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

项目总结/摘要 这是一个Beeson K76职业发展奖，颁发给胸肿瘤临床医生Melisa Wong博士- 接受过医学肿瘤学和老龄化研究双重培训的研究人员。黄博士的长远目标是成为 老年肿瘤学研究的国家领导者，通过调整治疗方法改善老年人的癌症护理 个性化的患者目标。超过72%的老年癌症患者报告说，他们不会选择 一种导致功能障碍的治疗，即使它能提高生存率。然而，肿瘤学家传统上 基于癌症特征的治疗决定，通常没有讨论治疗可能如何影响 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的决策 因此，肿瘤学家必须预测哪些老年人功能下降的风险最高， 向患者传达有关益处和危害的复杂信息，使治疗与 他们的功能、生活质量、寿命和其他优先事项的目标。该建议旨在：1）确定风险因素 用于化疗期间日常活动、身体表现和生活空间活动的功能下降 和/或免疫治疗; 2A）调整最佳情况/最差情况 (BC/WC）沟通工具;和2B）测试其在与老年人讨论治疗期间使用的可行性 患上了肺癌在Aim 1的多中心队列研究中，年龄在65岁及以上的转移性肺癌患者将 在化疗期间接受系列老年评估以测量功能状态和/或 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，以获取反馈意见，旨在调整BC/WC工具， 其他患者优先事项纳入以患者为中心的决策。在Aim 2B的前后试点研究中，肿瘤学家将 接受培训以使用适应的BC/WC工具;治疗前与老年肺癌患者进行讨论， 培训后，将进行分析。黄博士的杰出多学科指导团队由路易丝博士领导 Walter是国际公认的老年人癌症筛查个体化决策专家， 成年人了该奖项将通过以下方面的专门培训支持黄博士向研究独立的过渡： 老年癌症患者功能下降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进行决策干预; 3）临床 试验设计，以测试老年癌症患者的决策干预措施;和4）领导技能，以指导 多中心研究，以改变老年肿瘤护理。该提案的结果将作为 一项多中心队列研究的基础，以开发和验证功能下降的风险预测评分 在老年人肺癌治疗期间， BC/WC关于沟通、共同决策和接受符合目标的护理的工具。

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.