Improving Quality of Life Measurement in Older Dialysis Patients

 描述（由申请人提供）：75岁以上的成年人是接受透析的增长最快的群体。不幸的是，这些患者中的许多人在开始透析后经历了显著的功能障碍和生活质量（QOL）下降。由于QOL告知治疗决策（例如，关于透析方式、透析中止或治疗时间长度的共同决策）和治疗有效性（即，测量治疗对QOL的影响的研究），准确的QOL测量是必不可少的。肾脏疾病生活质量（KDQOL-36）量表广泛用于临床实践和研究，但尚未在接受透析治疗的老年患者中得到验证，在这些患者中可能存在地板效应。 有问题此外，尚不清楚KDQOL-36是否充分测量了对老年人最重要的QOL领域（例如，灵性、物理环境和生命结束域）。我的长期目标是开发一种以患者为中心的方法来改善老年透析患者的生活质量。作为实现这一目标的第一步，本申请的目的是改善老年透析患者的QOL测量。本申请的目的是：1）确定KDQOL-36在老年患者中的可靠性和有效性，2）确定KDQOL-36中未包含的其他QOL领域，接受透析的老年患者认为这些领域非常重要。在第一个目标中，KDQOL-36的心理测量特性将使用来自接受透析的老年患者的大型队列的数据进行评估。在第二个目标中，患者对生活质量的看法将通过半结构化的采访当地老年患者接受透析和他们的照顾者。在完成这些目标后，我将有初步的数据来开发一种新的，有效的，全面的工具（或一套工具），结合这一人群的价值观和偏好来衡量生活质量。改善老年透析患者的生活质量测量对于未来的干预和成本效益研究至关重要。

 DESCRIPTION (provided by applicant): Adults over 75 years of age comprise the fastest growing group receiving dialysis. Unfortunately, many of these patients experience significant functional impairment and declines in quality of life (QOL) after starting dialysis. Because QOL informs treatment decisions (e.g., shared decision-making about dialysis modality, dialysis discontinuation, or length of therapy) and treatment effectiveness (i.e., research that measures the effect of a treatment on QOL), accurate QOL measurement is essential. The Kidney Disease Quality of Life (KDQOL-36) instrument is widely used in clinical practice and research, but it has not been validated in older patients treated with dialysis, in whom floor effects may be problematic. Also, it is not known if the KDQOL-36 adequately measures QOL domains of highest importance to older adults (e.g., spirituality, physical environment, and end of life domains). My long-term goal is to develop a patient-centered approach to improving quality of life for older dialysis patients. As a first step towards this goal, the objectives of this applicaion are to improve the measurement of QOL in older dialysis patients. The aims of this application are to: 1) determine the reliability and validity of the KDQOL-36 in older patients, and 2) determine additional QOL domains not included in the KDQOL-36 that older patients receiving dialysis view as highly important. In the first aim, the KDQOL-36's psychometric properties will be evaluated using data from a large cohort of older patients receiving dialysis. In the second aim, patient perspectives on QOL will be obtained through semi-structured interviews of local older patients receiving dialysis and their caregivers. Upon completion of these aims, I will have preliminary data to develop a novel, valid, and comprehensive instrument (or set of instruments) that incorporates the values and preferences of this population to measure QOL. Improving the measurement of QOL among older dialysis patients is critical for future intervention and cost-effectiveness studies.