A communication tool to assist older adults facing difficult surgical decisions

描述(由申请人提供)：一种帮助面临艰难手术决定的老年人的沟通工具抽象手术经常会给年长的虚弱患者带来他们不想要的积极治疗1，并且通常在延长生存或使这些患者恢复到手术前的生活质量方面的能力有限。2，3对患有慢性病的老年患者进行的手术次数是显著的，而且还在增加4以至于25%的美国老年人在生命的最后三个月内接受了手术。5因为这些患者更有可能需要重症监护和长期住院，所以决定进行手术可能会让虚弱的老年患者沿着可能的护理轨迹开始 与他或她的个人喜好和目标不一致。这项建议服务于改善正在考虑手术的虚弱老年人的决策过程的长期目标，以便他们的治疗选择反映他们的个人偏好和目标。“帮助面临艰难手术决定的老年人的沟通工具”是一项为期两年的R03，GEMSSTAR提案，旨在支持决策支持干预的可行性研究，这是一种沟通工具，帮助老年患者做出符合他们个人偏好的手术决定。该项目有三个目标：目标1，证明外科医生可以学习使用沟通工具向患者描述治疗选择；目标2，评估患者在临床环境中对沟通工具的可接受性；以及目标3，发展招募和 数据收集标准操作程序，以备将来研究之用。这项裁决将提供必要的数据和程序，以提交具有竞争力的R34申请，进行更大规模的疗效试验。这项研究具有创新性，因为它在体外(标准化患者)和体内(临床实践)中测试了一种新的、理论上扎根的干预措施。 设置外科医生最有可能使用它的地方。这项研究意义重大，因为如果它是 最终被证明是有效的，它提供了一种低成本的策略，在困难的手术决定期间改善外科医生与老年虚弱患者的接触。这项研究是可行的，因为它经过精心设计，符合时间框架和预算，并将由老龄化相关、决策和医疗服务研究方面的专家团队指导。

DESCRIPTION (provided by applicant): A communication tool to assist older adults facing difficult surgical decisions ABSTRACT Surgery can frequently burden older frail patients with aggressive treatments they do not want1 and often has limited ability to prolong survival or return these patients to the quality of life they had before surgery.2,3 The number of operations performed on older patients with chronic illness is significant and increasing4 such that 25 percent of older Americans undergo a surgical procedure within the last three months of life.5 Because these patients are more likely to require intensive care and prolonged hospitalization, a decision to proceed with surgery can start a frail elderly patient along a care trajectory that may be inconsistent with his or her personal preferences and goals. This proposal serves the long-term goal of improving the decision-making process for frail older adults who are considering surgery, so that their treatment choices reflect their personal preferences and goals. "A communication tool to assist older adults facing difficult surgical decisions" is a two-year R03, GEMSSTAR proposal to support a feasibility study of a decision support intervention, a communication tool, to help older patients make surgical decisions that align with their personal preferences. This project has three aims: Aim 1, to demonstrate that surgeons can learn to use the communication tool to describe treatment choices to patients; Aim 2, to assess acceptability of the communication tool for patients in a clinical setting; and Aim 3, to develop recruitment and data collection standard operating procedures for a future study. This award will produce the data and the procedures necessary to submit a competitive R34 application for a larger-scale efficacy trial. The research is innovative because it tests a novel, theoretically grounded intervention in both an in vitro (with standardized patients) and an in vivo (in clinical practice) setting where surgeons would be most likely to use it. The research is significant because if it is ultimately found effective, it offers a low-cost strategy to improve surgeon engagement with older frail patients during difficult surgical decisions. The research is feasible because it has been carefully designed to fit the time frame and budget and will be guided by a team of experts in aging-related, decision-making and health services research.