Strengthening Shared Decision-Making for Older Adults with Kidney Failure Considering Kidney Transplant

项目摘要/摘要 此K23应用程序的目标是支持考虑肾脏的老年人的共享决策 移植评估和促进凯瑟琳·巴特勒博士向独立的内科科学家过渡 他们的研究重点是使移植评估过程更加以人为本和公平。 肾移植对于越来越多的患有肾衰竭的老年人来说是一种有价值的治疗选择， 但由于他们有限的预期寿命和高共病负担，大多数人将不会得到肾脏。 此外，移植评估本身可能会耗费时间、负担和风险，尤其是对老年人 特别容易受到积极筛查和治疗并发症影响的成年人。我们的 初步工作表明，患者通常不太了解移植会带来什么。 评估和塑造他们参与的机会有限。共享决策的过程可能会有所帮助 老年人需要在肾脏移植评估中进行复杂的权衡和不确定性。 我们提出了一项综合研究议程，旨在加强围绕推荐的共享决策 老年人的肾脏移植。首先，我们将进行以访谈为基础的定性研究，以得出 与移植评估过程相关的老年肾功能衰竭患者的经验和前景 以及他们的家人和临床医生(目标1)。第二，我们将描述持续时间和可能性 为一大批全国肾功能衰竭患者完成移植过程中的离散步骤 (目标2)。最后，受这前两个目标的启发，我们将调整和试运行一个通信工具来支持 关于肾功能衰竭的老年人的移植转诊的共同决策(目标3)。 在获奖期间，巴特勒博士将以她在生物伦理学方面的背景和早期在 定性和流行病学研究：在应用定性方法方面获得新的专门知识； 设计和进行队列研究，开发和测试通信工具。这份职业 发展计划将得到华盛顿大学特殊的研究环境的支持， 包括肾脏研究所和西雅图-丹佛退伍军人管理局创新中心。巴特勒医生的初诊 导师安·奥黑尔博士是一位国际公认的内科科学家，他的研究重点是 为患有肾病的老年人提供复杂的护理流程。巴特勒博士的联合导师有互补的 在移植流行病学(Peter Reese博士)和通信工具开发和测试(Dr.Peter Reese)方面的专业知识 玛格丽特·“格雷琴”·施瓦茨)这里提出的工作将为未来的试验奠定基础 在授奖期间开发的通信工具，更广泛地说，将确定多种途径来 在个人和系统两个层面改进移植评估过程。总而言之，这 这项工作将使巴特勒博士成为一名成功的独立内科科学家，他的研究重点是 在肾移植评估过程中培养更加以人为中心和公平的方法。

PROJECT SUMMARY / ABSTRACT The goals of this K23 application are to support shared decision-making for older adults considering kidney transplant evaluation and to facilitate Dr. Catherine Butler's transition to independence as a physician scientist whose research focuses on making the transplant evaluation process more person-centered and equitable. Kidney transplant can be a valuable treatment option for the growing number of older adults with kidney failure, but because of their limited life expectancy and high burden of comorbidity, most will not receive a kidney. Further, the transplant evaluation itself can be time-consuming, burdensome, and risky, especially for older adults who are particularly vulnerable to the complications of aggressive screening and treatments. Our preliminary work suggests that patients often have little understanding of what to expect from the transplant evaluation and limited opportunity to shape their involvement. A process of shared decision-making could help older adults to navigate the complex trade-offs and uncertainties involved in the kidney transplant evaluation. We propose an integrated research agenda intended to strengthen shared decision-making around referral for kidney transplant among older adults. First, we will conduct an interview-based qualitative study to elicit the experiences and perspectives of older adults with kidney failure related to the transplant evaluation process along with their family members and clinicians (Aim 1). Second, we will describe the duration and likelihood of completing discrete steps in the transplant process for a large national cohort of patients with kidney failure (Aim 2). Finally, informed by these first two aims, we will adapt and pilot-test a communication tool to support shared decision-making around referral for transplant among older adults with kidney failure (Aim 3). During the award period, Dr. Butler will build upon her background in bioethics and early experience in qualitative and epidemiologic research to acquire new expertise in the use of applied qualitative methods, design and conduct of cohort studies, and development and testing of communication tools. This career development plan will be supported by the exceptional research environment at the University of Washington, including the Kidney Research Institute and the Seattle-Denver VA Center of Innovation. Dr. Butler's primary mentor, Dr. Ann O'Hare, is an internationally recognized physician scientist whose research focuses on complex care processes for older adults with kidney disease. Dr. Butler's co-mentors have complementary expertise in transplant epidemiology (Dr. Peter Reese) and communication tool development and testing (Dr. Margaret “Gretchen” Schwarze). The work proposed here will lay the foundation for a future trial to test the communication tool developed during the award period and, more broadly, will identify multiple avenues to improve upon the transplant evaluation process at both the individual- and systems-levels. Collectively, this work will position Dr. Butler to become a successful independent physician scientist whose research focuses on fostering a more person-centered and equitable approach to the kidney transplant evaluation process.