Center on Advancing Decision Making in Aging (CADMA)

描述（由申请人提供）：斯坦福大学老龄化决策推进中心（CADMA）将促进对决策过程和影响晚年健康和福祉的选择决定因素的研究。CADMA研究人员计划对决策过程进行基础和应用研究，目标是制定和实施实用方法，以改善影响老年人福祉的基本决策。这项研究将由心理学家、精神病学家、老年病学家和其他医生、医学信息学专家、流行病学家和经济学家合作进行。CADMA的研究将首先集中在以下几个方面：1）日常生活中的决策，如运动和饮食的选择，影响老年人的健康和功能状态; 2）通过将决策支持工具与电子病历系统相结合，为面临困难医疗选择的老年患者提供临床决策支持;以及3）理解与年龄相关的情绪和认知变化在决策中所起的作用，特别是那些围绕复杂的（例如，健康护理计划选择）和/或情绪化（例如，预先指令）主题。 拟议为行政和通信/传播基础设施（核心A）和新项目开发（核心B）提供支助。这两个核心都建立在斯坦福大学卫生政策中心及其初级保健和成果研究中心正在进行的活动之上，这些中心在行政上是一体化的，支持医学院、人文科学学院、商学院以及外部附属机构（如退伍军人事务部帕洛阿尔托卫生保健系统和帕洛阿尔托医学基金会）的研究。CADMA将支持早期研究及其发展为长期综合项目，然后通过几个相关机制进行实际执行：建立征求和评估试点项目提案的正式程序;由高级教师提供持续的项目评估和指导;举办研讨会并利用其他渠道进行合作和信息交流;为大型研究项目的提案提供建议和支持;促进与社区附属机构和其他外部机构的合作，以进一步测试和传播罗伊巴尔中心研究的产品。 第一年的三个试点项目说明了CADMA对决策过程的关注。其中一个项目将包括开发名为e-Preference的新软件，该软件支持病人通过电子病历界面获取保健决策辅助工具;该项目还将评估该技术在老年患者及其医生共同决策方面的可用性，第二个项目将检查老年人在情感预测方面是否表现出与年轻人类似的缺陷，通过应用斯坦福大学的研究人员在年轻人中使用的范式来测量对金钱激励的情绪反应的预测、体验和回忆。第三部分将研究情绪和认知在决策中的作用，探索专注于深思熟虑和努力的心理处理是否可以帮助老年人做出良好的健康计划选择。 每个项目都建立在多学科合作的基础上，并有可能为越来越多的研究做出贡献，这些研究将转化为有用的决策工具。

DESCRIPTION (provided by applicant): The Stanford Center on Advancing Decision Making for Aging (CADMA) will promote the study of decision making processes and the determinants of choices that affect health and well-being in the later years of life. CADMA researchers plan to conduct basic and applied research on decision making processes with a goal of developing and implementing practical methods for improving fundamental decisions affecting the well-being of the elderly. The research will be conducted by collaborating psychologists, psychiatrists, geriatricians and other physicians, experts on medical informatics, epidemiologists, and economists. CADMA research will initially focus on the following areas: 1) Decision making involved in day-to-day life, such as choices regarding exercise and diet, that influence health and functional status at advanced ages; 2) decision support at the time of clinical encounters for elderly patients who face difficult medical choices by integrating decision support tools with electronic medical records systems; and 3) understanding the roles that aging-related changes in emotion and cognition play in decision making, especially those surrounding complex (e.g., health care plan choice) and/or emotionally charged (e.g., advance directives) topics. Support is proposed for administrative and communications/dissemination infrastructure (Core A) and new project development (Core B). Both of these cores build upon ongoing activities of Stanford's Center for Health Policy and its Center for Primary Care and Outcomes Research, administratively integrated centers that support research spanning the Medical School, the School of Humanities and Sciences, the Graduate School of Business, and external affiliated institutions such as the Veterans Affairs Palo Alto Health Care System and the Palo Alto Medical Foundation. CADMA will support early stage research and its development into longer term, comprehensive projects, followed by practical implementation via several linked mechanisms: Establishing formal procedures for soliciting and evaluating proposals for pilot projects; providing ongoing project evaluation and mentorship by senior faculty; conducting seminars and using other venues for collaboration and information exchange; giving advice and support for proposals for large-scale research projects; and facilitating collaboration with community affiliates and other external bodies for further testing and dissemination of the products of Roybal Center research. The three first-year pilot projects illustrate the CADMA focus on decision making processes. One of the projects will include the development of new software, called e-Preference, that supports patient access to health decision aids through an interface to electronic medical records; this project will also assess the usability of this technology for shared decision making by older patients and their physicians, A second examines whether older adults exhibit deficits similar to younger adults in affective forecasting, by applying a paradigm that Stanford researchers have used in younger adults for measuring prediction, experience, and recollection of emotional responses to monetary incentives. The third will investigate the roles of emotion and cognition in decision making, exploring whether a focus on deliberative and effortful mental processing could aid older people in making good health plan choices. Each project builds upon multidisciplinary collaboration and has the potential to contribute to a growing body of research that will translate into useful decision making tools.