Involving older adults in decision making for skin cancer

让老年人参与皮肤癌的决策

• 批准号: 9352742
• 负责人: Eleni Linos
• 金额: $ 21.47万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9352742
• 关键词: Actinic keratosis; Address; Affect; Age; Aging; Attitude; Basal Cell; Benefits and Risks; Caregivers; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Comorbidity; Data; Data Collection; Databases; Daughter; Decision Making; Dementia; Dermatologic; Dermatology; Development; Diagnosis; Disease; Elderly; Focus Groups; Frail Elderly; Frail Older Adults; Frequencies; Future; Geriatrics; Goals; Guidelines; Harm Reduction; Health; Hemorrhage; Hour; Infection; Interview; K-Series Research Career Programs; Knowledge; Learning; Lesion; Life; Life Expectancy; Link; Malignant Neoplasms; Medicare; Mentors; Mentorship; Modeling; Neoplasm Metastasis; Operative Surgical Procedures; Patient Outcomes Assessments; Patient Recruitments; Patients; Persons; Physicians; Preparation; Procedures; Published Comment; Publishing; Qualitative Research; Quality of life; Randomized Controlled Trials; Reporting; Research; Retirement; Risk; Science; Skin Cancer; Skin Carcinoma; Squamous cell carcinoma; Structure; Surveys; Testing; The Sun; Training; Training Programs; UV Radiation Exposure; Variant; Work; clinical practice; cost; end of life; evidence base; experience; functional status; improved; individualized medicine; medical specialties; older patient; patient oriented; preference; satisfaction; shared decision making; skills; skin disorder; skin lesion; standard of care; symposium; tool; tumor; wound

PROJECT SUMMARY/ABSTRACT .. Although over 3.6 million basal and squamous cell carcinoma (collectively termed non-melanoma skin cancer or NMSC) and almost 40 million pre-cursor lesions (actinic keratosis) are treated in the US each year, these skin lesions are not dangerous. I have argued that for many frail, older adults at the end of life, the risks of treatment of these highly prevalent tumors may often outweigh the benefits, making nonsurgical management, including active surveillance, a reasonable management option. As these are ubiquitous, slow- growing tumors, patients should be informed of the risks and benefits of all management options in order to make choices consistent with their clinical characteristics, values, and preferences. My goal in applying for a Beeson Emerging Leaders Career Development Award is to gain the knowledge and skills necessary to address the needs of older dermatologic patients with a new outlook informed by geriatrics. I recognize that the science of aging requires a unique skill set, and I cannot be successful in this new field without specific training and mentorship in geriatrics. To accomplish my goals, I need a deeper understanding of geriatric research principles and clinical geriatrics as well as new research skills in qualitative research, patient recruitment, primary data collection, and development and testing of decision tools. Together with my mentoring team, I have developed a rigorous training program that includes outstanding mentoring, structured tutorials, didactic coursework, and presentations at local and national conferences. This training plan will enable me to apply core principles of geriatric science and shared decision- making to the field of dermatology, which will ultimately improve individualized patient-centered dermatology care for older adults. My central hypothesis is that older adults who are fully informed and engaged in management decisions will likely choose more conservative treatment options, report fewer complications, higher satisfaction, and better quality of life. In preparation for testing this hypothesis, I propose to determine the extent of actinic keratosis procedure use near the end of life, using a national database of older adults (Aim 1). By conducting in-depth interviews and focus groups with patients, caregivers, and physicians, I will learn about patients' knowledge and preferences about NMSC and actinic keratoses treatment and barriers to shared decision-making. (Aim 2). This work will result in a set of evidence-based and patient-driven decision tools that can be used in clinical practice (Aim 3). Accomplishing these aims will provide the preliminary data needed to develop a competitive R01 application to test my central hypothesis by determining how these decision tools impact treatment utilization and patient-reported outcomes in a randomized, controlled trial of patients with limited life expectancy.

项目概要/摘要 虽然超过360万基底细胞癌和鳞状细胞癌（统称为非黑色素瘤皮肤）， 癌症或NMSC）和近4000万的前驱病变（光化性角化病）在美国每年被治疗， 这些皮肤损伤并不危险。我认为，对于许多体弱的老年人在生命的尽头， 这些高度流行的肿瘤的治疗可能往往超过好处，使非手术治疗， 管理，包括积极监测，是合理的管理选择。因为它们无处不在，缓慢- 对于生长中的肿瘤，应告知患者所有管理方案的风险和益处， 做出符合其临床特征、价值观和偏好的选择。 我申请Beeson新兴领导者职业发展奖的目标是获得 知识和技能，以满足老年皮肤病患者的需求与新的前景 由老年病学家提供信息。我认识到衰老的科学需要一套独特的技能，我不能 在这一新领域取得成功，而无需在老年医学方面接受专门培训和指导。为了实现目标，我 需要更深入地了解老年医学研究原理和临床老年医学以及新研究 定性研究、患者招募、原始数据收集以及开发和测试 决策工具。我和我的指导团队一起制定了一个严格的培训计划，包括 优秀的指导，结构化的教程，教学课程，并在当地和国家的演示文稿 两会这个培训计划将使我能够应用老年科学的核心原则和共同决策- 使皮肤科领域，这将最终提高个性化的患者为中心的皮肤科 照顾老年人。 我的中心假设是，那些充分了解并参与管理的老年人 决策可能会选择更保守的治疗方案，报告更少的并发症， 满意度和更好的生活质量。为了检验这一假设，我建议确定 使用国家老年人数据库（目标1），在接近生命结束时使用光化性角化病手术的程度。 通过与患者、护理人员和医生进行深入访谈和焦点小组讨论，我将了解 患者对NMSC和光化性角化病治疗的知识和偏好以及共享障碍 决策的(Aim 2）。这项工作将产生一套基于证据和患者驱动的决策工具， 可用于临床实践（目标3）。实现这些目标将提供所需的初步数据， 开发一个有竞争力的R01应用程序，通过确定这些决策工具如何 在一项随机对照试验中， 有限的预期寿命。