Mentoring Researchers in Advance Care Planning and Communication for Vulnerable Older Populations

摘要 这项提议的目的是(1)使应聘者能够进一步发展她的研究计划，重点是 改善针对弱势老年人的提前护理计划(ACP)和知情医疗决策 (2)利用她的研究项目作为指导初级调查人员以病人为中心的平台 老龄化研究，包括老年病学和其他医学子专业。候选人是一名老年病学家， 姑息医学内科医生，建立了高影响力的独立临床研究计划，这是 资金充足，有出色的出版记录。在完成她的老年医学研究后的10年里， 她已经确立了自己作为学生、研究员和初级教员的成功导师的地位，这些学生、研究员和初级教员发表了 高影响力的老龄化研究，成功获得资助，并继续参与以患者为中心 老龄化研究。候选人开发了广泛的研究组合，专注于创造和 测试识字和文化相适应的健康教育材料，以改善非典和医疗决策 为老年人做准备。她开发了更广泛的ACP范式，不仅专注于一次性 治疗决定，如心肺复苏(CPR)，但也关于准备过程 患者交流他们的意愿，并与临床医生一起进行实时、复杂的医疗 在病程上的决定。她将这一范例转化为一种易于理解的、耐心的- 中心网站名为Prepare，通过视频教患者如何识别他们的愿望和 与代孕者和临床医生沟通。候选人从NIA获得了R01资金，以测试 准备网站吸引来自城市和县医院的不同、脆弱的老年人的效果 使用有效的患者问卷进行ACP。这份K24提案将为候选人提供受保护的时间 将她的研究扩展到一个新的方向，专注于对患者-临床医生的直接观察(即，录音) 初级保健内的沟通是对准备干预的回应。这项新研究 将决定以患者为中心的ACP网站是否能够授权和激活患者讨论ACP和 以促进与其初级保健提供者的沟通。候选人还将发展她的正式 指导计划，包括招募、选拔、发展和评估以下学员的计划 成为老龄化研究领域的领导者。她将与每一位辅导者合作，建立专注的职业发展 制定计划，完成研究项目并培养独立所需的技能 调查人员。这些计划将充分利用加州大学旧金山分校出色的临床研究培训环境。 她将利用她在加州大学旧金山分校的领导职位，招募更多对ACP和 脆弱人群中的老龄化。

ABSTRACT The aims of this proposal are to (1) enable the candidate to further develop her research program focused on improving advance care planning (ACP) and informed medical decision making for vulnerable older adults and (2) use her research program as a platform for mentoring junior investigators interested in patient-oriented aging research, both within Geriatrics and other medical subspecialties. The candidate is a Geriatrician and Palliative Medicine physician who has established a high-impact independent clinical research program that is well funded with an outstanding publication record. In the 10 years since completing her Geriatrics fellowship, she has established herself as a successful mentor of students, fellows, and junior faculty who have published high-impact aging research, become successfully funded, and continue to participate in patient-oriented research in aging. The candidate has developed an extensive research portfolio focused on creating and testing literacy- and culturally appropriate health education materials to improve ACP and medical decision making for older adults. She developed a broader paradigm of ACP that focuses not only on one-time treatment decisions, such as for cardiopulmonary resuscitation (CPR), but also on the process of preparing patients to communicate their wishes and to participate with clinicians in making real-time, complex medical decisions over the course of illness. She operationalized this paradigm into an easy-to-understand, patient- centered website called PREPARE that teaches patients, through videos, how to identify their wishes and communicate with surrogates and clinicians. The candidate received R01 funding from the NIA to test the efficacy of the PREPARE website to engage diverse, vulnerable older adults from an urban, county hospital in ACP using validated patient questionnaires. This K24 proposal will provide the candidate with protected time to expand her research in a new direction focused on direct observation (i.e., audio recording) of patient-clinician communication within primary care encounters in response to the PREPARE intervention. This new research will determine whether a patient-centered ACP website can empower and activate patients to discuss ACP and to facilitate communication with their primary care providers. The candidate will also develop her formal mentoring program with plans for the recruitment, selection, development, and evaluation of mentees who will become leaders in aging research. She will work with each mentee to establish a focused career development plan in which they complete research projects and develop the skills needed to become independent investigators. These plans will make full use of the outstanding clinical research training environment at UCSF. She will leverage her leadership positions at UCSF to recruit more mentees interested in research on ACP and aging in vulnerable populations.