Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies

描述（由申请人提供）：这是NIA K23 Paul B的首次提交。Beeson奖（RFA-AG-11-009）由Dan D.马特洛克医学博士公共卫生硕士马特洛克的首要职业目标是成为一名领导者，进行从根本上改变和改善老年人如何围绕侵入性技术做出决定的研究。他在本文中提出的研究使用植入式心律转复除颤器（ICD）作为模型，研究如何改善老年人决策的更大问题。候选人：马特洛克博士是一名董事会认证的老年病学家，也是科罗拉多丹佛大学（UCD）普通内科学系的医学助理教授。他已经完成了公共卫生硕士学位，并进行了大量的研究，重点是区域差异和决策的ICD。他与他的主要导师密切合作; Jean Kutner博士，MD，MPH。作为科罗拉多心血管结局研究组（CCOR）的成员，他还接受了他的合作者（包括Fred Masoudi博士，医学博士，MSPH）的指导，该研究组是美国领先的心血管结局研究组之一。培训内容：拟议的K23职业发展计划建立在奖学金和早期职业发展的经验基础上，重点关注三个需要额外培训的领域：1）观察数据分析; 2）定性研究; 3）共同决策/决策辅助发展。因此，马特洛克博士提出了密集的专题辅导，重点课程，研讨会，并通过拟议的研究上下文学习。这些培训活动将使马特洛克博士能够学习如何最好地制定适合老年人需求的决策支持干预措施。导师/环境：马特洛克博士和他的主要导师库特纳博士组建了一个强大的本地导师团队，他们将指导马特洛克博士完成拟议的培训和研究活动。为了加强这个团队，马特洛克和库特纳博士组建了一个由国内和国际顾问组成的小组，他们在老年人决策的各个方面都有专业知识，以监测马特洛克博士通过职业发展计划取得的进展，并在他们的专业领域提供指导。此外，马特洛克博士是CCOR中唯一的老年病学家，这使得马特洛克博士成为与老龄化有关的项目的自然带头人。调研：迫切需要挑战普遍存在于医疗决策尤其是老年人决策中的过时的家长主义。这项研究将产生与临床实践工作直接相关的信息。目标1将提供ICD治疗的风险和生存率的真实的估计，这是为决策提供信息的基本知识。目标2将建立在马特洛克博士先前的研究基础上，以回答有关老年人及其家庭成员ICD决策重要方面的其他问题。关于ICD的一个特别具有挑战性的问题是如何讨论心源性猝死与进展性心力衰竭的潜在生存时间之间的权衡。这项研究将提供一个清晰的了解ICD的决策，因为它适用于老年人，并将直接导致发展的ICD决策援助。目标3将使用一个既定的决策支持框架和决策辅助开发指南，开发和试点测试基于网络的ICD决策辅助。总结：也许这项奋进的最大创新在于，它是与心脏病专家合作完成的，可以充分了解决策背景，并最大限度地提高未来的实施和传播。这种合作也有助于更大的目标，将老年医学的原则传播到医学的亚专业。这指导研究和培训的建议，“植入式兴奋剂和老年人：决策和技术的模型”，将促进博士马特洛克的发展成为一个国家认可的独立调查员和领导者进行研究，从根本上改变和改善老年人如何围绕侵入性技术作出决定。 公共卫生相关性：迫切需要挑战普遍存在于医疗决策尤其是老年人决策中的过时的家长主义。我们的初步研究表明，决策是有缺陷的使用植入式心脏复律除颤器（ICD）作为一个模型，本项目旨在改善这一决策。这个职业发展奖的总体目标是促进丹博士的发展。马特洛克，医学博士，公共卫生硕士成为一个领导者，从根本上改变和改善老年人如何作出医疗决定。

DESCRIPTION (provided by applicant): This is a first submission for an NIA K23 Paul B. Beeson award (RFA-AG-11-009) by Dan D. Matlock, MD, MPH. Dr. Matlock's overarching career goal is to be a leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies. His research proposed herein uses Implantable Cardioverter-Defibrillators (ICDs) as a model to study the larger question of how to improve decision making for older adults. Candidate: Dr. Matlock is a board-certified geriatrician and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Denver (UCD). He has completed a Master's in Public Health and has conducted a host of studies focused on regional variations and decision making for ICDs. He works closely with his primary mentor; Dr. Jean Kutner, MD, MPH. He also receives mentorship from his collaborators (including Dr. Fred Masoudi, MD, MSPH) as a member the Colorado Cardiovascular Outcomes Research Group (CCOR), one of the leading cardiovascular outcomes research groups in the country. Training: The proposed K23 career development plan builds on prior experience from fellowship and early career development to focus on three areas that require additional training: 1) Observational data analysis; 2) Qualitative research; and 3) Shared decision making/decision aid development. Accordingly, Dr. Matlock proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. These training activities will enable Dr. Matlock to learn how to best develop decision support interventions tailored to the needs of older adults. Mentors/Environment: Dr. Matlock and his primary mentor, Dr. Kutner have assembled a strong local mentorship team who will guide Dr. Matlock through the proposed training and research activities. To augment this team, Drs. Matlock and Kutner have assembled a panel of national and international advisors with expertise in various aspects of decision making among older adults to monitor Dr. Matlock's progress through the career development program and provide mentorship within their areas of expertise. Additionally, Dr. Matlock is the sole geriatrician in the CCOR making Dr. Matlock the natural lead for projects related to aging. Research: There is a pressing need to challenge the antiquated paternalism that persists in medical decision making in general and decision making for older adults in particular. This study will produce information of direct relevance to those working in clinical practice. Aim 1 will provide real world estimates of the risks and survival for ICD therapy which are essential knowledge to inform decision making. Aim 2 will build upon Dr. Matlock's prior research to answer additional questions about important aspects of ICD decision making for older adults and their family members. A particularly challenging question around ICDs is how to discuss the trade-off between sudden cardiac death versus potentially living longer with progressive heart failure. This study will provide a clear understanding of ICD decision making as it applies to older adults and will lead directly to the development of an ICD decision aid. Aim 3 will use an established framework for decision support and decision aid development guidelines to develop and pilot test a web based ICD decision aid. Summary: Perhaps the biggest innovation of this endeavor is that it is done in collaboration with cardiologists allowing for full understanding of the decision context and maximizing future implementation and dissemination. This collaboration also serves larger goals of spreading geriatric principles into the subspecialties of medicine. Conduct of this mentored research and training proposal, "Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies", will facilitate Dr. Matlock's development into a nationally-recognized independent investigator and leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies. PUBLIC HEALTH RELEVANCE: There is a pressing need to challenge the antiquated paternalism that persists in medical decision making in general and decision making for older adults in particular. Our preliminary research suggests that decision making is defective using implantable cardioverter-defibrillators (ICDs) as a model and this project aims to improve this decision making. The overarching objective of this career development award is to foster the development of Dr. Dan D. Matlock, MD, MPH into a leader fundamentally changing and improving how older adults make medical decisions.