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

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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.