Decision Support for Older and Frail Patients Considering Advanced Cardiovascular Therapies: Improving Models of Personal Values Clarification

项目摘要/摘要 这是NHLBI K23导师以患者为中心的职业发展奖(PA-19- 119)作者克里斯托弗·诺普克，LCSW博士，MSW，LCSW。诺普克博士的目标是成为一名领先的社会工作科学家 改进在考虑先进疗法时纳入患者价值观的方法。这 建议使用经导管主动脉瓣置换术(TAVR)作为研究决策支持的模型 心血管疾病患者一般。候选人：诺普克博士是一名有执照的临床社会工作者 现任科罗拉多大学医学院心脏病学系助理研究教授 医学。他拥有硕士学位(华盛顿大学圣路易斯分校)和社会工作博士学位(丹佛大学)。他在工作 与他的主要导师(Daniel Matlock博士，医学博士，公共卫生硕士和Larry Allen，医学博士，MHS)密切合作，接受 来自导师/合作者的指导(包括Russ Glasgow博士、Megan Morris博士、Eric Campbell博士、John Carroll和Laura Scherer)通过科罗拉多州心血管结果研究小组(CCOR)和 科罗拉多大学传播与实施工作组，和ACCETS。培训/导师：这一点 该奖项加强了诺普克医生早期的培训，将重点放在决策中与患者价值相关的三个领域 支持：1)高级定性研究；2)临床医生调查方法；3)传播和 实施科学。诺普克博士建议加强导师指导、课程作业和研讨会，以及 通过拟议的研究进行情景学习。诺普克博士和马特洛克博士组建了一个强大的团队 由当地导师和合作者指导诺普克博士完成培训和研究活动。这些 这些活动将使诺普克博士能够创新地为现实世界的护理开发决策支持工具。研究： 迫切需要提高澄清实施患者价值评估的科学性 他们决定是否接受高级疗法。晚期心血管疾病患者被提供的比例不成比例 这样的疗法。由于高龄和共病可能会降低预期收益，因此有必要将患者的 决策中的价值至高无上。这项研究将产生与临床实践相关的信息。目标1将 描述当前在价值澄清方面的实践状态，因为它实际发生在患者和护理之间 提供商在讨论TAVR时。目标2将包括制定和部署一项从头调查 心脏病学专家，评估支持共享传播所需的设计和背景因素 TAVR中的决策。AIM 3将务实地试行调整决策辅助以适应较老和/或高风险的TAVR 候选人(由Knoepke博士分别开发)，以包括AIMS 1和2的发现。总结： AWARD在社会工作和心脏病学之间的创新合作将最大限度地实施研究结果 并促进诺普克医生发展成为改善患者价值如何得到尊重的领导者 对他们的健康做出复杂的决定。

Project Summary/Abstract This is a first submission for an NHLBI K23 Mentored Patient-Centered Career Development Award (PA-19- 119) by Christopher Knoepke, PhD, MSW, LCSW. Dr. Knoepke’s goal is to be a leading social work scientist improving the methods by which patients’ values are included as they consider advanced therapies. This proposal uses Transcatheter Aortic Valve Replacement (TAVR) as a model for studying decision support for cardiovascular disease patients generally. Candidate: Dr. Knoepke is a Licensed Clinical Social Worker who is currently an Assistant Research Professor in the Division of Cardiology at the University of Colorado School of Medicine. He has a Masters (Washington U. in St. Louis) and PhD in social work (U. of Denver). He works closely with his primary mentors (Drs. Daniel Matlock, MD, MPH & Larry Allen, MD, MHS), receiving mentorship from mentors/collaborators (including Drs. Russ Glasgow, Megan Morris, Eric Campbell, John Carroll, and Laura Scherer) through the Colorado Cardiovascular Outcomes Research Group (CCOR) & the University of Colorado’s Dissemination & Implementation Workgroup, and ACCORDS. Training/Mentors: This award augments Dr. Knoepke’s earlier training by focusing on three areas relevant to patient values in decision support:1) Advanced qualitative research; 2) clinician survey methodology; and 3) Dissemination & Implementation science. Dr. Knoepke proposes intensive mentorship; coursework & workshops, and contextual learning through the proposed research. Drs. Knoepke and Matlock have assembled a strong team of local mentors and collaborators to guide Dr. Knoepke through the training and research activities. These activities will enable Dr. Knoepke to innovatively develop decision support tools for real world care. Research: There is a pressing need to improve the science of clarifying implementing the assessment of patient values as they decide whether to accept advanced therapies. Advanced CVD patients are disproportionately offered such therapies. As advanced age & comorbidity can reduce expected benefits, the need to include patients’ values in decisions is paramount. This study will produce information relevant to clinical practice. Aim 1 will characterize the current state of practice in values clarification as it actually occurs between patients and care providers when they discuss TAVR. Aim 2 will include the development and deployment of a de novo survey of cardiology specialists, assessing design and contextual factors necessary to support dissemination of shared decision making in TAVR. Aim 3 will pragmatically pilot adapt a decision aid for older and/or high risk TAVR candidates (separately developed by Dr. Knoepke) to include findings from Aims 1 & 2. Summary: This award’s innovative collaboration between social work and cardiology will maximize implementation of findings and facilitate Dr. Knoepke’s development into a leader in improving how patient values are honored as they make complicated decisions about their health.