Mentoring Researchers in Advance Care Planning for Underrepresented Older Adults at Risk for Alzheimer’s Disease and Related Dementias and Their Caregivers

项目摘要 该建议的目的是（1）使候选人能够进一步发展她的研究计划，重点是 改善老年人的提前护理计划（ACP）和医疗决策，特别是历史上 边缘化的个人和健康知识有限的人;（2）将她的研究扩大到老年人， 轻度认知功能障碍（PMCI）有患阿尔茨海默病和相关痴呆症（ADRD）的风险， PMCI或ADRD的护理人员;（3）利用她的研究平台指导对以下方面感兴趣的初级研究人员： 以病人为导向的老龄化研究，无论是在老年医学和其他子专业。候选人是一名老年病学家 和姑息医学医生谁建立了资金充足，高影响力，独立的临床 研究计划与杰出的出版物和指导记录。在过去的十年里，她 确立了自己作为一个成功的导师的学生，居民，研究员，和初级教师谁拥有 发表了高影响力的老龄化研究，成功获得资助，并继续参与患者- 研究方向为老龄化。候选人还开发了广泛的研究组合，重点是 编写和测试扫盲和文化上适当的健康教育材料，以改善ACP和医疗保健， 为被边缘化的老年人做出决策。她开发了一种扩展的ACP范式， 不仅对一次性治疗决定，如心肺复苏术（CPR），而且对 准备患者和护理人员沟通他们的愿望并与临床医生一起参与的过程， 随着时间的推移，做出复杂的，即时的医疗决定。她将这一扩展的范式操作化， 易于理解的、以人为中心的程序（即，感谢您对患者的护理，感谢您对 他们的照顾照顾者），使用视频故事来教人们如何识别和沟通他们的 医疗偏好，并做出明智的医疗决定。候选人已收到正在进行的R 01， 其他资金，以测试这些方案在初级保健环境中的效力。该K24提案将提供 候选人与保护时间扩展她的研究在一个新的方向。以实施科学为基础 框架和社区参与的研究，候选人将进行研究，以适应 与PMCI和护理人员一起制定计划，并测试新的在线交付模式的可接受性， 直播、辅导班。候选人还将继续发展她的正式指导 该计划包括招募、选择、发展和评估将成为 老龄化研究的领导者她将与每个学员一起建立个性化的职业发展 完成研究项目并发展独立所需的技能的计划 investigators.这些计划将充分利用优秀的临床研究培训环境， 加州大学弗朗西斯科分校（UCSF）。她将利用她在加州大学旧金山分校的领导地位， 在全国范围内招募对老龄化研究，ACP和边缘化人口感兴趣的学员。

PROJECT 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 medical decision making for older adults, particularly historically marginalized individuals and persons with limited health literacy; (2) expand her research to older persons with mild cognitive impairment (PMCI) at risk for Alzheimer's Disease and Related Dementias (ADRD) and caregivers of PMCI or ADRD; and (3) use her research platform to mentor junior investigators interested in patient-oriented aging research, both within Geriatrics and other subspecialties. The candidate is a Geriatrician and Palliative Medicine physician who has established a well-funded, high-impact, independent clinical research program with an outstanding publication and mentoring record. In the past decade she has established herself as a successful mentor of students, residents, 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 also 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 marginalized older adults. She developed an expanded ACP paradigm that focuses not only on one-time treatment decisions, such as for cardiopulmonary resuscitation (CPR), but also on the process of preparing patients and caregivers to communicate their wishes and to participate with clinicians in making complex, in-the-moment medical decisions over time. She operationalized this expanded paradigm into easy-to-understand, person-centered programs (i.e., PREPARE for YOUR Care for patients and PREPARE for THEIR Care for caregivers) that use video stories to teach people how to identify and communicate their medical preferences and to make informed medical decisions. The candidate has received ongoing R01 and other funding to test the efficacy of these programs in primary care settings. This K24 proposal will provide the candidate with protected time to expand her research in a new direction. Grounded in implementation science frameworks and community-engaged research, the candidate will conduct research to adapt the PREPARE programs with and for PMCI and caregivers and test the acceptability of a new delivery model of online, livestreaming, facilitated group classes. The candidate will also continue to 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 an individualized 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 the University of California, San Francisco (UCSF). She will leverage her leadership positions at UCSF and nationally to recruit mentees interested in aging research, ACP, and marginalized populations.