Surrogate Decision Making for Hospitalized Older Adults

这是一项为Alexia Torke设立的以患者为导向的导师研究职业发展奖(K23)的建议。 托克医生开始了她的医疗生涯，当时她是一名临床医生，从事普通内科，专注于医学 伦理道德。在埃默里大学当了五年教员后，她重新开始接受培训，完成了 伦理和初级保健方面的团契。她目前是印第安纳大学的医学助理教授 以及印第安纳大学老龄化研究中心的研究科学家。她的研究现在集中在这两个方面 老年人决策的医疗和伦理方面。托克博士的长期目标是改善 医疗护理住院的老年人谁不能作出自己的决定。这份职业发展 获奖将为她提供完成这一关键步骤所需的培训和受保护的时间 目标：描述这些患者的决策过程。托克博士提议进行一项 对老年人及其代理决策者进行前瞻性、观察性研究。这样做的具体目的是 研究是描述代孕决定的频率、特征和临床背景，并确定 来自代理人的成功沟通和高质量决策的重要决定因素 透视。65岁及以上的患者将在入院时被识别出来，并在住院期间进行跟踪。数据 将从治疗医生、从病历审查和从深入访谈中收集 代理决策者。这些结果将作为未来干预措施的基础，以改善对 不能做出自己的医疗决定的老年人。托克博士还设计了一种具有教育意义的 这一计划将进一步促进她作为独立调查员的发展。该计划重点关注四个领域。 托克和她的导师认为对她的职业发展至关重要的是：衰老和临床老年病学； 沟通理论；拨款撰写；临床试验设计。托克博士将出席相关国家 参加会议并完成与这四个领域相关的正式课程工作。她还将扩大她的 参与老年急诊护理和记忆护理对临床老年病的认识 位于印第安纳大学内的诊所。 相关性(请参阅说明)： 随着人口老龄化，面临严重疾病但无法自己制造疾病的患者数量 医疗决定将会上升。生命末期的护理往往与患者或家属的愿望不一致， 而指导代孕决策的法律可能与临床实践不符。尽管如此，非常 很少有研究探索决策过程在临床环境中发生的情况。

This is a proposal for a Mentored Patient-Oriented Research Career Development Award (K23) for Alexia Torke. Dr. Torke began her medical career as a clinician educator in general internal medicine with a focus on medical ethics. After five years as a faculty member at Emory University, she went back into training to complete a fellowship in ethics and primary care. She is currently an Assistant Professor of Medicine at Indiana University and a Research Scientist at the Indiana University Center for Aging Research. Her research now focuses on both medical and ethical aspects of decision making for older adults. Dr. Torke's long term goalis to improve the medical care ofhospitalized older adults who are unable to make their own decisions. This Career Development Award would provide her with the training and protected time needed to accomplish a crucial step toward that goal: characterizing the decision making process as it occurs for these patients. Dr. Torke proposes to conduct a prospective, observational study of older adults and their surrogate decision makers. The specific aims ofthis study are to describe the frequency, characteristics, and clinical context of surrogate decisions, and to identify important determinants of successful communication and high quality decision making from the surrogate's perspective. Patients 65 and older will be identified on admission and followed during their hospital stay. Data will be collected from treating physicians, from medical record review and from in-depth interviews with surrogate decision makers. These results will serve as the basis for future interventions to improve the care of older adults who are unable to make their own medical decisions. Dr. Torke has also designed an educational plan that will further her development as an independent investigator. The plan focuses on four areas that Dr. Torke and her mentors have identified as crucial to her career development: aging and clinical geriatrics; communication theory; grant writing; and clinical trial design. Dr. Torke will attend relevant national conferences and complete formal course work related to each ofthese four areas. She will also expand her knowledge of clinical geriatrics by participating in the Acute Care for the Elders Unit and the memory care practice located within Indiana University. RELEVANCE (See Instructions): As the population ages, the number of patients who face serious illness but are unable to make their own medical decisions will rise. Care at the end of life Is often inconsistent with what patients or families want, and laws that guide surrogate decision making may be out of step with clinical practice. In spite of this, very little research is available that explores the process of decision making as it occurs in the clinical setting.