Identifying Barriers to Patient-Centered Decision Making for Older Adults with Diverticulitis

识别患有憩室炎的老年人以患者为中心的决策的障碍

• 批准号: 10263217
• 负责人: Jessica N Cohan
• 金额: $ 15.25万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10263217
• 关键词: Address; Affect; Age; Aging; Caring; Clinic Visits; Clinical Research; Colectomy; Collaborations; Colorectal; Colorectal Surgery; Colostomy Procedure; Decision Making; Development; Development Plans; Discipline; Disease; Diverticulitis; Elderly; Emergency Situation; Evaluation; Extramural Activities; Foundations; Funding; Future; Geriatrics; Goals; Health; Health Personnel; Health Status; Impaired cognition; Incidence; Interview; Knowledge; Life; Literature; Measures; Mentorship; Methods; Morbidity - disease rate; Nature; Neurocognitive; Older Population; Operative Surgical Procedures; Patient-Centered Care; Patients; Personal Satisfaction; Population; Process; Provider; Public Health; Qualitative Research; Quality of life; Recurrence; Research; Research Methodology; Research Training; Role; Science; Self Efficacy; Sepsis; Site; Social support; Structure; Surgeon; Surveys; Talents; Time; Training; United States; Vulnerable Populations; Work; career; clinical encounter; comorbidity; experience; frailty; functional decline; high risk; improved; innovation; instrument; mortality; mortality risk; novel; patient oriented; patient population; preference; prevent; prophylactic; research clinical testing; support tools; surgical risk; tool

PROJECT SUMMARY/ABSTRACT Diverticulitis affects hundreds of thousands of people over age 60 years in the United States and is the 4th most common reason for emergency surgery in older adults. Due to the substantial consequences of diverticulitis, patient-centered decision making is imperative for this vulnerable population. Existing frameworks for decision making are inadequate for older adults facing surgery because they fail to incorporate the high-risk, irreversible nature of surgical decisions and the unique considerations in older adults (for example, multiple comorbidity, neurocognitive changes, and varying preferences regarding participation in decision making). The central hypothesis of this proposal is that patient-centered decision making is not routinely achieved for older adults with diverticulitis who are faced with a high-stakes decision about proceeding with surgery or observation. The objective of this proposal is to guide the management of older adults facing high-risk surgery through the identification of patient-centered decisions by accomplishing the following specific aims: 1) characterize the decision making process for older adults with diverticulitis, including how patient/provider goals are incorporated into treatment decisions, using a thorough and comprehensive evaluation of “real-time” evaluation of clinical encounters followed by post-encounter interviews with patients and their providers and 2) identify barriers and facilitators to patient-centered decision making using survey instruments informed by the findings of Aim 1 in a large population of older adults with diverticulitis at multiple sites. This is an innovative study that will address significant gaps in the literature regarding surgical decision making for older adults with diverticulitis. This work represents a substantive departure from the existing literature, which focuses on short term morbidity and mortality, by examining the complexity of surgical decision making between older adults and their providers. The results will have a substantial impact because they can be used to 1) tailor existing decision making frameworks for older adults making high-stakes surgical decisions and 2) define the necessary components of a future decision support tool to support. Dr. Cohan’s overall career goal is to become a leader at the intersection of colorectal surgery and aging-related research that improves patient-centered surgical care for older adults. This project includes a comprehensive professional development plan that incorporates mentorship and training to support this career goal. The mentorship team is talented, diverse, and dedicated, spanning the disciplines of geriatrics, surgery, decision science, and qualitative research. The proposed training in geriatric science and mixed-methods research will allow Dr. Cohan to expand upon her prior clinical and research training. Together, the research and professional development in this GEMSSTAR proposal will allow Dr. Cohan to become a colorectal surgeon-leader focused on improving patient-centered care for older surgical patients. The results will directly impact the health and well- being of older adults with diverticulitis.

项目总结/摘要 憩室炎影响美国数十万60岁以上的人，是第四大 老年人紧急手术的常见原因。由于憩室炎的严重后果， 以病人为中心的决策对这一弱势群体至关重要。现有决策框架 对于面临手术的老年人来说，制作是不够的，因为他们没有将高风险，不可逆的 手术决定的性质和老年人的独特考虑因素（例如，多种合并症， 神经认知变化，以及参与决策的不同偏好）。中央 这一建议的假设是，以患者为中心的决策是不是经常实现老年人与 憩室炎患者面临着关于继续手术或观察的高风险决定。的 该提案的目的是通过以下方式指导面临高风险手术的老年人的管理： 通过实现以下具体目标来识别以患者为中心的决策：1）表征 老年憩室炎患者的决策过程，包括如何将患者/提供者的目标结合起来 纳入治疗决策，采用彻底和全面的评价“实时”评价临床 与患者及其提供者进行接触后访谈，2）识别障碍， 促进以患者为中心的决策，使用调查工具，根据目标1的结果， 大量老年人多部位憩室炎。 这是一项创新性研究，将解决文献中关于手术决策的重大空白 对于患有憩室炎的老年人。这项工作是一个实质性的背离现有的文献， 通过检查手术决策的复杂性， 老年人及其提供者。结果将产生重大影响，因为它们可以用于1）定制 现有的决策框架，为老年人作出高风险的手术决定和2）定义 未来决策支持工具的必要组成部分。 博士Cohan的总体职业目标是成为结直肠手术和衰老相关交叉点的领导者 改善以患者为中心的老年人外科护理的研究。该项目包括一个全面的 专业发展计划，包括指导和培训，以支持这一职业目标。的 导师团队才华横溢，多元化，专注，跨越老年医学，外科，决策等学科 科学和定性研究。拟议的老年科学和混合方法研究培训将 允许Cohan博士扩展她之前的临床和研究培训。在一起，研究和专业 GEMSSTAR提案的发展将使Cohan博士成为专注于结直肠外科医生的领导者 改善以病人为中心的老年外科病人护理。结果将直接影响健康和良好的- 老年人憩室炎的症状