Tube-feeding in Elderly: Decision-making and Outcomes

描述(由申请人提供)：建议发展的目标 该计划是为申请者苏珊·L·米切尔医学博士的职业生涯做准备 老龄化领域的独立调查者和领导者。该奖项将 提供为期五年的有监督的老年病健康服务研究 以下是具体目标：1.培养创新的专门知识 老年人临终前的决策办法，2.至 成为成果研究和资源利用方面的专家 在体弱多病的疗养院患者中使用医疗技术，以及3.利用 这种在决策、健康结果和资源利用方面的专业知识 通过影响临床改善老年人的临终关怀 管理和卫生保健政策。候选人将实现这些目标 通过有指导的研究、课程作业、定向阅读和教育 活动。刘易斯·A·利普西茨博士，老年病学的国际领导者， 哈佛医学院医学教授，哈佛大学老年医学系主任 贝丝以色列女执事医疗中心(BIDMC)，希伯来语联合主任 老年康复中心(HRCA)研究培训研究所将 担任赞助商。利普西茨博士将确保米切尔博士将拥有 利用HRCA丰富的环境优势，成为致力于 老年学护理和研究，以及哈佛老年学分部， BIDMC和哈佛大学公共卫生学院。 这项拟议的研究是一项关于喂养管辅助决策的随机试验 对晚期痴呆患者的养老院居民进行了一年的随访 临床结果和成本。该项目的具体目标是 确定：1.决策辅助(与通常的护理相比)是否会改善 长期管饲的决策过程，2. 关于替代试管喂养的决策者偏好的决策辅助， 3.长期管喂(与不管喂)对临床的影响 养老院老年居民的转归及资源利用 痴呆症。 除了拟议的项目，米切尔博士还将实现她的职业生涯 通过定期与利普西茨博士以及 她的顾问小组包括：1.A·O·康纳博士和A·穆利博士- 决策，卫生政策，2.J.布坎南博士--经济评估，3. M·吉利克博士--生物伦理学，4.温伯格SCD--高级统计方法 5.M.Slaven医生的临终关怀。她的研究活动将是 通过有重点的临床、教育和管理活动予以赞扬 包括哈佛老年医学联谊会副主任 程序。 到获奖期结束时，申请者将具备以下技能、经验 以及成为独立调查员所需的研究记录和 学术老年病学的领军人物。

DESCRIPTION (provided by applicant): The goal of the proposed development program is to prepare the applicant, Susan L. Mitchell MD for a career as an independent investigator and leader in the field of aging. The award will provide five years of supervised geriatrics health services research with the following specific objectives: 1. to develop expertise in innovative approaches to decision-making for older persons at the end-of-life, 2. to become an expert in outcomes research and resource utilization related to the use medical technologies in frail nursing home patients, and 3. to utilize this expertise in decision-making, health outcomes, and resource utilization to improve the end-of-life care in older persons by influencing clinical management and health care policy. The candidate will achieve these goals through mentored research, coursework, directed readings and educational activities. Dr. Lewis A. Lipsitz, an international leader in geriatrics, Professor of Medicine at Harvard Medical School, Chief of Geriatrics at the Beth Israel Deaconess Medical Center (BIDMC) and Co-Director of the Hebrew Rehabilitation Center for Aged (HRCA) Research and Training Institute will serve as sponsor. Dr. Lipsitz will ensure that Dr. Mitchell will have full advantage of the rich environment of the HRCA, a reknowned center dedicated to gerontological care and research, as well as the Harvard Division on Aging, BIDMC and Harvard School of Public Health. The proposed research is a randomized trial of a feeding tube decision aid for nursing home residents with advanced dementia with a one year follow-up of clinical outcomes and costs. The specific aims of the project are to determine: 1. whether a decision-aid (vs. usual care) improves the decision-making process for long-term tube-feeding, 2. the impact of a decision aid on the substitute decision-makers preferences for tube-feeding, 3. the impact of long-term tube-feeding (vs. no tube-feeding) on clinical outcomes and resource utilization in nursing home residents with advanced dementia. In addition to the proposed project, Dr. Mitchell will achieve her career goals by regularly scheduled meeting with Dr. Lipsitz, as well as members of her advisory panel including; 1. Drs. A. O Connor and A. Mulley - decision-making, health policy, 2. Dr. J. Buchanan - economic evaluation, 3. Dr. M. Gillick - bioethics, 4. J. Weinberg ScD - advanced statitstical methods and 5. Dr. M. Slaven - end-of-life care. Her research activities will be complimented by focussed clinical, educational and administrative activities including the associate directorship of the Harvard Geriatrics Fellowship Program. By the end of the award period the applicant will have the skills, experience and research track record necessary to become an independent investigator and leader in academic geriatrics.