Communication in the Hospital: Impact on the Patient and Surrogate

弱势老年人及其家人在医疗决策、健康方面面临多重挑战 沟通，以及面临重病和死亡所涉及的情感痛苦。亚历克西娅·托克医生的 研究的重点是决策的沟通、伦理、宗教和精神方面 那些丧失行为能力的患者，需要家庭代孕来为他们做决定。这个K24 该奖项将为Torke博士的研究计划提供支持，并将允许她有更多受保护的时间 追求她对指导他人的热情。 这个K24奖项的具体目的是：培养未来的老龄研究人员进行高质量的研究 重点关注弱势老年人及其家庭成员的决策和结果；研究 家庭代孕决策者的经验，包括沟通质量对决策的影响 质量和家庭结果，如焦虑、抑郁和创伤后应激；以及测量 代孕者的宗教和精神经历，以确定这些因素是否与医疗 决策和病人在生命末期所接受的医疗护理。 托克博士的研究主题很重要，因为近一半住院的老年人无法使他们的 拥有自己的医疗决定，并要求家庭成员或其他代孕母亲为他们做出决定。她的前科 研究表明，许多代孕者在高度紧张的情况下对生死问题做出决定 压力大，而且往往得不到临床医生的支持。代孕者依赖于各种来源的情感支持和 医疗决策的价值来源，包括个人、宗教和精神信仰。然而，两者 代孕者和临床医生报告由于情绪和沟通方面的挑战而高度痛苦 替别人做决定。尽管有来自患者研究的证据表明宗教与 在生命末期更倾向于更积极的护理，这还没有被研究用于代孕 为他人做决定。随着人口老龄化和更多的老年人面临认知障碍的风险 减值，代孕决策的重要性只会增加。了解相关机制 从根本上讲，高质量的决策将使我们能够最好地支持家庭成员，并提供最好的 对老年人的可能照顾。 该奖项建议的项目将利用359名住院老年人和他们的数据库 托克博士通过国家R01拨款开发的代理决策者 老龄问题研究所。印第安纳大学健康价值基金和绿色墙提供的额外资金 基金会允许Torke博士还收集由代理CARE认可的CARE目标的数据 在生命末期收到的资料，以及代孕母亲的宗教和精神经历。项目1将探索 沟通质量对决策质量和代孕幸福感的影响，例如 创伤后应激障碍。项目2将考察代孕和遗嘱的宗教和精神层面 研究这些是否会影响医疗决策以及40%的受访者接受的实际护理 在6个月研究观察期内死亡的入选患者。这些项目的发现将 通知制定干预措施，以提高丧失工作能力的患者的医疗护理质量 以及他们家庭成员的福祉。 托克博士是印第安纳大学的终身副教授。她的临床实践涉及姑息疗法 为年老体弱的老年人提供护理和初级护理。她曾指导过16名研究员、住院医生、研究生 和初级教员，从事与医疗决策、沟通和健康结果相关的研究 上了年纪的人。她在印第安纳大学的领导角色，包括她被任命为 印第安纳大学老龄化研究中心(IUCAR)，使她能够指导早期职业调查人员专注于 以病人为中心的研究。这项奖励将为她提供有保障的时间来进一步发展她自己的研究 计划并扩大她的指导活动的范围。 印第安纳大学为这项工作提供了一个理想的地点。Torke博士的主要任命是在IUCAR，在那里 有10名研究人员进行衰老研究。该研究所提供了基础设施，校内 为托克博士的研究提供资金和空间。她正在承担起越来越多的责任，在 研究员和初级教员。通过在IU Health担任领导职务，Torke博士指导了一位牧师 研究人员，并指导了许多伦理学研究员，包括医生和准备攻读博士学位的科学家 开始了他们的研究生涯。其他资源，如印第安纳州临床和翻译 科学研究所(CTSI)为学员提供更多机会，通过临床 调查和翻译教育(CITE)计划和通过KL2职业生涯的资金支持 发展奖。

Vulnerable older adults and their families face multiple challenges in medical decision making, health communication, and the emotional distress involved in facing serious illness and death. Dr. Alexia Torke's research has focused on the communication, ethical, religious and spiritual aspects of decision making for those patients who are incapacitated and require a family surrogate to make decisions for them. This K24 award will provide support for Dr. Torke's program of research and will allow her additional protected time to pursue her passion for mentoring others. The specific aims of this K24 award are to: train future aging researchers to conduct high quality research focused on decision making and outcomes for vulnerable older adults and their family members; to study the experience of family surrogate decision makers, including the impact of communication quality on decision quality and family outcomes such as anxiety, depression, and posttraumatic stress; and to measure surrogates' religious and spiritual experiences to determine whether these factors are associated with medical decision making and the medical care that patients receive at the end of life. Dr. Torke' research topic is important because nearly half of hospitalized older adults are unable to make their own medical decisions and require a family member or other surrogate to make decisions for them. Her prior research has shown that many surrogates make decisions about life and death issues under conditions of high stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both surrogates and clinicians report high levels of distress due to the emotional and communication challenges of making decisions for others. Although there is evidence from patient studies that religion is associated with preferences for more aggressive care at the end of life, this has not been studied for surrogates making decisions for others. As the population ages and a greater number of older adults are at risk for cognitive impairment, the importance of surrogate decision making will only increase. Understanding the mechanisms underlying high quality decision making will allow us to best support family members and to provide the best possible care to older adults. The projects proposed in this award will leverage a database of 359 older hospitalized adults and their surrogate decision makers that Dr. Torke has developed through funding from an R01 grant from the National Institute on Aging. Additional funding from the Indiana University Health Values Grant and the Greenwall Foundation allowed Dr. Torke to also collect data on the goals of care endorsed by the surrogate, care received at the end of life, and the religious and spiritual experiences of the surrogates. Project 1 will explore the impact of communication quality on decision making quality and surrogate well-being, such as posttraumatic stress. Project 2 will examine the religious and spiritual dimensions of the surrogates and will study whether these impact medical decision making as well as the actual care received by the 40% of our enrolled patients who died within the 6-month study observation period. The findings from these projects will inform the development of interventions to improve both the quality of medical care for incapacitated patients and the well-being of their family members. Dr. Torke is a tenured Associate Professor at Indiana University. Her clinical practice has involved palliative care and primary care for older, frail adults. She has mentored over 16 fellows, residents, graduate students and junior faculty in research related to medical decision making, communication and health outcomes for older adults. Her leadership roles at Indiana University, including her appointment as Associate Director of the IU Center for Aging Research (IUCAR), put her in a position to mentor early career investigators focused on patient oriented research. This award will provide her with protected time to further develop her own research program and expand the scope of her mentoring activities. Indiana University provides an ideal location for this work. Dr. Torke's primary appointment is in IUCAR, where there are 10 investigators conducting aging research. The institute has provided infrastructure, intramural funding and space for Dr. Torke's research. She is taking on increasing responsibilities in the mentorship of research fellows and junior faculty. Through leadership roles at IU Health, Dr. Torke mentors a chaplain researcher and has mentored numerous ethics fellows, including physicians and PhD-prepared scientists who are embarking on research careers. Additional resources such as the Indiana Clinical and Translational Sciences Institute (CTSI) enrich opportunities for mentees to obtain research training through the Clinical Investigation and Translational Education (CITE) program and funding support through the KL2 career development awards.