Strengthening Shared Decision-Making for Older Adults with Kidney Failure Considering Kidney Transplant

项目总结/摘要 此K23应用程序的目标是支持考虑肾脏疾病的老年人的共同决策 移植评估和促进凯瑟琳巴特勒博士的过渡到独立作为一个医生科学家 其研究重点是使移植评估过程更加以人为本和公平。 对于越来越多的老年肾衰竭患者来说，肾移植是一种有价值的治疗选择， 但由于他们的预期寿命有限和高并发症负担，大多数人不会接受肾脏。 此外，移植评估本身可能是耗时的，繁重的，并且有风险，特别是对于老年人来说。 特别容易受到积极筛查和治疗并发症影响的成年人。我们 初步工作表明，患者通常对移植的预期知之甚少 评估和有限的机会塑造他们的参与。一个共同决策的过程可能会有所帮助 老年人导航复杂的权衡和肾移植评估中涉及的不确定性。 我们提出了一个综合研究议程，旨在加强围绕转诊的共同决策， 老年人的肾脏移植首先，我们将进行一项基于访谈的定性研究， 老年肾衰竭患者与移植评估过程相关的经验和观点 沿着其家庭成员和临床医生（目标1）。其次，我们将描述的持续时间和可能性， 为全国范围内的肾衰竭患者队列完成移植过程中的离散步骤 (Aim 2）。最后，根据前两个目标，我们将调整和试点测试一个通信工具，以支持 在肾衰竭老年人中，围绕移植转诊的共同决策（目标3）。 在获奖期间，巴特勒博士将建立在她的生物伦理学背景和早期经验， 定性和流行病学研究，以获得新的专业知识，在使用应用定性方法， 设计和开展群组研究，开发和测试交流工具。这个职业 开发计划将得到华盛顿大学特殊研究环境的支持， 包括肾脏研究所和西雅图-丹佛弗吉尼亚州创新中心。巴特勒医生的主要 导师Ann O 'Hare博士是一位国际公认的医生科学家，其研究重点是 复杂的护理过程，为老年肾病患者。巴特勒博士的共同导师 移植流行病学（Peter Reese博士）和通信工具开发和测试（Dr. Margaret“Gretchen”Schwarze）。这里提出的工作将为未来的试验奠定基础， 在授予期间开发的沟通工具，更广泛地说，将确定多种途径， 在个人和系统层面上改进移植评估过程。总的来说，这 工作将定位巴特勒博士成为一个成功的独立的医生科学家，其研究重点 促进以人为本和公平的方法来评估肾移植过程。

PROJECT SUMMARY / ABSTRACT The goals of this K23 application are to support shared decision-making for older adults considering kidney transplant evaluation and to facilitate Dr. Catherine Butler's transition to independence as a physician scientist whose research focuses on making the transplant evaluation process more person-centered and equitable. Kidney transplant can be a valuable treatment option for the growing number of older adults with kidney failure, but because of their limited life expectancy and high burden of comorbidity, most will not receive a kidney. Further, the transplant evaluation itself can be time-consuming, burdensome, and risky, especially for older adults who are particularly vulnerable to the complications of aggressive screening and treatments. Our preliminary work suggests that patients often have little understanding of what to expect from the transplant evaluation and limited opportunity to shape their involvement. A process of shared decision-making could help older adults to navigate the complex trade-offs and uncertainties involved in the kidney transplant evaluation. We propose an integrated research agenda intended to strengthen shared decision-making around referral for kidney transplant among older adults. First, we will conduct an interview-based qualitative study to elicit the experiences and perspectives of older adults with kidney failure related to the transplant evaluation process along with their family members and clinicians (Aim 1). Second, we will describe the duration and likelihood of completing discrete steps in the transplant process for a large national cohort of patients with kidney failure (Aim 2). Finally, informed by these first two aims, we will adapt and pilot-test a communication tool to support shared decision-making around referral for transplant among older adults with kidney failure (Aim 3). During the award period, Dr. Butler will build upon her background in bioethics and early experience in qualitative and epidemiologic research to acquire new expertise in the use of applied qualitative methods, design and conduct of cohort studies, and development and testing of communication tools. This career development plan will be supported by the exceptional research environment at the University of Washington, including the Kidney Research Institute and the Seattle-Denver VA Center of Innovation. Dr. Butler's primary mentor, Dr. Ann O'Hare, is an internationally recognized physician scientist whose research focuses on complex care processes for older adults with kidney disease. Dr. Butler's co-mentors have complementary expertise in transplant epidemiology (Dr. Peter Reese) and communication tool development and testing (Dr. Margaret “Gretchen” Schwarze). The work proposed here will lay the foundation for a future trial to test the communication tool developed during the award period and, more broadly, will identify multiple avenues to improve upon the transplant evaluation process at both the individual- and systems-levels. Collectively, this work will position Dr. Butler to become a successful independent physician scientist whose research focuses on fostering a more person-centered and equitable approach to the kidney transplant evaluation process.