Improving Older Adults' Decision Making For Obstructive Sleep Apnea Treatment

简介(由申请人提供)：MSHS医学博士Constance H.Fung致力于成为一名独立资助的研究人员，开发和实施以患者为中心的策略，帮助老年人做出明智的医疗决策，纳入他们的偏好和需求。她对应用这些策略护理患有阻塞性睡眠呼吸暂停(OSA)的老年人特别感兴趣。她独特的背景使她成为这一研究领域的理想人选。她拥有老年医学和睡眠医学方面的研究员培训和董事会认证，卫生服务研究方面的研究员培训，以及在改善患者护理方面的领导和研究经验。目前，冯博士得到了美国睡眠医学基金会和加州大学洛杉矶分校/哈特福德卓越中心的种子基金的支持。她正在完成一项关于老年人使用OSA设备障碍的定性研究。职业发展和培训计划：该计划以加州大学洛杉矶分校大卫·格芬医学院卓越的研究和教育环境为特色，以及由在进行老年人睡眠相关临床试验、开发工具以改进共享决策和改善以患者为中心的护理方面经验丰富的研究人员提供的跨学科指导。其他主要资源包括加州大学洛杉矶分校/哈特福德卓越中心、加州大学洛杉矶分校临床和翻译科学研究所，以及退伍军人事务部大洛杉矶医疗系统老年医学、研究、教育和临床中心。该计划还包括精心挑选的正式课程和动手培训。研究计划：拟议研究的总体目标是开发和测试一种策略，将个别老年人的偏好和需求纳入有关阻塞性睡眠呼吸暂停的治疗决策中。该项目将为新诊断为阻塞性睡眠呼吸暂停综合征并面临各种治疗选择的老年人开发和测试一种决策援助。在第一阶段，她将使用定性方法和患者调查来探索影响老年人OSA治疗决定的因素。在第二阶段，她将利用这些发现开发一种为患有阻塞性睡眠呼吸暂停综合征的老年人量身定做的决策辅助工具。在第三阶段，她将为未来的随机对照试验收集可行性数据，该试验将把辅助决策与注意力控制进行比较。有关主要结果(接受/坚持、决策相关结果)和次要结果(睡眠、其他与健康相关的结果和健康系统结果)的过程变量(例如，招聘率)和效果大小的信息将为未来由R01或PCORI资助的大规模试验的设计提供信息。执行这一培训和研究计划所培养的技能将使冯博士成为一名独立研究员，并在帮助老年人将他们的偏好和需求纳入医疗决策的战略方面处于领先地位。

DESCRIPTION (provided by applicant): Constance H. Fung, MD, MSHS is committed to becoming an independently-funded investigator who develops and implements patient-centered strategies for helping older adults make informed health care decisions that incorporate their preferences and needs. She has a particular interest in applying these strategies to care of older adults who have obstructive sleep apnea (OSA). Her unique background makes her an ideal candidate for this field of research. She has fellowship training and board certification in both Geriatrics and Sleep Medicine, fellowship training in Health Services Research, and leadership and research experience in improving patient care. Currently, Dr. Fung is supported by seed funding from the American Sleep Medicine Foundation and the UCLA/Hartford Center of Excellence. She is completing a qualitative study on barriers to OSA equipment use among older adults. Career development and training plan: This plan features an outstanding research and education environment at the David Geffen School of Medicine at UCLA, as well as interdisciplinary mentoring by researchers experienced in conducting sleep-related clinical trials in older adults, developing tools to improve shared decision making, and improving patient-centered care. Additional key resources include the UCLA/Hartford Center of Excellence, UCLA Clinical and Translational Science Institute, and the VA Greater Los Angeles Healthcare System Geriatrics, Research, Education and Clinical Center. This plan also features carefully selected formal coursework as well as hands-on training. Research plan: The overall goal of the proposed research is to develop and test a strategy for incorporating individual older adults' preferences and needs into treatment decisions about OSA. This project will develop and test a decision aid for older adults who are newly diagnosed with OSA and face various treatment options. In phase 1, she will explore the factors that impact OSA treatment decisions among older adults, using qualitative methods and a patient survey. In phase 2, she will use these findings to develop a decision aid tailored to older adults with OSA. In phase 3, she will collect feasibility data for a future randomized controlled trial that will compare the decision aid to an attention control. Information on process variables (e.g., recruitment rates) and effect size for primary (acceptance/adherence, decision-related outcomes) and secondary outcomes (sleep, other health-related, and health system outcomes) will inform the design of a future large-scale R01- or PCORI-funded trial. Skills developed from executing this training and research plan will enable Dr. Fung to become an independent researcher and leader in strategies for helping older adults incorporate their preferences and needs into medical decisions.