with AUD. The central hypothesis is that the decision aid will improve decision quality and increase treatment initiation. Using mixed-methods and guided by the Practical Robust Implementation and Sustainability Model and the Reach, Effectiveness, Adoption, Implementation, Maintenance (PRISM-REAIM) evaluation framework, the research plan includes two specific aims. In Aim 1, Dr. Hills-Dunlap will conduct a single-center randomized controlled trial comparing the alcohol treatment decision aid to an attention control. The trial will assess the decision aid's effectiveness in improving decision quality (primary outcome), evaluate early implementation outcomes, and explore short-term alcohol- related outcomes, including treatment engagement. In Aim 2, she will conduct a contextual analysis with multi- level stakeholders at three distinct hospital sites across Colorado to identify barriers, facilitators, and adaptation needs for future implementation. Completion of these proposed studies and research training activities will position Dr. Hills-Dunlap to lead a larger, multicenter pragmatic effectiveness trial (future R01) to further test, refine, and implement the alcohol treatment decision aid for ICU survivors with AUD, ultimately helping to close the treatment gap for a high-risk population at a time when they are uniquely motivated to change.
