Improving Older Adults' Decision Making For Obstructive Sleep Apnea Treatment

描述（由申请人提供）：Constance H.冯，医学博士，MSHS致力于成为一个独立资助的研究者谁开发和实施以患者为中心的战略，帮助老年人作出明智的医疗保健决策，结合他们的喜好和需求。她对将这些策略应用于患有阻塞性睡眠呼吸暂停（OSA）的老年人的护理特别感兴趣。她独特的背景使她成为这一研究领域的理想人选。她在老年医学和睡眠医学方面都有奖学金培训和董事会认证，在卫生服务研究方面有奖学金培训，在改善病人护理方面有领导和研究经验。目前，冯博士得到了美国睡眠医学基金会和加州大学洛杉矶分校/哈特福德卓越中心的种子基金的支持。她正在完成一项关于老年人使用OSA设备障碍的定性研究。职业发展和培训计划：该计划在加州大学洛杉矶分校大卫格芬医学院提供出色的研究和教育环境，以及在老年人睡眠相关临床试验方面经验丰富的研究人员的跨学科指导，开发工具以改善共同决策，并改善以患者为中心的护理。其他关键资源包括加州大学洛杉矶分校/哈特福德卓越中心，加州大学洛杉矶分校临床和转化科学研究所，以及VA大洛杉矶医疗保健系统老年病，研究，教育和临床中心。该计划还包括精心挑选的正式课程以及实践培训。研究计划：拟议研究的总体目标是开发和测试一种策略，将老年人的个人偏好和需求纳入OSA的治疗决策。该项目将为新诊断患有OSA并面临各种治疗选择的老年人开发和测试决策辅助工具。在第一阶段，她将探索影响老年人OSA治疗决策的因素，使用定性方法和患者调查。在第二阶段，她将利用这些发现开发一种针对OSA老年人的决策辅助工具。在第三阶段，她将为未来的随机对照试验收集可行性数据，该试验将比较决策辅助和注意力控制。有关过程变量的信息（例如，招募率）和主要结局（接受/依从性、决策相关结局）和次要结局（睡眠、其他健康相关结局和卫生系统结局）的效应量将为未来大规模R 01或PCORI资助试验的设计提供信息。通过执行这项培训和研究计划开发的技能将使冯博士成为一名独立的研究人员和领导者，帮助老年人将他们的偏好和需求纳入医疗决策。

DESCRIPTION (provided by applicant): Constance H. Fung, MD, MSHS is committed to becoming an independently-funded investigator who develops and implements patient-centered strategies for helping older adults make informed health care decisions that incorporate their preferences and needs. She has a particular interest in applying these strategies to care of older adults who have obstructive sleep apnea (OSA). Her unique background makes her an ideal candidate for this field of research. She has fellowship training and board certification in both Geriatrics and Sleep Medicine, fellowship training in Health Services Research, and leadership and research experience in improving patient care. Currently, Dr. Fung is supported by seed funding from the American Sleep Medicine Foundation and the UCLA/Hartford Center of Excellence. She is completing a qualitative study on barriers to OSA equipment use among older adults. Career development and training plan: This plan features an outstanding research and education environment at the David Geffen School of Medicine at UCLA, as well as interdisciplinary mentoring by researchers experienced in conducting sleep-related clinical trials in older adults, developing tools to improve shared decision making, and improving patient-centered care. Additional key resources include the UCLA/Hartford Center of Excellence, UCLA Clinical and Translational Science Institute, and the VA Greater Los Angeles Healthcare System Geriatrics, Research, Education and Clinical Center. This plan also features carefully selected formal coursework as well as hands-on training. Research plan: The overall goal of the proposed research is to develop and test a strategy for incorporating individual older adults' preferences and needs into treatment decisions about OSA. This project will develop and test a decision aid for older adults who are newly diagnosed with OSA and face various treatment options. In phase 1, she will explore the factors that impact OSA treatment decisions among older adults, using qualitative methods and a patient survey. In phase 2, she will use these findings to develop a decision aid tailored to older adults with OSA. In phase 3, she will collect feasibility data for a future randomized controlled trial that will compare the decision aid to an attention control. Information on process variables (e.g., recruitment rates) and effect size for primary (acceptance/adherence, decision-related outcomes) and secondary outcomes (sleep, other health-related, and health system outcomes) will inform the design of a future large-scale R01- or PCORI-funded trial. Skills developed from executing this training and research plan will enable Dr. Fung to become an independent researcher and leader in strategies for helping older adults incorporate their preferences and needs into medical decisions.