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

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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.