A communication tool to assist older adults facing difficult surgical decisions

摘要：手术常常会给年老体弱的患者带来他们不想要的积极治疗的负担，而且延长患者生存期或使患者恢复到手术前的生活质量的能力往往有限为患有慢性疾病的老年患者做手术的数量很大，而且还在不断增加，以至于25%的美国老年人在生命的最后三个月内接受过外科手术由于这些患者更有可能需要重症监护和长期住院治疗，进行手术的决定可能会开始一个虚弱的老年患者沿着可能的护理轨迹

DESCRIPTION (provided by applicant): A communication tool to assist older adults facing difficult surgical decisions ABSTRACT Surgery can frequently burden older frail patients with aggressive treatments they do not want1 and often has limited ability to prolong survival or return these patients to the quality of life they had before surgery.2,3 The number of operations performed on older patients with chronic illness is significant and increasing4 such that 25 percent of older Americans undergo a surgical procedure within the last three months of life.5 Because these patients are more likely to require intensive care and prolonged hospitalization, a decision to proceed with surgery can start a frail elderly patient along a care trajectory that may be inconsistent with his or her personal preferences and goals. This proposal serves the long-term goal of improving the decision-making process for frail older adults who are considering surgery, so that their treatment choices reflect their personal preferences and goals. "A communication tool to assist older adults facing difficult surgical decisions" is a two-year R03, GEMSSTAR proposal to support a feasibility study of a decision support intervention, a communication tool, to help older patients make surgical decisions that align with their personal preferences. This project has three aims: Aim 1, to demonstrate that surgeons can learn to use the communication tool to describe treatment choices to patients; Aim 2, to assess acceptability of the communication tool for patients in a clinical setting; and Aim 3, to develop recruitment and data collection standard operating procedures for a future study. This award will produce the data and the procedures necessary to submit a competitive R34 application for a larger-scale efficacy trial. The research is innovative because it tests a novel, theoretically grounded intervention in both an in vitro (with standardized patients) and an in vivo (in clinical practice) setting where surgeons would be most likely to use it. The research is significant because if it is ultimately found effective, it offers a low-cost strategy to improve surgeon engagement with older frail patients during difficult surgical decisions. The research is feasible because it has been carefully designed to fit the time frame and budget and will be guided by a team of experts in aging-related, decision-making and health services research.