Understanding and Improving Surgical Decision-Making for Persons Living with Dementia, their Family Caregivers, and their Providers: A Mixed Methods Study

了解和改善痴呆症患者、其家庭护理人员及其提供者的手术决策：一项混合方法研究

• 批准号: 10595437
• 负责人: Joel S. Weissman
• 金额: $ 29.22万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595437
• 关键词: Address; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Surgical Procedures; Area; Award; Awareness; Benign; Blood Vessels; Budgets; Caregivers; Caring; Case Study; Cholecystectomy; Clinical; Colectomy; Consensus; Data; Decision Making; Dementia; Elderly; Emergency Situation; Epidemiology; Family Caregiver; Funding; Goals; Health; Health system; Hip Fractures; Interview; Investigation; Investments; Link; Malignant Neoplasms; Medical; Medicare; Methods; Obstruction; Operating Rooms; Operative Surgical Procedures; Orthopedic Procedures; Outcome; Outpatients; Parents; Patient-Centered Care; Patient-Focused Outcomes; Patients; Peer Review; Persons; Policies; Population; Procedures; Process; Provider; Quality of life; Recommendation; Recovery; Research; Research Infrastructure; Research Priority; Risk; Specific qualifier value; Surgeon; Time; Training; United States National Institutes of Health; Vulnerable Populations; Work; acute care; base; comparative; cost; design; evidence base; evidence based guidelines; experience; improved; informant; interest; knee replacement arthroplasty; malignant breast neoplasm; mortality; operation; post-operative rehabilitation; preservation; recruit; surgery outcome

Project Summary/Abstract (30 lines max) Our project, R01AG067507: “Understanding and Improving Surgical Decision-Making for Persons Living with Dementia, their Family Caregivers, and their Providers: A Mixed Methods Study”, has made great progress toward our goals. As per the criteria of PA-20-272, this proposed work will "increase and preserve the parent award’s overall impact " by "achieving certain new research objectives… within the original scope of the peer reviewed and approved project." We have identified four areas of investigation that would benefit from supplemental funding: 1) The need for evidence on outcomes for surgeries in addition to ones specified in the original project. 2) The need to investigate surgery taking place in outpatient settings including Ambulatory Surgery Centers. 3) The need to investigate medical (non-surgical) alternatives for patients who are eligible for surgery yet prefer not to proceed. 4) The need to examine longer term outcomes, such as 4-5 year survival, with more current data. We therefore propose to supplement our current project to understand the epidemiology of surgery for PLWDs, as well as patient, caregiver, and provider practices and challenges of surgical decision-making in clinical settings. Supplemental Aim 1) Develop the evidence base to understand comparative outcomes of surgery provided to PLWDs. We will use Medicare data to: 1) describe the epidemiology of surgery for PLWDs for selected elective major cancer (e.g., breast cancer) and non-cancer surgery (e.g., colectomy for benign conditions, cholecystectomy), and analyze the association of dementia status with outcomes, including 5 year survival and Excess Days in Acute Care (EDAC); 2) Compare outcomes among alternative surgical interventions; and 3) Track outcomes for patients with and without surgery. Supplemental Aim 2) Characterize surgical decision-making for PLWDs in clinical settings for the surgical situations described in Supplemental Aim 1. Supplemental Aim 3) We will supplement our modified Delphi panel to consider the situations described in Supplemental Aim 1. Impact. Results of this supplemental work will greatly increase the impact of the current project using the currently funded research infrastructure. Our study will support key advancements in ADRD research by focusing on under-studied areas of surgical decision-making. Our Aims are linked but not conditional, and results from Aims 1 and 2 will inform the Delphi panel. Our work also will address other NIH research priorities including barriers faced by vulnerable populations, goals of care, and better decision-making.

项目摘要/摘要（最多30行） 我们的项目，R 01 AG 067507：“了解和改善生活在美国的人的手术决策” 与痴呆症，他们的家庭照顾者和他们的提供者：一项混合方法研究”，已经取得了很大的进展， 朝着我们的目标前进。根据PA-20-272的标准，这项拟议工作将“增加和保留 在原有的研究范围内，通过实现某些新的研究目标， 同行评审和批准的项目。“我们已经确定了四个调查领域， 补充资金： 1)除了原始项目中规定的手术外，还需要手术结局的证据。 2)需要调查在门诊环境中进行的手术，包括门诊手术中心。 3)需要为符合手术条件的患者研究医疗（非手术）替代方案 我不想继续了 4)需要用更多的最新数据检查更长期的结果，如4-5年生存率。 因此，我们建议补充我们目前的项目，以了解外科手术的流行病学， PLWD，以及患者，护理人员和提供者的手术决策实践和挑战， 临床环境。 补充目标1）开发证据基础，以了解手术的比较结局 提供给艾滋病毒携带者。我们将使用医疗保险数据：1）描述PLWD手术的流行病学， 选择的选择性主要癌症（例如，乳腺癌）和非癌症手术（例如，结肠良性切除术 条件、胆囊切除术），并分析痴呆状态与结局（包括5年）的相关性 生存率和急性护理中的剩余天数（EDAC）; 2）比较替代手术治疗的结果 干预; 3）跟踪手术和非手术患者的结局。 补充目标2）描述PLWD在临床环境中的手术决策， 补充目标1中描述的情况。 补充目标3）我们将补充修改后的德尔菲面板，以考虑 补充目标1. 冲击这项补充工作的结果将大大增加目前项目的影响， 目前，研究基础设施。我们的研究将支持ADRD研究的关键进展， 专注于研究不足的外科决策领域。我们的目标是相互联系的，但不是有条件的， 目标1和2的结果将通知德尔菲小组。我们的工作也将解决其他NIH研究的优先事项 包括弱势群体面临的障碍、护理目标和更好的决策。