Improving Patient-Centered Decision-Making for Stress Urinary Incontinence Treatment in Older Men

改善老年男性压力性尿失禁治疗中以患者为中心的决策

• 批准号: 10729838
• 负责人: Lindsay Ann Hampson
• 金额: $ 24.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729838
• 关键词: Academic Medical Centers; Address; Adoption; Affect; Age Years; Aging; Award; Caring; Characteristics; Cohort Studies; Complex; Data; Decision Making; Dedications; Diagnosis; Disease; Disparity; Elderly; Equity; Ethics; Evaluation; Experimental Designs; Face; Foundations; Funding; Future; Geographic Locations; Geriatrics; Goals; Guidelines; Health; Health Services Accessibility; Health Services Research; Health system; Healthcare Systems; Incontinence; Individual; Institution; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Leadership; Link; Malignant neoplasm of prostate; Measures; Medicare; Mental Depression; Mentors; Mentorship; Methods; Operative Surgical Procedures; Patient Preferences; Patients; Prostate Cancer therapy; Prostatectomy; Protocols documentation; Quality of life; Race; Radical Prostatectomy; Regrets; Reporting; Research; Research Personnel; Risk; Rural; Shame; Site; Social isolation; Socioeconomic Factors; Stress Urinary Incontinence; Structure; Surveys; Testing; Time; Training; United States Department of Veterans Affairs; Urinary Incontinence; Urologist; Urology; career; career development; clinical practice; cohort; cost; design; effectiveness/implementation study; effectiveness/implementation trial; experience; experimental study; feasibility trial; functional decline; health care disparity; health related quality of life; implementation outcomes; implementation science; improved; individual patient; individualized medicine; innovation; male; men; multidisciplinary; older men; patient oriented; patient population; personalized decision; pilot test; preference; prototype; recruit; satisfaction; support tools; theories; treatment disparity; urinary; urologic; usability; young man

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Lindsay Hampson, a clinician investigator with a background in ethics, health services research, and stress urinary incontinence (SUI). Dr. Hampson is pivoting her career towards aging, with a goal of becoming a national leader in geriatric urology research focused on achieving goal-concordant care for older adults with urologic issues that affect quality of life (QOL) through reducing treatment disparities and improving treatment decision-making. This proposal seeks to improve goal-concordant management for post-prostatectomy SUI among older adults by: 1) identifying drivers of disparities in the care of older post-prostatectomy men, 2) determining treatment preferences and priorities of this patient population, and 3) promoting individualized evaluation and treatment decision-making in the context of geriatric-informed health and values. Significance: Post-prostatectomy SUI significantly impacts QOL, disproportionately impacting older men. Despite a focus on reducing treatment of prostate cancer, one quarter of men 65-75 years of age diagnosed with prostate cancer will still undergo prostatectomy. An estimated 25-30% of men are using pads, diapers, or complaining of bothersome incontinence beyond one year following prostatectomy, and these rates likely represent underestimation of continence rates in older men. SUI surgery has been shown to result in near-term QOL improvements with high satisfaction rates, yet is severely underutilized and delayed, and men facing treatment decisions have substantial decisional regret. In Aim 1’s national cohort study using Veterans Affairs and Medicare data, we aim to identify factors associated with post-prostatectomy SUI under-treatment and treatment delays among older men. In Aim 2’s discrete choice experiment survey of older post-prostatectomy men, we aim to identify patient-centered SUI treatment priorities and understand how these preferences vary based on characteristics associated with access to care. These data will be utilized to develop an Incontinence Post-Prostatectomy Assessment & Decision Support (I- PADS) tool which will be evaluated in Aim 3 through a mixed methods study and feasibility/acceptability trial. Mentoring team: Dr. Hampson’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for in older adults. This award will support Dr. Hampson’s transition to aging research through dedicated training in 1) conducting national cohort studies of older adults, 2) developing expertise in measuring treatment preferences, 3) implementation science theory and methods to implement interventions for older adults, and 4) leadership in geriatric urology to become a leader in goal-concordant urologic care among older adults by reducing treatment disparities and improving treatment decision-making. Next Steps: These results will serve as the foundation for a multicenter hybrid implementation-effectiveness study of the I-PADS tool to test its effect on addressing disparities in SUI surgery, decisional and treatment regret, and receipt of goal-concordant care for post-prostatectomy SUI.

项目总结/摘要 这是一个比森K76职业发展奖博士林赛汉普森，临床研究与 在伦理学，卫生服务研究和压力性尿失禁（SUI）的背景。汉普森博士是 将她的职业生涯转向老龄化，目标是成为老年泌尿学研究的全国领导者 专注于为患有影响生活质量（QOL）的泌尿系统问题的老年人实现目标一致的护理 通过减少治疗差异和改善治疗决策。这项建议旨在 通过以下方法改善老年人子宫切除术后SUI目标一致性管理：1）确定 在老年男性前列腺切除术后的护理差异的驱动因素，2）确定治疗偏好， 这一患者群体的优先事项，以及3）促进个体化评估和治疗决策 在老年人知情的健康和价值观的背景下。意义：腰椎切除术后SUI显著 影响生活质量，不成比例地影响老年男性。尽管关注于减少前列腺的治疗 尽管如此，在65-75岁被诊断患有前列腺癌的男性中，仍有四分之一的人将接受前列腺切除术。 据估计，25-30%的男性使用护垫、尿布，或抱怨超过一次的尿失禁 这些发生率可能代表了对老年人的复发率的低估。 男人SUI手术已被证明可导致近期QOL改善，满意率高，但 严重未充分利用和拖延，面临治疗决定的男性有很大的决定后悔。在 目标1的国家队列研究使用退伍军人事务和医疗保险的数据，我们的目标是确定相关的因素 在老年男性中，膀胱切除术后SUI治疗不足和治疗延迟。在目标2的离散 选择实验调查老年人的前列腺切除术后，我们的目的是确定以病人为中心的SUI治疗 优先事项，并了解这些偏好如何根据与获得护理相关的特征而变化。 这些数据将用于制定尿失禁前列腺切除术后评估和决策支持（I- 港口及机场发展策略（PADS）工具，将在目标3中通过混合方法研究和可行性/可接受性试验进行评估。 指导团队：汉普森博士杰出的多学科指导团队由路易斯·沃尔特博士领导， 国际公认的老年人个性化决策专家。该奖项将支持 博士汉普森的过渡到老龄化研究通过专门的培训1）进行国家队列 老年人的研究，2）发展测量治疗偏好的专业知识，3）实施科学 实施老年人干预的理论和方法，以及4）老年泌尿外科的领导， 通过减少治疗差异，成为老年人目标一致性泌尿外科护理的领导者， 改善治疗决策。下一步：这些结果将作为多中心研究的基础。 对港口和机场发展综合战略工具进行混合执行-效果研究，以测试其对解决特殊工业化差距的影响 手术、决策和治疗后悔，以及接受与目标一致的治疗。