Treatment goals at the end of life

描述(申请人提供)：一名老年医生，既有定量的 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，被描述为一种休假诊所 职责奖，将允许她避免额外的临床 如果不是这样的话，她应该承担的责任就是她早期的职业生涯 发展奖结束了。她的研究项目专注于启发 老年人对不同护理强度和地点的偏好 关于这些替代护理战略的结果。它始于项目 检查对维持生命的治疗和先行指令的态度， 接受和不接受治疗的养老院居民肺炎的转归 医院转院。其他研究已经检查了和更老的使用情况 急症和临终病人对家作为治疗场所的态度 生病了。最近的工作集中在老年人的治疗偏好上。 严重的绝症。这项工作的结果是可靠和有效的 以患者为中心的新的治疗偏好措施和发展 独一无二的老年重病患者队列。 在这项早期工作的基础上，拟议研究的总体目标 是检查患者及其家属喜好的变化 跨越了一系列疾病。其主要目的是确定 的主要诊断、健康状况和医疗保健利用情况 患者及其家属的喜好。这项研究将涉及226人 患有绝症的老年人和一名家庭成员。他们将在#年接受面试。 如果医疗状况稳定，他们的家每四个月一次，而且每隔一次 如果病情恶化，则每月一次。疾病诊断的关系， 健康状态(功能状态、症状、自评健康)、医疗保健 利用，并了解疾病的预后，以偏好 采用纵向重复测量分析进行检验。弗里德·S博士研究 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中得到加强 医患沟通。 与擅长以患者为中心的研究的同事、广泛的数据 管理和分析支持，以及高级教职员工和行政人员 致力于为S博士继续取得成功，耶鲁提供资源 确保S博士继续独立发展是必要的 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.