Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussions

促进老年肺癌患者以患者为中心的决策：将功能下降的风险纳入治疗讨论

• 批准号: 9973181
• 负责人: Melisa L Wong
• 金额: $ 24.26万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9973181
• 关键词: Affect; Age; Aging; Award; Cancer Center; Cancer Etiology; Cancer Patient; Caregivers; Caring; Characteristics; Clinic; Clinical; Clinical Trials; Clinical Trials Design; Cluster randomized trial; Cohort Studies; Communication; Communication Tools; Complex; Data; Decision Making; Elderly; Enrollment; Environment; Feedback; Focus Groups; Foundations; Frail Elderly; Funding; Future; Geriatric Assessment; Goals; Immunotherapy; Impaired cognition; Individual; International; Intervention; Judgment; K-Series Research Career Programs; Knowledge; Lead; Leadership; Life; Longevity; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medical Oncology; Mentors; Modeling; Multicenter Studies; Older Population; Oncologist; Oncology; Operative Surgical Procedures; Outcome; Participant; Patient Recruitments; Patients; Physical Performance; Pilot Projects; Positioning Attribute; Quality of life; Reporting; Research; Research Personnel; Risk; Risk Factors; Screening for cancer; Site; Structure; Testing; Thoracic Oncology; Toxic effect; Training; Translating; Treatment outcome; Uncertainty; base; cancer care; cancer therapy; care outcomes; career development; chemotherapy; functional adaptation; functional decline; functional disability; functional status; high risk; human old age (65+); improved; innovation; instrumental activity of daily living; mortality; multidisciplinary; novel; patient oriented; personalized decision; primary outcome; shared decision making; skills; tool; treatment choice; treatment risk

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Melisa Wong, a thoracic oncology clinician- investigator dually trained in medical oncology and aging research. Dr. Wong’s long-term goal is to become a national leader in geriatric oncology research, improving cancer care for older adults by aligning treatments with individualized patient goals. More than 72% of older adults with cancer report that they would not choose a treatment that results in functional impairment, even if it improves survival. Yet, oncologists traditionally make treatment decisions based on cancer characteristics, often without discussing how treatment might affect function or eliciting patients’ goals and values. To move from cancer-centered to patient-centered decision making, oncologists must both predict which older adults are at highest risk for functional decline and communicate complex information about benefits and harms to patients in a way that aligns treatments with their goals for function, quality of life, longevity, and other priorities. This proposal aims to 1) identify risk factors for functional decline in daily activities, physical performance, and life-space mobility during chemotherapy and/or immunotherapy in older adults with metastatic lung cancer; 2A) adapt the Best Case/Worst Case (BC/WC) communication tool; and 2B) test its feasibility for use during treatment discussions with older adults with lung cancer. In Aim 1’s multi-site cohort study, patients age 65 and older with metastatic lung cancer will undergo serial geriatric assessments to measure functional status during chemotherapy and/or immunotherapy. In Aim 2A’s focus group study, older adults with lung cancer, caregivers, and oncologists will participate in focus groups to elicit feedback aimed at adapting the BC/WC tool to incorporate function and other patient priorities into patient-centered decision making. In Aim 2B’s pre-post pilot study, oncologists will be trained to use the adapted BC/WC tool; treatment discussions with older adults with lung cancer before and after training will be analyzed. Dr. Wong’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for cancer screening in older adults. This award will support Dr. Wong’s transition to research independence through dedicated training in 1) longitudinal modeling and risk prediction for functional decline in older adults with cancer; 2) shared decision making and decision-making interventions for older adults with functional or cognitive impairment; 3) clinical trial design to test decision-making interventions for older adults with cancer; and 4) leadership skills to direct multicenter research to transform geriatric oncology care. The results from this proposal will serve as the foundation for a multicenter cohort study to develop and validate a risk prediction score for functional decline during lung cancer treatment in older adults and a cluster-randomized trial to test the effect of the adapted BC/WC tool on communication, shared decision making, and receipt of goal-concordant care.

项目概要/摘要 这是为胸部肿瘤临床医生 Melisa Wong 医生颁发的 Beeson K76 职业发展奖 - 研究人员接受过医学肿瘤学和衰老研究的双重培训。黄博士的长远目标是成为 老年肿瘤学研究的国家领导者，通过调整治疗方法改善老年人的癌症护理 具有个性化的患者目标。超过 72% 的患有癌症的老年人表示他们不会选择 即使可以提高生存率，也会导致功能障碍的治疗。然而，肿瘤学家传统上认为 基于癌症特征的治疗决策，通常不讨论治疗可能如何影响 功能或引发患者的目标和价值观。从以癌症为中心的决策转变为以患者为中心的决策 因此，肿瘤学家必须预测哪些老年人功能衰退的风险最高，并且 以与治疗相一致的方式传达有关患者益处和危害的复杂信息 他们的功能、生活质量、长寿和其他优先事项的目标。该提案旨在 1) 识别风险因素 化疗期间日常活动、身体表现和生活空间活动能力下降 和/或患有转移性肺癌的老年人的免疫治疗； 2A) 适应最好情况/最坏情况 （BC/WC）通讯工具； 2B) 测试其在与老年人讨论治疗过程中使用的可行性 患有肺癌。在 Aim 1 的多中心队列研究中，65 岁及以上的转移性肺癌患者将 接受系列老年评估以测量化疗期间的功能状态和/或 免疫疗法。在 Aim 2A 的焦点小组研究中，患有肺癌的老年人、护理人员和肿瘤学家将 参加焦点小组以征求反馈，旨在调整 BC/WC 工具以纳入功能和 将其他患者优先事项纳入以患者为中心的决策中。在 Aim 2B 的前后试点研究中，肿瘤学家将 接受培训以使用改编的 BC/WC 工具；与患有肺癌的老年人讨论治疗前和治疗前的情况 训练后将进行分析。黄博士杰出的多学科指导团队由 Louise 博士领导 Walter，国际公认的老年人癌症筛查个体化决策专家 成年人。该奖项将支持黄博士通过以下方面的专门培训过渡到独立研究：1) 患有癌症的老年人功能衰退的纵向建模和风险预测； 2）共同决策 对有功能或认知障碍的老年人进行制定和决策干预； 3）临床 试验设计以测试对患有癌症的老年人的决策干预措施； 4）指导的领导技能 改变老年肿瘤护理的多中心研究。该提案的结果将作为 为多中心队列研究奠定基础，以开发和验证功能衰退的风险预测评分 在老年人肺癌治疗期间进行了一项整群随机试验，以测试适应后的效果 用于沟通、共同决策和接受目标一致护理的 BC/WC 工具。