Decision Support for Older and Frail Patients Considering Advanced Cardiovascular Therapies: Improving Models of Personal Values Clarification

项目总结/摘要 这是第一次提交NHLBI K23指导的以患者为中心的职业发展奖（PA-19- 119)克里斯托弗Knoepke，博士，MSW，LCSW。Knoepke博士的目标是成为一名领先的社会工作科学家 改善在考虑先进疗法时纳入患者价值的方法。这 建议使用经导管主动脉瓣置换术（TAVR）作为研究决策支持的模型， 心血管疾病患者一般。候选人：Knoepke博士是一名持牌临床社会工作者， 目前是科罗拉多大学心脏病学院的助理研究教授。 药他拥有硕士学位（华盛顿大学）。在圣路易斯）和博士学位的社会工作（美国。丹佛）。他工作 密切与他的主要导师（博士丹尼尔马特洛克，医学博士，公共卫生硕士和拉里艾伦，医学博士，MHS），接收 导师/合作者（包括Russ格拉斯哥、Megan Morris、Eric坎贝尔、John 卡罗尔和劳拉谢勒）通过科罗拉多心血管结局研究组（CCOR）和 科罗拉多大学的传播和实施工作组，和ACCORDS。培训/导师：这 该奖项通过关注与患者决策价值相关的三个领域，增强了Knoepke博士早期的培训 支持：1）先进的定性研究; 2）临床医生调查方法; 3）传播和 执行科学。Knoepke博士提出了密集的指导;课程和研讨会，以及 通过所提出的研究进行情境学习。克诺普克和马特洛克博士组建了一个强大的团队 当地的导师和合作者，以指导博士Knoepke通过培训和研究活动。这些 这些活动将使Knoepke博士能够创新地开发真实的世界护理的决策支持工具。调研： 迫切需要改进科学，澄清实施患者价值评估， 他们决定是否接受先进的治疗。晚期CVD患者不成比例地被提供 这样的疗法。由于高龄和合并症会降低预期获益，因此需要将患者的 决策中的价值观至关重要。本研究将产生与临床实践相关的信息。目标1将 描述当前在价值澄清方面的实践状态，因为它实际上发生在患者和护理之间 当他们讨论TAVR时，目标2将包括制定和部署一项重新调查 心脏病学专家，评估设计和背景因素，以支持共享的传播 TAVR的决策。目标3将务实地试点调整老年和/或高风险TAVR的决策辅助工具 候选人（由Knoepke博士单独开发），包括目标1和2的发现。总结：这 社会工作和心脏病学之间的创新合作将最大限度地实现研究结果 并促进Knoepke博士发展成为改善患者价值观的领导者，因为他们 对自己的健康做出复杂的决定。

Project Summary/Abstract This is a first submission for an NHLBI K23 Mentored Patient-Centered Career Development Award (PA-19- 119) by Christopher Knoepke, PhD, MSW, LCSW. Dr. Knoepke’s goal is to be a leading social work scientist improving the methods by which patients’ values are included as they consider advanced therapies. This proposal uses Transcatheter Aortic Valve Replacement (TAVR) as a model for studying decision support for cardiovascular disease patients generally. Candidate: Dr. Knoepke is a Licensed Clinical Social Worker who is currently an Assistant Research Professor in the Division of Cardiology at the University of Colorado School of Medicine. He has a Masters (Washington U. in St. Louis) and PhD in social work (U. of Denver). He works closely with his primary mentors (Drs. Daniel Matlock, MD, MPH & Larry Allen, MD, MHS), receiving mentorship from mentors/collaborators (including Drs. Russ Glasgow, Megan Morris, Eric Campbell, John Carroll, and Laura Scherer) through the Colorado Cardiovascular Outcomes Research Group (CCOR) & the University of Colorado’s Dissemination & Implementation Workgroup, and ACCORDS. Training/Mentors: This award augments Dr. Knoepke’s earlier training by focusing on three areas relevant to patient values in decision support:1) Advanced qualitative research; 2) clinician survey methodology; and 3) Dissemination & Implementation science. Dr. Knoepke proposes intensive mentorship; coursework & workshops, and contextual learning through the proposed research. Drs. Knoepke and Matlock have assembled a strong team of local mentors and collaborators to guide Dr. Knoepke through the training and research activities. These activities will enable Dr. Knoepke to innovatively develop decision support tools for real world care. Research: There is a pressing need to improve the science of clarifying implementing the assessment of patient values as they decide whether to accept advanced therapies. Advanced CVD patients are disproportionately offered such therapies. As advanced age & comorbidity can reduce expected benefits, the need to include patients’ values in decisions is paramount. This study will produce information relevant to clinical practice. Aim 1 will characterize the current state of practice in values clarification as it actually occurs between patients and care providers when they discuss TAVR. Aim 2 will include the development and deployment of a de novo survey of cardiology specialists, assessing design and contextual factors necessary to support dissemination of shared decision making in TAVR. Aim 3 will pragmatically pilot adapt a decision aid for older and/or high risk TAVR candidates (separately developed by Dr. Knoepke) to include findings from Aims 1 & 2. Summary: This award’s innovative collaboration between social work and cardiology will maximize implementation of findings and facilitate Dr. Knoepke’s development into a leader in improving how patient values are honored as they make complicated decisions about their health.