Treatment goals at the end of life

描述（由申请人提供）：一名老年病学家， 和定性研究技能，弗里德博士准备巩固她的职业生涯， 作为一名独立调查员 K02，被描述为一个暂停临床 责任奖励，将允许她避免额外的临床 否则，她将在她的早期职业生涯中承担的责任 发展奖励结束。 她的研究项目集中在 老年人对不同照料强度和地点的偏好， 这些替代照料战略的成果。 它始于项目 检查对维持生命治疗和预先指示的态度， 护理之家居民肺炎的治疗和结果 医院转移。 更多的研究已经检查了使用和更老的 人的态度，以家庭为治疗地点，在急性和终端 病 最近的工作重点是老年人的治疗偏好， 严重的绝症。 本工作的结果包括可靠性和有效性 新的以患者为中心的治疗偏好措施和发展的一个 这是一个独特的老年重症门诊患者队列。 在这一早期工作的基础上，拟议研究的总体目标 是检查病人及其家属的偏好变化 一系列的疾病。 主要目的是确定 主要诊断，健康状况和医疗保健利用率 患者及其家属的偏好。 该研究将涉及226 身患绝症的老年人和一名家庭成员。 他们将在 如果病情稳定，每四个月回家一次， 月，病情进展。疾病诊断的关系， 健康状况（功能状态、症状、自评健康）、医疗保健 利用率，并了解疾病预后的偏好将是 使用纵向重复测量分析进行检查。 弗里德博士的研究 该计划还包括额外的队列研究检查沟通， 症状和功能，在本研究组和干预研究，以提高 医患沟通 与擅长以患者为中心的研究的同事一起， 管理和分析支持，以及高级教师和行政 致力于弗里德博士的持续成功，耶鲁大学提供的资源 确保弗里德博士作为一个独立的人继续发展是必要的 调查员

DESCRIPTION (provided by applicant): A geriatrician with both quantitative and qualitative research skills, Dr. Fried is poised to consolidate her career as an independent investigator. The K02, described as a time-off clinical duties award, would permit her to avoid the additional clinical responsibilities she would otherwise be expected to assume as her early career development awards end. Her research program is focused on the elicitation of older persons preferences for different intensities and sites of in care and on the outcomes of these alternative care strategies. It began with projects examining attitudes toward life-sustaining treatment and advance directives, and outcomes of pneumonia in nursing home residents treated with and without hospital transfer. Additional studies have examined the use of and older persons attitudes toward home as a treatment site in acute and terminal illness. Recent work has focused on older persons treatment preferences in serious and terminal illness. Results of this work include reliable and valid new patient-centered measures of treatment preference and the development of a unique cohort of seriously ill older outpatients. Building upon this earlier work, the overall objective of the proposed study is to examine changes in the preferences of both patients and their families across a spectrum of diseases. The primary aim is to determine the effect of primary diagnosis, health status, and healthcare utilization on the preferences of patients and their families. The study will involve 226 terminally ill older persons and a family member. They will be interviewed in their homes every four months if medically stable, and as frequently as every month if the illness is progressing. The relationship of disease diagnosis, health status (functional status, symptoms, self-rated health), healthcare utilization, and understanding of the illness prognosis to preferences will be examined using longitudinal repeated measures analysis. Dr. Fried s research program also consists of additional cohort studies examining communication, symptoms, and function in this study group and intervention studies to enhance physician-patient communication. With colleagues skilled in patient-centered research, extensive data management and analysis support, and senior faculty and administration committed to Dr. Fried s continued success, Yale offers the resources necessary to ensure Dr. Fried s continued development as an independent investigator.