Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision

加强患有阿尔茨海默病或相关痴呆症的老年人面临癌症管理决策时关于认知的三元沟通

基本信息

  • 批准号:
    10436554
  • 负责人:
  • 金额:
    $ 42.28万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2022
  • 资助国家:
    美国
  • 起止时间:
    2022-05-15 至 2027-04-30
  • 项目状态:
    未结题

项目摘要

Project Summary: The overarching goal of this proposal, submitted in response to RFA-AG-22-020, is to adapt an existing communication tool developed by our team for use in patients with Alzheimer’s Disease or Related Dementias (ADRD) and their care partners, and to evaluate if this tool can enhance communication about cognition in the context of a cancer management decision. This proposal is important because approximately 7% of older adults diagnosed with cancer have pre-existing dementia. For older adults with ADRD and cancer, medical decision making is more complex, and integrates information about the risks and benefits of potential interventions in the context of the dual diagnoses. Limited data are available to guide the “best” approach and thus, relies on discussions about the risks and benefits of options in the context of patient and care partner goals and preferences. Unfortunately, there is no standard approach among oncology clinicians as to how to discuss cognition in the context of a cancer management decision for patients with pre- existing ADRD and their care partners. Preliminary research by the PI (Magnuson) and team suggest that cognitive impairment is prevalent in older patients with cancer and that a geriatric assessment-based communication tool can facilitate conversations about aging-related conditions, such as cognition, with older patients and their care partners. However, the intervention was not tested in patients with ADRD and did not address patient and care partner concerns about cognition in the context of cancer. Adapting this tool for patients with ADRD (adapted tool called “COACH-Cog”) may improve both care partner and patient outcomes through greater acknowledgement and support of cognitive concerns and cognitive-related goals, thereby improving goal concordant care. COACH-Cog adaptations will include: 1) brief, focused training for oncology clinicians about ADRD in the context of cancer and communication training to navigate the triadic nature of these conversations, thereby enhancing oncology clinician knowledge and supporting their decision processes; and 2) care partner and patient Communication Coaching and Question Prompt List providing knowledge, skills, and behavioral cueing for discussing their cognitive concerns and cognitive-related goals with oncology clinicians. Focus groups with key stakeholders will guide the adaptation. Subsequently, we propose to conduct a pilot, Stage I RCT (cluster randomized at physician) with older adults with a clinical diagnosis of ADRD and their care partners (N=130 dyads) to evaluate the preliminary efficacy of COACH-Cog on care partner and patient autonomy support, care partner well-being, and goal concordance in outcomes at 3 months. Our uniquely qualified, multidisciplinary team includes expertise in geriatric oncology, cognition, behavioral neurology, intervention development, communication science, biostatistics, palliative care, and care partner research. This innovative proposal will develop a pragmatic tool for improving communication about cognition in the context of cancer treatment decision making for patients with ADRD and their care partners.
项目摘要:本提案的总体目标是响应RFA-AG-22-020, 调整我们团队开发的现有沟通工具,用于阿尔茨海默病患者,或 相关痴呆症(ADRD)及其护理伙伴,并评估该工具是否可以加强沟通 关于认知在癌症管理决策中的作用这一建议很重要,因为 大约7%的被诊断患有癌症的老年人患有预先存在的痴呆症。对于老年人, ADRD和癌症,医疗决策更加复杂,并整合了有关风险和 在双重诊断的背景下,潜在干预措施的好处。有限的数据可用于指导 “最佳”的方法,因此,依赖于讨论的风险和利益的选择,在病人的背景下, 以及护理伙伴的目标和偏好。不幸的是,在肿瘤学中, 临床医生如何在癌症管理决策的背景下讨论认知, 现有的ADRD及其护理伙伴。PI(Magnuson)和团队的初步研究表明, 认知障碍在老年癌症患者中很普遍, 交流工具可以促进与老年人有关的与衰老有关的条件的对话,例如认知, 患者及其护理伙伴。然而,该干预措施未在ADRD患者中进行测试, 解决患者和护理伙伴对癌症背景下认知的担忧。调整此工具以 ADRD患者(称为“COACH-Cog”的适应工具)可改善护理伙伴和患者结局 通过更多地承认和支持认知问题和认知相关目标, 改善目标一致的护理。COACH-Cog适应性调整将包括:1)简短的肿瘤学重点培训 临床医生关于ADRD在癌症和沟通培训的背景下,导航的三重性质, 这些对话,从而提高肿瘤临床医生的知识,并支持他们的决策过程; 以及2)提供知识的护理伙伴和患者沟通指导和问题提示列表, 技能和行为提示,以便与肿瘤学讨论他们的认知问题和认知相关目标 临床医生由主要利害关系方组成的焦点小组将指导适应工作。随后,我们建议进行 一项在临床诊断为ADRD的老年人中开展的先导性I期RCT(在医生处进行分组随机化), 他们的护理伙伴(N=130对),以评估COACH-Cog对护理伙伴的初步疗效, 3个月时患者自主性支持、护理伙伴福祉和结局目标一致性。我们 独特的资格,多学科团队包括老年肿瘤学,认知,行为 神经病学、干预开发、通信科学、生物统计学、姑息治疗和护理伙伴 research.这一创新的建议将开发一种实用的工具,以改善有关认知的沟通 在ADRD患者及其护理伙伴的癌症治疗决策背景下。

项目成果

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Allison Marian Magnuson其他文献

Allison Marian Magnuson的其他文献

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{{ truncateString('Allison Marian Magnuson', 18)}}的其他基金

Enhancing Triadic Communication About Cognition for Older Adults with Alzheimer's Disease or Related Dementias Facing a Cancer Management Decision
加强患有阿尔茨海默病或相关痴呆症的老年人面临癌症管理决策时关于认知的三元沟通
  • 批准号:
    10617370
  • 财政年份:
    2022
  • 资助金额:
    $ 42.28万
  • 项目类别:
Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer
缓解老年乳腺癌患者与癌症相关的认知功能障碍
  • 批准号:
    9811864
  • 财政年份:
    2019
  • 资助金额:
    $ 42.28万
  • 项目类别:
Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer
缓解老年乳腺癌患者与癌症相关的认知功能障碍
  • 批准号:
    10584472
  • 财政年份:
    2019
  • 资助金额:
    $ 42.28万
  • 项目类别:
Feasibility of the Memory and Attention Adaptation Training-Geriatrics Intervention in Older Cancer Survivors with Mild Cognitive Impairment
轻度认知障碍老年癌症幸存者记忆和注意力适应训练老年病干预的可行性
  • 批准号:
    10288545
  • 财政年份:
    2019
  • 资助金额:
    $ 42.28万
  • 项目类别:
Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer
缓解老年乳腺癌患者与癌症相关的认知功能障碍
  • 批准号:
    9973127
  • 财政年份:
    2019
  • 资助金额:
    $ 42.28万
  • 项目类别:
Mitigating Cancer-Related Cognitive Dysfunction in Older Adults with Breast Cancer
缓解老年乳腺癌患者与癌症相关的认知功能障碍
  • 批准号:
    10356909
  • 财政年份:
    2019
  • 资助金额:
    $ 42.28万
  • 项目类别:

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