Enhancing Advance Care Planning in Diverse Elders with Limited Literacy

描述(由申请人提供)：所有老年人最终都将面临临终治疗的决定；然而，这些复杂的决定可能会因为有限的识字而变得更加复杂。我的长期目标是改善识字能力有限的老年人的临终决策。我接受过临床老年病学方面的培训，获得了NIA资助的高级老年病学研究培训，为这一应用设计了一个增量研究议程，并为该议程进行了初步研究。我寻求K23奖，以便在老年人的健康素养和临终决策方面进行指导性研究，并培养研究技能，以成为一名独立的调查者。 美国老年人的平均阅读水平是5年级，识字能力有限与决策能力受损有关。大多数临终决策工具都是在12年级以后编写的。此外，尽管这种方法被认为可以使护理更符合患者的目标，但大多数方法并不能引出患者对治疗结果的价值观(例如，治疗后严重痴呆是可接受的还是不可接受的)。在本应用程序中，我将满足大多数美国老年人的识字需求，以满足对价值观工具的需求(即，一种能够得出患者对治疗结果的价值的工具)。此应用程序的目标是(1)调整价值观工具以满足大多数美国老年人的识字需求；(2)评估首选格式(调查问卷与故事格式)；(3)将价值观工具调整为视频媒体；以及(4)评估呈现价值观工具的首选媒体(书面与视频)。所有受试者都将从旧金山的一家县医院招募，那里的患者组合多样，识字率有限，仅为40%。对于目标1-4，我将评估长者对书面、故事或视频价值工具的满意度。对于目标1-3，我将评估该工具的心理测量学特性(信度和效度)。目标2和目标4将评估价值工具的两种形式和媒介之间的满意度、知识和偏好。 我组建了一支强大的指导团队，拥有老年病学、健康素养和心理测量分析方面的专业知识。我还设计了一个强有力的职业发展计划，在这个计划中，我将获得心理测量和定性方法、试验设计和成人学习技术方面的培训，并完成一系列有指导的研究项目，在这些项目中，我将获得成为老龄化研究领导者的技能。 拟议的工作将使我成为老龄化研究的独立调查员，并开发出一种适合识字水平的工具，以得出老年人对治疗结果的可靠和有效的价值观。这项应用将导致独立的研究，以检验我的假设，即我开发的价值观工具将导致与价值观一致的医疗护理，并提高老年人及其家人的满意度。

DESCRIPTION (provided by applicant): All elders will eventually face end-of-life treatment decisions; however, these complex decisions may be compounded by limited literacy. My long-term goal is to improve end-of-life decision making for elders with limited literacy. I have trained in clinical geriatrics, obtained advanced NIA-funded geriatrics research training, designed an incremental research agenda for this application, and conducted the initial studies for that agenda. I seek a K23 award to conduct mentored research in health literacy and end-of life decision making in the elderly and to develop the research skills to become an independent investigator. The mean reading level of US elders is < 5th grade, and limited literacy has been associated with impaired decision-making. Most end-of-life decision tools are written beyond the 12th grade level. Also, most do not elicit patients' values concerning treatment outcomes (e.g. whether, after treatment, being severely demented is acceptable or unacceptable), though this approach is thought to result in care more consistent with patients' goals. In this application, I address the need for a values tool (i.e., a tool that elicits patient values about treatment outcomes) that meets the literacy needs of most U.S. elders. The aims of this application are to (1) adapt a values tool to meet the literacy needs of most US elders; (2) assess the preferred format (questionnaire vs. story format); (3) adapt a values tool into a video medium; and (4) assess the preferred medium (written vs. video) to present the values tool. All subjects will be recruited from a county hospital in San Francisco with a diverse patient mix and a limited literacy prevalence of 40%. For Aims 1-4, I will assess elder's satisfaction with the written, story or video values tool. For Aims 1-3, I will assess the tool's psychometric properties (reliability and validity). Aims 2 and 4 will assess satisfaction, knowledge, and preference between the two formats and mediums of the values tool. I have assembled a strong mentoring team with expertise in geriatrics, health literacy, and psychometric analysis. I have also designed a strong career development plan in which I will obtain training in psychometric and qualitative methods, trial design, and adult learning technologies and complete a series of mentored research projects where I will gain the skills to become a leader in aging research. The proposed work will lead to my development as an independent investigator in aging research, and to the development of a literacy level-appropriate tool to elicit elders' values about treatment outcomes that is reliable and valid. This application will lead to independent research to test my hypothesis that the values tool I develop will result in value-concordant medical care and improved satisfaction for elders and their families.