Developing a framework to individualize surgical decision-making for older adults with primary hyperparathyroidism
开发一个框架,为患有原发性甲状旁腺功能亢进症的老年人提供个性化的手术决策
基本信息
- 批准号:10337961
- 负责人:
- 金额:$ 24.3万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-09-30 至 2026-05-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAffectAgingBenefits and RisksCaringCharacteristicsChronic Kidney FailureClinicalClinical TrialsComparative Effectiveness ResearchCounselingDataDecision MakingDevelopmentEducational workshopElderlyEndocrine System DiseasesEndocrinologistEnsureFeedbackFocus GroupsFractureFundingFutureGoalsHealthHybridsHyperparathyroidismIncidenceInternationalK-Series Research Career ProgramsKidney CalculiKnowledgeLeadershipMedicalMethodologyMethodsMorbidity - disease rateOperative Surgical ProceduresOutcomeParathyroidectomyPatient SelectionPatient-Centered CarePatientsPerioperativePopulationPositioning AttributePrimary Care PhysicianProceduresProviderRecommendationResearchResearch MethodologyResearch PriorityResearch TrainingRiskRisk EstimateRisk ReductionSeverity of illnessStandardizationSurgical ManagementTestingTrainingVeterans Health AdministrationVulnerable Populationscareercareer developmentcomparative effectivenessdesigneffectiveness implementation studyeffectiveness implementation trialeffectiveness trialevidence baseexpectationexperiencefracture riskfrailtyimplementation scienceimprovedindividual patientindividualized medicineinnovationmortality risknoveloperationosteoporosis with pathological fracturepatient orientedpersonalized carepersonalized decisionpersonalized risk predictionpredictive modelingpreventprogramsrisk predictionskillssupport toolssurgical risktooltreatment centertreatment choicetreatment effect
项目摘要
PROJECT SUMMARY/ABSTRACT
This K76 Career Development award will address the large unmet need for patient-specific decision support
tools for surgical interventions in older adults and provide a platform for the applicant to become a leader in
geriatric surgery. Primary hyperparathyroidism (PHPT) is a common endocrine disorder in older adults that is
associated with serious long-term morbidity, including osteoporotic fractures, kidney stones, and chronic
kidney disease (CKD). Parathyroidectomy can prevent these morbid sequelae. However, increased surgical
risk associated with advanced age and frailty, in addition to the competing risk of death prior to achieving
benefit from surgical intervention, raises the question of whether the short-term risks of parathyroidectomy
outweigh long-term risk reduction in this group. Identifying older adults likely to benefit from surgical
interventions, such as parathyroidectomy, while preventing overuse of surgery in this vulnerable group, is
critical to improve patient-centered care. Currently, there is no standardized methodology for developing
surgical decision support for older adults that incorporates individualized risk prediction and stakeholder input
to facilitate informed, patient-centered decision-making. Therefore, this coordinated research and training
proposal aims to: 1) compare the effects of parathyroidectomy vs. medical management on the incidence of
fractures, symptomatic kidney stones, and CKD in older adults with PHPT; 2) develop and validate predictive
models for the perioperative risks of parathyroidectomy and long-term risks of fractures, kidney stones, and
CKD specific to older adults with PHPT; and 3) design and test with stakeholder feedback a PHPT decision
support tool that describes the tradeoffs of parathyroidectomy vs. non-operative management. To accomplish
these aims, Dr. Seib will obtain training in comparative effectiveness and predictive modeling, qualitative and
mixed methods research to develop decision support, and implementation science. Upon completion of this
research, Dr. Seib will have a user-tested risk/benefit calculator that will form the basis of a decision support
tool to improve individualized, patient-centered treatment recommendations for older adults with PHPT. In
addition, this research will establish a framework for developing patient-centered decision support that can be
applied to other conditions to promote appropriate surgical management of older adults. This proposal is
significant because it directly addresses the gap in decision support tools for PHPT and other surgically
managed conditions in older adults. This project is innovative because it proposes a paradigm shift to
incorporate geriatric principles to individualize treatment decisions in older adults with PHPT to optimize clinical
outcomes. At the end of the proposed research, Dr. Seib will have the data and skills necessary to successfully
pursue R01 funding for a hybrid type 1 effectiveness-implementation trial to test this decision support tool and
apply this methodology to other conditions with surgical treatment options that affect older adults.
项目总结/摘要
这个K76职业发展奖将解决患者特定决策支持的大量未满足需求
为老年人手术干预提供工具,并为申请人成为
老年外科原发性甲状旁腺功能亢进(PHPT)是老年人常见的内分泌疾病,
与严重的长期发病率相关,包括骨质疏松性骨折、肾结石和慢性
肾病(CKD)。甲状旁腺切除术可以预防这些病态后遗症。然而,增加的外科手术
与高龄和虚弱相关的风险,除了在实现之前死亡的竞争风险之外,
受益于手术干预,提出了一个问题,是否甲状旁腺切除术的短期风险
超过了这一组的长期风险降低。确定老年人可能受益于手术
干预措施,如甲状旁腺切除术,同时防止过度使用手术在这个脆弱的群体,
对改善以病人为中心的护理至关重要。目前,还没有标准化的方法来开发
结合个体化风险预测和利益相关者输入的老年人手术决策支持
促进知情的、以患者为中心的决策。因此,这次协同调研和培训,
提案旨在:1)比较甲状旁腺切除术与药物治疗对
骨折、症状性肾结石和CKD的老年PHPT患者; 2)开发并验证预测性
甲状旁腺切除术的围手术期风险和骨折、肾结石的长期风险模型,
慢性肾脏病特定于老年人与PHPT;和3)设计和测试与利益相关者的反馈PHPT的决定
描述甲状旁腺切除术与非手术治疗的权衡的支持工具。完成
为了实现这些目标,Seib博士将接受比较有效性和预测建模、定性和
混合方法研究,以发展决策支持和实施科学。在完成此
研究,Seib博士将有一个用户测试的风险/效益计算器,将形成决策支持的基础
工具,以改善个性化,以患者为中心的治疗建议,老年人与PHPT。在
此外,本研究将建立一个框架,发展以病人为中心的决策支持,
适用于其他条件,以促进老年人的适当手术管理。这项建议是
重要的是,它直接解决了PHPT和其他外科手术决策支持工具中的差距,
老年人的管理条件。这个项目是创新的,因为它提出了一个范式转变,
结合老年医学原则,对老年PHPT患者进行个体化治疗决策,以优化临床
结果。在拟议的研究结束时,Seib博士将拥有成功完成研究所需的数据和技能。
寻求R 01资金用于混合1型有效性实施试验,以测试该决策支持工具,
将这种方法应用于影响老年人的其他手术治疗选择。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Carolyn Dacey Seib其他文献
Carolyn Dacey Seib的其他文献
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{{ truncateString('Carolyn Dacey Seib', 18)}}的其他基金
Developing a framework to individualize surgical decision-making for older adults with primary hyperparathyroidism
开发一个框架,为患有原发性甲状旁腺功能亢进症的老年人提供个性化的手术决策
- 批准号:
10493450 - 财政年份:2021
- 资助金额:
$ 24.3万 - 项目类别:
Developing a framework to individualize surgical decision-making for older adults with primary hyperparathyroidism
开发一个框架,为患有原发性甲状旁腺功能亢进症的老年人提供个性化的手术决策
- 批准号:
10661770 - 财政年份:2021
- 资助金额:
$ 24.3万 - 项目类别:
The Impact of Treatment Choice on Long-term Outcomes in Older Adults with Primary Hyperparathyroidism
治疗选择对患有原发性甲状旁腺功能亢进症的老年人长期预后的影响
- 批准号:
9751150 - 财政年份:2018
- 资助金额:
$ 24.3万 - 项目类别:
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