Improving age-related risk assessment and documentation for diverse older adults with cancer

改善不同老年癌症患者的年龄相关风险评估和记录

• 批准号: 10371440
• 负责人: Melody K Schiaffino
• 金额: $ 13.7万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10371440
• 关键词: Address; Adult; Affect; Age; Aging; Algorithms; American; Award; Bioinformatics; Biometry; Cancer Center; Cancer Survivor; Caring; Cities; Classification; Clinic; Clinical; Clinical Data; Clinical Trials; Clinical assessments; Communication; Comprehensive Cancer Center; Data; Data Science; Data Set; Decision Making; Development; Diagnosis; Disease; Doctor of Philosophy; Documentation; Elderly; Electronic Health Record; English Language; Ensure; Epidemiology; Face; Faculty; Future; Geriatric Assessment; Geriatrics; Gerontology; Goals; Health Services Research; Health Status; Health system; Interview; K-Series Research Career Programs; Knowledge; Language; Limited English Proficiency; Location; Machine Learning; Malignant Neoplasms; Medical Records; Medicine; Mentors; Methods; Minority; Natural Language Processing; Oncologist; Oncology; Outcome; Patient-Focused Outcomes; Patients; Pattern; Persons; Prevalence; Process; Provider; Quality of Care; Radiation; Radiation Oncology; Research; Research Personnel; Risk; Risk Assessment; Risk Estimate; Risk Factors; Scientist; Series; Survivors; Symptoms; System; Testing; Text; Time; Training; Translational Research; Treatment outcome; Treatment-related toxicity; Uncertainty; Universities; Variant; age effect; age related; algorithm development; cancer care; cancer health disparity; cancer risk; cancer therapy; cancer type; care coordination; care delivery; career; career development; clinical decision-making; clinical examination; clinical implementation; clinical practice; demographics; education research; evidence base; experience; health disparity; health equity; human old age (65+); implementation science; improved; information gathering; medical specialties; member; older patient; oncology program; optimal treatments; patient health information; patient-clinician communication; predictive modeling; professor; routine practice; screening; shared decision making; skills; tenure track; tool; treatment planning

PROJECT SUMMARY Melody K Schiaffino, PhD, MPH is a tenure-track Assistant Professor at San Diego State University (SDSU), a core faculty member in the Center for Health Equity, Education, and Research in Radiation Medicine and Translational Science at UC San Diego, and Associate Member of the UCSD Moores Cancer Center. Dr. Schiaffino received her PhD in Health Services Research in 2014 and MPH in Epidemiology in 2008. As a health disparities systems scientist, Dr. Schiaffino’s goals are to identify organizational and provider-level risk factors that affect how care is delivered to diverse older adults undergoing treatment for cancer to improve sub- optimal care delivery and treatment outcomes. Older, specifically minority, adults are at greater risk due to the higher symptom burden and treatment-related toxicity risk of cancer therapy. The proposal entitled, Improving age-related risk assessment and documentation in diverse older adults diagnosed with cancer, seeks to examine provider and documentation barriers that result in sub-optimal assessment of age-related risk. Age- related risk assessments are a series of evidence based clinical tests and screening that can improve cancer treatment planning for older adults, it is especially salient for older adults experiencing language barriers. There is currently insufficient research on the mechanisms contributing to sub-optimal assessment and documentation of age-related risk in radiation oncology. While evidence supports improved communication and cancer outcomes for patients when age-related risk is assessed, recent clinical trial findings show that only 1 in 4 providers are implementing this assessment in routine practice. Effective assessments are even less common in older adults with English language barriers. Understanding organizational and provider-level perspectives on assessment and documentation practices using electronic health records (EHRs), and qualitatively interviewing and observing oncologists, will help inform future clinic workflow redesign. The proposed career development and training plan supports Dr. Schiaffino’s trajectory toward becoming an independent, aging-systems scientist through the following three goals: 1) Obtain advanced natural language processing (NLP) algorithm development training to extract unstructured text from EHRs, 2) Engage in observation and training in geriatric oncology care delivery, to understand clinical workflow and clinical practices around assessment of age-related risk, and 3) Gain experience in clinical workflow implementation science proposal development. This project will take place at SDSU, UCSD, and City of Hope (Duarte, CA) with mentors who are experts in Geriatrics/Gerontology (Primary: Alison Moore, MD, MS); Radiation Oncology/HSR (Co- Primary: James Murphy, MD, MS, UCSD); Geriatric Oncology/ Decision-Making (Mentor: William Dale, MD, PhD, City of Hope); NLP/Bioinformatics (Mentor: Mike Hogarth, MD, UCSD); Predictive Models/Biostatistics (Collaborator: Barbara Bailey, PhD, SDSU) and clinical implementation science and Limited English Proficiency (LEP) disparities (Collaborator: Alicia Fernandez, MD, UCSF).

项目概要 Melody K Schiaffino 博士、公共卫生硕士是圣地亚哥州立大学 (SDSU) 的终身教授助理教授， 放射医学健康公平、教育和研究中心的核心教员 加州大学圣地亚哥分校的转化科学，加州大学圣地亚哥分校摩尔斯癌症中心的准会员。博士。 Schiaffino 于 2014 年获得卫生服务研究博士学位，并于 2008 年获得流行病学硕士学位。 健康差异系统科学家 Schiaffino 博士的目标是识别组织和提供者层面的风险 影响如何向正在接受癌症治疗的不同老年人提供护理以改善亚健康的因素 最佳的护理服务和治疗结果。老年人，特别是少数族裔成年人，由于以下原因面临更大的风险： 癌症治疗的较高症状负担和治疗相关毒性风险。该提案题为“改进 对被诊断患有癌症的不同老年人进行与年龄相关的风险评估和记录，旨在 检查导致年龄相关风险评估欠佳的提供者和文件障碍。年龄- 相关风险评估是一系列基于证据的临床测试和筛查，可以改善癌症 对于老年人的治疗计划，对于有语言障碍的老年人来说尤其重要。 目前对于导致次优评估和评估的机制还缺乏足够的研究。 放射肿瘤学中年龄相关风险的记录。虽然证据支持改善沟通和 在评估与年龄相关的风险时，患者的癌症结局，最近的临床试验结果表明，只有 1 % 4 家提供商正在日常实践中实施此项评估。有效评估更是少之又少 常见于有英语语言障碍的老年人。了解组织和提供商级别 对使用电子健康记录 (EHR) 的评估和记录实践的看法，以及 定性采访和观察肿瘤科医生，将有助于为未来的临床工作流程重新设计提供信息。这 拟议的职业发展和培训计划支持斯基亚菲诺博士成为一名 独立的衰老系统科学家通过以下三个目标：1）获得先进的自然 用于从 EHR 中提取非结构化文本的语言处理 (NLP) 算法开发培训，2) 参与老年肿瘤护理服务的观察和培训，以了解临床工作流程 和围绕年龄相关风险评估的临床实践，以及 3) 获得临床工作流程经验 实施科学提案制定。该项目将在 SDSU、UCSD 和 City of Hope（加利福尼亚州杜阿尔特）的导师是老年病学/老年学专家（主要：Alison Moore，医学博士、理学硕士）； 放射肿瘤学/HSR（共同主修：James Murphy，医学博士、理学硕士、加州大学圣地亚哥分校）；老年肿瘤学/决策 （导师：William Dale，医学博士、博士，希望之城）； NLP/生物信息学（导师：Mike Hogarth，医学博士，加州大学圣地亚哥分校）； 预测模型/生物统计学（合作者：Barbara Bailey 博士，SDSU）和临床实施科学 和有限英语水平 (LEP) 差异（合作者：Alicia Fernandez，医学博士，加州大学旧金山分校）。