Deciding about Dialysis: Improving Decision-Making Among Older Adults with ESRD

决定是否进行透析：改善患有 ESRD 的老年人的决策

• 批准号: 10599524
• 负责人: MELISSA WACHTERMAN
• 金额: $ 14.52万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10599524
• 关键词: Address; Adult; Aging; Biometry; Caregiver Burden; Chronic Disease; Clinical; Cognitive; Communication; Communities; Complex; Data; Decision Aid; Decision Making; Development; Dialysis patients; Dialysis procedure; Disease; Elderly; End stage renal failure; Ensure; Family; Funding; Goals; Health Policy; Health Services; Health and Retirement Study; Hearing; Impairment; Individual; International; Interview; K-Series Research Career Programs; Kidney Failure; Knowledge; Learning; Life; Life Expectancy; Link; Longevity; Longitudinal Surveys; Medical; Medicare; Medicine; Melissa; Mentored Patient-Oriented Research Career Development Award; Mentors; Modeling; Pain; Palliative Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Phase; Physicians; Process; Prognosis; Qualitative Research; Quality of Care; Quality of life; Regrets; Research; Research Methodology; Research Personnel; Resources; Science; Surveys; Symptoms; Time; Training; Transition Career Development Award (K22); aged; aggressive therapy; burden of illness; career; career development; cognitive function; demographics; design; expectation; functional status; health data; improved; longitudinal analysis; medical schools; mid-career faculty; mortality; older patient; patient oriented; pilot test; preference; prognostic; reduce symptoms; skills; success; treatment center

Individuals 70 and older are the fastest growing group of patients with end-stage renal disease (ESRD). Research shows that decision-making regarding initiation of dialysis is impaired by poor communication and lack of understanding about the options for management of ESRD. Some small studies suggest that, among older adults, dialysis is likely associated with longer life expectancy compared to conservative management without dialysis. Yet little is known about what older adults can expect after initiating dialysis in terms of patient- centered outcomes such as functional status and cognitive function. Furthermore, there has been little research into patient, family, and clinician perspectives on this decision-making process. This proposal has the following three complementary aims that address these challenges related to dialysis decision-making: 1) Define the trajectories of functional status and cognitive function for adults 70 and older with ESRD before and after initiation of dialysis, compared to the trajectories of adults not on dialysis. 2) Explore perspectives about the decision to initiate dialysis (versus conservative management) among adults 70 and older, their families, and clinicians. 3) Develop a decision aid for older patients with impending ESRD. The first project is a quantitative analysis using nationally-representative longitudinal survey data from the Health and Retirement Study. The second project features qualitative interviews with patients, families, and clinicians about the dialysis decision-making process. The third project will use the knowledge gained from Aims 1 and 2 to inform the design of a decision aid for adults 70 and older who are expected to need dialysis. The overall objective of this K23 Career Development Award (CDA) is to support the early career of Dr. Melissa Wachterman, a palliative care physician and health services researcher at Harvard Medical School. Dr. Wachterman is a promising junior investigator specializing in research related to geriatric palliative care. Her career goal is to become an independently-funded clinician-investigator conducting research that improves quality of care and patient-centered treatment decision-making for seriously-ill older adults and their families. This K23 award will help Dr. Wachterman accomplish the following goals: 1) to obtain advanced training in biostatistics, including analytic skills using longitudinal nationally-representative survey data; 2) to acquire training in qualitative research methods; 3) to develop skills in decision aid development; 4) to develop as an investigator to ensure a successful transition from this CDA to independent R01-level funding. To achieve these goals, Dr. Wachterman has a mentoring team committed to her success as a clinician investigator. Her primary mentor is Dr. Nancy Keating, Associate Professor of Medicine and Health Policy at Harvard Medical School and an internationally-recognized health services researcher with expertise in palliative care. Her co-mentor is Dr. Edward Marcantonio, a geriatrician and internationally-renowned aging researcher. Dr. Wachterman will benefit greatly from working in Harvard’s vibrant research community.

70岁及以上的人是终末期肾病(ESRD)患者中增长最快的群体。 研究表明，沟通不畅会影响有关开始透析的决策 对ESRD的管理方案缺乏了解。一些小型研究表明，在 老年人，与保守治疗相比，透析可能与更长的预期寿命有关 不需要透析。然而，对于老年人开始透析后患者的预期情况，人们知之甚少。 以功能状态和认知功能为中心的结果。此外，几乎没有研究。 关于这一决策过程的患者、家庭和临床医生的观点。 该提案有以下三个相辅相成的目标，以应对与以下相关的挑战 透析决策：1)确定成人的功能状态和认知功能的轨迹 老年ESRD患者在开始透析前后与未接受透析的成年人的轨迹进行比较。2) 探讨在成人中决定开始透析(与保守治疗相比)的观点70 更年长的人，他们的家人，和临床医生。3)为即将发生终末期肾病的老年患者开发决策辅助工具。 第一个项目是使用具有全国代表性的纵向调查数据进行量化分析 健康与退休研究。第二个项目是对患者、家属、 和临床医生对透析决策过程的了解。第三个项目将使用从 目标1和目标2旨在为预计需要透析的70岁及以上成年人提供决策辅助设计。 这个K23职业发展奖(CDA)的总体目标是支持博士的早期职业生涯。 哈佛医学院姑息治疗内科医生和卫生服务研究员梅丽莎·瓦赫特曼说。 Wachterman博士是一名有前途的初级研究员，专门从事与老年姑息治疗相关的研究。 她的职业目标是成为一名独立资助的临床医生兼研究员，从事改善 为重病老年人及其家人提供高质量的护理和以患者为中心的治疗决策。 这一K23奖项将帮助Wachterman博士实现以下目标：1)获得高级 生物统计学方面的培训，包括使用具有全国代表性的纵向调查数据的分析技能；2) 获得定性研究方法方面的培训；3)发展决策辅助开发的技能；4)发展 作为一名研究人员，确保从CDA成功过渡到独立的R01级资金。 为了实现这些目标，Wachterman博士有一个指导团队致力于她作为一名临床医生的成功 调查员。她的主要导师是南希·基廷博士，医学和卫生政策副教授 哈佛医学院和国际公认的卫生服务研究员，在 姑息治疗。她的共同导师是老年病学家、国际知名的老年医生爱德华·马坎托尼奥博士 研究员。瓦赫特曼博士将从哈佛充满活力的研究界工作中受益匪浅。

项目成果

Association of Hospice Payer With Concurrent Receipt of Hospice and Dialysis Among US Veterans With End-stage Kidney Disease: A Retrospective Analysis of a National Cohort.

• DOI: 10.1001/jamahealthforum.2022.3708
• 发表时间: 2022-10-07
• 期刊: JAMA HEALTH FORUM
• 作者: Wachterman, Melissa W;Corneau, Emily E;O'Hare, Ann M;Keating, Nancy L;Mor, Vincent
• 通讯作者: Mor, Vincent

A comparison of end-of-life care quality for Veterans receiving hospice in VA nursing homes and community nursing homes.

在退伍军人管理局疗养院和社区疗养院接受临终关怀的退伍军人临终护理质量的比较。

• DOI: 10.1111/jgs.18606
• 发表时间: 2024
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Wachterman,MelissaW;Smith,Dawn;Carpenter,JoanG;Griffin,HillaryL;Thorpe,Joshua;Feder,ShelliL;Hoelter,Jillian;Ersek,Mary;Shreve,Scott;Kutney-Lee,Ann
• 通讯作者: Kutney-Lee,Ann

Breaking the Link Between Enrollment in Hospice and Discontinuation of Dialysis.

• DOI: 10.1001/jamainternmed.2022.6390
• 发表时间: 2023-03-01
• 期刊: JAMA INTERNAL MEDICINE
• 影响因子: 39
• 作者: Romero, Kai;Widera, Eric;Wachterman, Melissa W.
• 通讯作者: Wachterman, Melissa W.

Dying Poor in the US-Disparities in End-of-Life Care.

美国的贫困临终——临终关怀方面的差异。

• DOI: 10.1001/jamahealthforum.2020.1533
• 发表时间: 2020
• 期刊: JAMA health forum
• 作者: Wachterman,MelissaW;Sommers,BenjaminD
• 通讯作者: Sommers,BenjaminD

Family Perceptions of Quality of End-of-Life Care for Veterans with Advanced CKD.

家庭对患有晚期 CKD 的退伍军人的临终护理质量的看法。

• DOI: 10.2215/cjn.01560219
• 发表时间: 2019
• 期刊: Clinical journal of the American Society of Nephrology : CJASN
• 作者: Richards,ClaireA;Liu,Chuan-Fen;Hebert,PaulL;Ersek,Mary;Wachterman,MelissaW;Reinke,LynnF;Taylor,LeslieL;O'Hare,AnnM
• 通讯作者: O'Hare,AnnM