Improving Older Adults' Decision Making For Obstructive Sleep Apnea Treatment

描述（由申请人提供）：Constance H. Fung， MD， MSHS致力于成为一名独立资助的研究者，她开发并实施以患者为中心的策略，帮助老年人做出明智的医疗保健决策，包括他们的偏好和需求。她对将这些策略应用于患有阻塞性睡眠呼吸暂停（OSA）的老年人的护理特别感兴趣。她独特的背景使她成为这个研究领域的理想人选。她拥有老年医学和睡眠医学的奖学金培训和委员会认证，健康服务研究的奖学金培训，以及改善患者护理的领导和研究经验。目前，Fung博士获得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支持。她正在完成一项关于老年人使用阻塞性睡眠呼吸暂停设备障碍的定性研究。职业发展和培训计划：该计划的特点是在加州大学洛杉矶分校的大卫·格芬医学院提供出色的研究和教育环境，以及由在老年人睡眠相关临床试验中经验丰富的研究人员提供跨学科指导，开发工具以改善共同决策，并改善以患者为中心的护理。其他关键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转化科学研究所，以及VA大洛杉矶医疗保健系统老年病学，研究，教育和临床中心。该计划还包括精心挑选的正式课程以及实践培训。研究计划：本研究的总体目标是开发和测试一种策略，将老年人的个人偏好和需求纳入OSA的治疗决策中。该项目将开发和测试一种决策辅助工具，用于新诊断为阻塞性睡眠呼吸暂停并面临各种治疗选择的老年人。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治疗决策的因素。在第二阶段，她将利用这些发现开发一种针对OSA老年人的决策辅助工具。在第三阶段，她将为未来的随机对照试验收集可行性数据，该试验将比较决策辅助和注意力控制。有关过程变量（例如，招募率）和主要（接受/依从性、决策相关结局）和次要结局（睡眠、其他健康相关和卫生系统结局）的效应大小的信息将为未来大规模R01或pcori资助试验的设计提供信息。执行该培训和研究计划所培养的技能将使Fung博士成为一名独立的研究人员和领导者，帮助老年人将他们的偏好和需求纳入医疗决策。

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.