Developing a framework to individualize surgical decision-making for older adults with primary hyperparathyroidism

项目摘要/摘要 这项K76职业发展奖将解决针对患者的决策支持的大量未得到满足的需求 为老年人提供手术干预工具，并为申请者提供一个平台，使其成为 老年外科手术。原发性甲状旁腺功能亢进症(PHPT)是一种常见的老年人内分泌疾病，即 与严重的长期发病率有关，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，增加了外科手术 与高龄和虚弱相关的风险，以及在达到以下目标之前的死亡风险 从手术干预中获益，提出了甲状旁腺切除术的短期风险是否 在这一群体中，重于长期风险降低。确定可能从手术中受益的老年人 干预措施，如甲状旁腺切除术，在防止这一弱势群体过度使用手术的同时， 对改善以患者为中心的护理至关重要。目前，还没有标准化的开发方法 结合个性化风险预测和利益相关者意见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，这种协调的研究和培训 该提案旨在：1)比较甲状旁腺切除术和内科治疗对甲状旁腺癌发病率的影响。 患有PHPT的老年人的骨折、症状性肾结石和慢性肾脏病；2)发展和验证预测性 甲状旁腺切除术的围手术期风险和骨折、肾结石和 专门针对患有PHPT的老年人的CKD；以及3)根据利益相关者的反馈设计和测试PHPT决策 描述甲状旁腺切除术与非手术治疗的权衡的支持工具。要完成 为了实现这些目标，Seib博士将接受比较有效性和预测性建模、定性和 发展决策支持和实施科学的混合方法研究。在完成此操作后 研究，Seib博士将拥有一个经过用户测试的风险/收益计算器，它将构成决策支持的基础 为患有PHPT的老年人改进个性化、以患者为中心的治疗建议的工具。在……里面 此外，这项研究将建立一个框架，以开发以患者为中心的决策支持，可以 适用于其他条件，以促进适当的老年人手术治疗。这项建议是 意义重大，因为它直接解决了PHPT和其他外科手术决策支持工具的缺口 老年人的管理性疾病。该项目具有创新性，因为它提出了一种范式转换， 结合老年学原则对患有PHPT的老年人进行个体化治疗以优化临床 结果。在拟议的研究结束时，塞布博士将拥有成功完成这项研究所需的数据和技能 为混合类型1有效性实施试验寻求R01资金，以测试此决策支持工具和 将这一方法应用于其他影响老年人的手术治疗选择。

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.