Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussions

项目摘要/摘要 这是为胸部肿瘤临床医生Melisa Wong颁发的Beeson K76职业发展奖- 受过医学肿瘤学和老龄研究双重培训的调查员。王博士的长期目标是成为一名 全国老年肿瘤学研究领先者，通过联合治疗改善老年人的癌症护理 有个性化的病人目标。超过72%的患有癌症的老年人表示他们不会选择 一种导致功能障碍的治疗方法，即使它可以提高存活率。然而，肿瘤学家传统上认为 基于癌症特征的治疗决定，通常不讨论治疗可能产生的影响 功能或引出患者的目标和价值观。从以癌症为中心转向以患者为中心 因此，肿瘤学家既必须预测哪些老年人功能衰退的风险最高，也必须预测 以一种与治疗相一致的方式向患者传达关于益处和危害的复杂信息 他们的目标是功能、生活质量、寿命和其他优先事项。该提案旨在1)确定风险因素 治疗化疗期间日常活动、体能表现和生活空间活动的功能下降 和/或对患有转移性肺癌的老年人进行免疫治疗；2A)适应最好/最坏情况 (BC/WC)通信工具；以及2B)测试其在与老年人讨论治疗期间使用的可行性 患有肺癌。在Aim 1‘S多点队列研究中，65岁及以上的转移性肺癌患者将 接受一系列老年评估，以测量化疗和/或期间的功能状态 免疫疗法。在Aim 2A的焦点小组研究中，患有肺癌的老年人、照顾者和肿瘤学家将 参加焦点小组，以获得旨在调整BC/WC工具以纳入功能和 将其他患者的优先事项转变为以患者为中心的决策。在Aim 2B的前期试点研究中，肿瘤学家将 接受使用经调整的BC/WC工具的培训；与老年肺癌患者讨论治疗之前和 培训结束后将进行分析。王博士卓越的多学科指导团队由路易丝博士领导 沃尔特是国际公认的老年人癌症筛查个性化决策专家 成年人。该奖项将支持王博士通过1)中的专门培训过渡到研究独立 老年癌症患者功能衰退的纵向建模和风险预测；2)共同决策 对有功能或认知障碍的老年人的决策和决策干预；3)临床 试验设计，以测试对患有癌症的老年人的决策干预；以及4)领导技能以指导 转变老年肿瘤护理的多中心研究。这项提案的结果将作为 多中心队列研究的基础，以开发和验证功能衰退的风险预测评分 在老年人肺癌治疗期间和一项整群随机试验，以测试适应的 BC/WC关于沟通、共同决策和接受与目标一致的护理的工具。

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Melisa Wong, a thoracic oncology clinician- investigator dually trained in medical oncology and aging research. Dr. Wong’s long-term goal is to become a national leader in geriatric oncology research, improving cancer care for older adults by aligning treatments with individualized patient goals. More than 72% of older adults with cancer report that they would not choose a treatment that results in functional impairment, even if it improves survival. Yet, oncologists traditionally make treatment decisions based on cancer characteristics, often without discussing how treatment might affect function or eliciting patients’ goals and values. To move from cancer-centered to patient-centered decision making, oncologists must both predict which older adults are at highest risk for functional decline and communicate complex information about benefits and harms to patients in a way that aligns treatments with their goals for function, quality of life, longevity, and other priorities. This proposal aims to 1) identify risk factors for functional decline in daily activities, physical performance, and life-space mobility during chemotherapy and/or immunotherapy in older adults with metastatic lung cancer; 2A) adapt the Best Case/Worst Case (BC/WC) communication tool; and 2B) test its feasibility for use during treatment discussions with older adults with lung cancer. In Aim 1’s multi-site cohort study, patients age 65 and older with metastatic lung cancer will undergo serial geriatric assessments to measure functional status during chemotherapy and/or immunotherapy. In Aim 2A’s focus group study, older adults with lung cancer, caregivers, and oncologists will participate in focus groups to elicit feedback aimed at adapting the BC/WC tool to incorporate function and other patient priorities into patient-centered decision making. In Aim 2B’s pre-post pilot study, oncologists will be trained to use the adapted BC/WC tool; treatment discussions with older adults with lung cancer before and after training will be analyzed. Dr. Wong’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for cancer screening in older adults. This award will support Dr. Wong’s transition to research independence through dedicated training in 1) longitudinal modeling and risk prediction for functional decline in older adults with cancer; 2) shared decision making and decision-making interventions for older adults with functional or cognitive impairment; 3) clinical trial design to test decision-making interventions for older adults with cancer; and 4) leadership skills to direct multicenter research to transform geriatric oncology care. The results from this proposal will serve as the foundation for a multicenter cohort study to develop and validate a risk prediction score for functional decline during lung cancer treatment in older adults and a cluster-randomized trial to test the effect of the adapted BC/WC tool on communication, shared decision making, and receipt of goal-concordant care.