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

植入式除颤器和老年人：决策和技术模型

• 批准号: 8520150
• 负责人: Daniel D Matlock
• 金额: $ 14.31万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8520150
• 关键词: Address; Age; Aging; Americas; Area; Award; Brain; Breast Cancer Detection; Cardiovascular system; Categories; Clinical Trials; Cognition; Cognitive; Collaborations; Colorado; Comorbidity; Country; Data; Data Analyses; Daughter; Decision Aid; Decision Making; Decision Modeling; Defibrillators; Development; Development Plans; Diffuse; Elderly; Environment; Family; Family member; Fathers; Fellowship; Fostering; Future; Goals; Guidelines; Health; Healthcare; Heart failure; Hospitalization; Implant; Implantable Defibrillators; Internal Medicine; International; Intervention; Interview; Journals; K-Series Research Career Programs; Knowledge; Lead; Learning; Life; Malignant neoplasm of prostate; Medical; Medicare; Medicine; Mentors; Mentorship; Modeling; Monitor; Morbidity - disease rate; New York; Observational Study; Online Systems; Operative Surgical Procedures; Outcome; Outcomes Research; Pacemakers; Parents; Parkinson Disease; Paternalism; Patient Preferences; Patients; Positioning Attribute; Primary Prevention; Prior Therapy; Process; Public Health; Qualitative Research; Quality of life; Registries; Research; Research Activity; Research Personnel; Research Training; Risk; Risk Estimate; Shock; Sleep; Societies; Technology; Testing; Time; Training; Training Activity; Uncertainty; Universities; Variant; Wife; Work; beneficiary; career; career development; caregiving; clinical practice; design; exhaust; experience; functional status; improved; innovation; medical specialties; member; mortality; older patient; policy implication; professor; prognostic; programs; shared decision making; skills; sudden cardiac death; ventricular assist device

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.

描述（由申请人提供）：这是由Dan D. Matlock， MD， MPH提交的NIA K23 Paul B. Beeson奖（RFA-AG-11-009）的首次提交。马特洛克博士的首要职业目标是成为一名领导者，开展研究，从根本上改变和改善老年人对侵入性技术的决策方式。他在此提出的研究使用植入式心律转复除颤器（ICDs）作为模型来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委员会认证的老年病专家，也是科罗拉多大学丹佛分校（UCD）普通内科医学助理教授。他完成了公共卫生硕士学位，并开展了一系列研究，重点关注国际疾病分类的区域差异和决策。他与他的主要导师密切合作；Jean Kutner博士，医学博士，公共卫生硕士。他还接受了他的合作者（包括Fred Masoudi博士，医学博士，MSPH）作为科罗拉多州心血管结果研究小组（CCOR）成员的指导，该小组是全国领先的心血管结果研究小组之一。培训：拟议的K23职业发展计划以以前的奖学金和早期职业发展经验为基础，重点关注需要额外培训的三个领域：1)观察数据分析；2)定性研究；3)共同决策/决策援助开发。因此，Matlock博士建议通过建议的研究进行密集的专题指导、重点课程、研讨会和情境学习。这些培训活动将使Matlock博士能够学习如何最好地制定适合老年人需要的决策支持干预措施。导师/环境：Matlock博士和他的主要导师Kutner博士组建了一个强大的本地导师团队，他们将指导Matlock博士完成拟议的培训和研究活动。为了加强这个团队，dr。Matlock和Kutner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，通过职业发展计划监督Matlock博士的进展，并在他们的专业领域提供指导。此外，Matlock博士是CCOR唯一的老年病专家，这使他成为与衰老相关项目的天然领导者。研究：迫切需要挑战在医疗决策中普遍存在的过时的家长式作风，特别是对老年人的决策。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治疗的风险和生存的真实世界估计，这是为决策提供信息的基本知识。目标2将以Matlock博士之前的研究为基础，回答有关老年人及其家庭成员ICD决策的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可能延长进行性心力衰竭之间的权衡。这项研究将提供对ICD决策制定的清晰理解，因为它适用于老年人，并将直接导致ICD决策辅助工具的开发。目标3将使用已建立的决策支持和决策援助发展准则框架，开发和试点测试基于web的ICD决策援助。总结：也许这项努力最大的创新是它是与心脏病专家合作完成的，可以充分理解决策背景，并最大限度地提高未来的实施和传播。这种合作也服务于将老年医学原理传播到医学的亚专业的更大目标。这项指导研究和培训提案的实施，“植入式除颤器和老年人：决策和技术的模型”，将促进Matlock博士发展成为一个国家认可的独立研究者和领导者，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策的研究。