Research and mentoring program in shared decision making in the care of older adults

老年人护理共同决策的研究和指导计划

• 批准号: 10592391
• 负责人: MARA A SCHONBERG
• 金额: $ 18.92万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10592391
• 关键词: Adult; Age; Aging; Ancillary Study; Anxiety; Awareness; Breast Cancer Risk Factor; Caliber; Caregivers; Caring; Cessation of life; Client satisfaction; Colorectal Cancer; Decision Aid; Dementia; Detection; Development; Diagnosis; Elderly; Ensure; Family member; Funding; Future; Goals; Guidelines; Habits; Health; Incidence; Infrastructure; Intervention; Investigation; Israel; Knowledge; Life Expectancy; Malignant Neoplasms; Mammographic screening; Mammography; Medical; Medical center; Mentors; Mentorship; Modeling; Online Systems; Outcome; Output; Paper; Patient Care; Patient risk; Patients; Population; Prognosis; Recommendation; Recording of previous events; Research; Research Personnel; Research Project Grants; Resources; Screening for cancer; System; Teacher Professional Development; Testing; Time; Training; Visit; Woman; cancer risk; cancer therapy; colorectal cancer screening; implementation science; improved; malignant breast neoplasm; medical schools; models and simulation; next generation; novel; older women; overtreatment; patient engagement; patient oriented research; pilot test; predictive modeling; preference; primary care clinician; programs; randomized trial; randomized, clinical trials; recruit; screening; secondary analysis; shared decision making; skills; support tools; supportive environment; tool; tumor

Adults >75 years are the fastest growing segment of the US population and are increasingly receiving medical interventions from which they often have little chance to benefit, such as cancer screening. Few of the randomized trials of cancer screening tests included adults >75 years and thus the benefits of screening are uncertain; yet, there are important harms which include anxiety, complications as a result of false positive tests and/or work-up of cancer, and overdiagnosis (detection of non-lethal tumors) leading to overtreatment. Guidelines recommend that cancer screening decisions for adults >75 years be individualized based on their risk for cancer, 10-year life expectancy, and values and preferences. Yet, many older adults are screened for cancer with little knowledge of the harms, including many with <10 year life expectancy who are very unlikely to benefit. Since engaging patients in shared decision making (SDM) improves care, patient satisfaction, and outcomes, my research program aims to improve SDM around cancer screening between older adults and their clinicians through: 1) improving estimation of older adults' long-term prognosis; 2) developing prediction models for late-life cancer; and 3) creating decision aids to help older adults make more informed, preference- sensitive, screening decisions. With a K24 and the supportive environment and resources at Beth Israel Deaconess Medical Center and Harvard Medical School, I aim to continue to build my patient oriented research program in SDM around cancer screening for older adults, to expand my mentorship program to prepare the next generation of aging researchers in SDM, and to expand my own research skills and mentor- ship program by developing new expertise in implementation science. My Specific Aims are: 1)To continue to conduct high quality research that will lead to improved SDM around cancer screening for older adults, with an emerging focus on implementation science. This will be accomplished through my newly funded 5-year NIA R01 project that aims to develop and test a quick and easy-to-use web-based conversation aid to support SDM between PCPs, women >75 years, and their involved family members during a visit and through my ongoing research projects. 2) To use my research as a platform to mentor new investigators in research on improving SDM around medical interventions for older adults, especially for cancer screening, and to help them become independent investigators. This aim will be accomplished by: i. direct involvement of trainees in my research projects, ii. completion of ancillary studies related to my new R01, iii. leveraging my research program's infrastructure to enable my mentees' investigations, and iv. ongoing recruitment and retention of high caliber mentees. Impact: As more medical interventions, like cancer screening, with uncertain benefit but important harms for older adults become available, there is great need for high quality decision tools to support SDM between PCPs and older adults. With mentees I will develop and test novel decision tools to support SDM. A focus on implementation science will ensure these tools are widely implemented thus improving patient care.

75岁的成年人是美国人口中增长最快的部分，他们越来越多地接受医疗服务 他们通常几乎没有机会受益的干预措施，如癌症筛查。几乎没有几个 癌症筛查试验的随机试验包括75年的成年人，因此筛查的好处是 不确定；然而，也有一些重要的危害，包括焦虑、假阳性测试导致的并发症 和/或癌症的工作，以及过度诊断(检测到非致命性肿瘤)导致过度治疗。 指南建议，75岁成年人的癌症筛查决定应根据他们的情况进行个性化 癌症风险、10年预期寿命、价值观和偏好。然而，许多老年人都要接受筛查 对危害知之甚少的癌症，包括许多预期寿命为10年的癌症，他们的可能性很小 从中受益。因为让患者参与共享决策(SDM)可以提高护理、患者满意度和 结果，我的研究计划旨在改善老年人和老年人之间的癌症筛查 他们的临床医生通过：1)改善对老年人长期预后的估计；2)发展预测 老年癌症的模型；以及3)创建决策辅助工具，帮助老年人做出更有见地的、更好的选择- 敏感的筛选决定。拥有K24以及贝斯以色列的支持性环境和资源 女执事医学中心和哈佛医学院，我的目标是继续建立以病人为中心的 围绕老年人癌症筛查的SDM研究计划，将我的导师计划扩大到 为SDM的下一代老年研究人员做好准备，并扩大我自己的研究技能和导师- 通过在实施科学方面发展新的专业知识，SHIP计划。我的具体目标是：1)继续 进行高质量的研究，以改善老年人癌症筛查方面的SDM， 新出现的对实施科学的关注。这将通过我新资助的5年NIA来实现 R01项目，旨在开发和测试快速且易于使用的基于Web的对话辅助工具，以支持SDM 在一次访问期间和我正在进行的过程中，在PCP、妇女和75岁；及其相关的家庭成员之间 研究项目。2)以我的研究为平台，指导新的研究人员改进 围绕老年人的医疗干预，特别是癌症筛查，并帮助他们成为 独立调查人员。这一目标将通过以下方式实现：一、学员直接参与我的研究 项目，II.完成与我的新R01，III相关的辅助研究。利用我的研究项目 基础设施，使我的指导者能够进行调查，以及iv。持续招聘和留住高素质人才 指导者。影响：随着更多的医疗干预，如癌症筛查，虽然益处不确定，但很重要 老年人的危害变得可用，因此非常需要高质量的决策工具来支持SDM 在初级保健医生和老年人之间。我将与学员一起开发和测试支持SDM的新型决策工具。一个 注重实施科学将确保这些工具得到广泛实施，从而改善患者护理。