Enhancing Advance Care Planning in Diverse Elders with Limited Literacy

描述（由申请人提供）：所有老年人最终都将面临临终治疗的决定;然而，这些复杂的决定可能会因有限的识字而复杂化。我的长期目标是改善识字能力有限的老年人的临终决策。我接受过临床老年病学培训，获得了高级NIA资助的老年病学研究培训，为该应用程序设计了增量研究议程，并为该议程进行了初步研究。我寻求一个K23奖进行健康素养和老年人临终决策的指导研究，并发展研究技能，成为一名独立的调查员。 美国老年人的平均阅读水平<5年级，有限的识字能力与决策能力受损有关。大多数生命终结决策工具都是在12年级以上编写的。此外，大多数没有引出患者对治疗结果的价值观（例如，治疗后，严重痴呆是否可以接受或不可接受），尽管这种方法被认为会导致更符合患者目标的护理。在本申请中，我解决了对价值观工具的需求（即，一种提高患者对治疗结果的价值的工具），满足了大多数美国老年人的识字需求。该应用程序的目的是（1）调整价值观工具，以满足大多数美国老年人的识字需求;（2）评估首选格式（问卷与故事格式）;（3）将价值观工具调整为视频媒体;（4）评估首选媒体（书面与视频）来呈现价值观工具。所有受试者将从旧金山弗朗西斯科的一家县医院招募，患者组合多样，识字率有限，为40%。对于目标1-4，我将评估老人对书面，故事或视频价值观工具的满意度。对于目标1-3，我将评估该工具的心理测量特性（可靠性和有效性）。目标2和4将评估满意度、知识和对价值观工具的两种形式和媒介的偏好。 我组建了一个强大的指导团队，他们在老年医学、健康素养和心理测量分析方面都有专业知识。我还设计了一个强大的职业发展计划，在其中我将获得心理测量和定性方法，试验设计和成人学习技术的培训，并完成一系列指导研究项目，在那里我将获得技能，成为老龄化研究的领导者。 拟议的工作将导致我的发展作为一个独立的调查员在老龄化研究，并开发一个识字水平适当的工具，以引出老年人的价值观的治疗结果是可靠和有效的。这个应用程序将导致独立的研究，以测试我的假设，我开发的价值观工具将导致价值一致的医疗保健和提高老年人及其家人的满意度。

DESCRIPTION (provided by applicant): All elders will eventually face end-of-life treatment decisions; however, these complex decisions may be compounded by limited literacy. My long-term goal is to improve end-of-life decision making for elders with limited literacy. I have trained in clinical geriatrics, obtained advanced NIA-funded geriatrics research training, designed an incremental research agenda for this application, and conducted the initial studies for that agenda. I seek a K23 award to conduct mentored research in health literacy and end-of life decision making in the elderly and to develop the research skills to become an independent investigator. The mean reading level of US elders is < 5th grade, and limited literacy has been associated with impaired decision-making. Most end-of-life decision tools are written beyond the 12th grade level. Also, most do not elicit patients' values concerning treatment outcomes (e.g. whether, after treatment, being severely demented is acceptable or unacceptable), though this approach is thought to result in care more consistent with patients' goals. In this application, I address the need for a values tool (i.e., a tool that elicits patient values about treatment outcomes) that meets the literacy needs of most U.S. elders. The aims of this application are to (1) adapt a values tool to meet the literacy needs of most US elders; (2) assess the preferred format (questionnaire vs. story format); (3) adapt a values tool into a video medium; and (4) assess the preferred medium (written vs. video) to present the values tool. All subjects will be recruited from a county hospital in San Francisco with a diverse patient mix and a limited literacy prevalence of 40%. For Aims 1-4, I will assess elder's satisfaction with the written, story or video values tool. For Aims 1-3, I will assess the tool's psychometric properties (reliability and validity). Aims 2 and 4 will assess satisfaction, knowledge, and preference between the two formats and mediums of the values tool. I have assembled a strong mentoring team with expertise in geriatrics, health literacy, and psychometric analysis. I have also designed a strong career development plan in which I will obtain training in psychometric and qualitative methods, trial design, and adult learning technologies and complete a series of mentored research projects where I will gain the skills to become a leader in aging research. The proposed work will lead to my development as an independent investigator in aging research, and to the development of a literacy level-appropriate tool to elicit elders' values about treatment outcomes that is reliable and valid. This application will lead to independent research to test my hypothesis that the values tool I develop will result in value-concordant medical care and improved satisfaction for elders and their families.