Surrogate Decision Making for Hospitalized Older Adults

这是Alexia Torke的指导患者为导向的研究职业发展奖（K23）的建议。 博士Torke开始了她的医学生涯，作为一名普通内科的临床医生教育者，专注于医学 伦理在埃默里大学担任教职五年后，她重返培训并完成了一项 伦理学和初级保健研究金。她目前是印第安纳州大学的医学助理教授 也是印第安纳州大学老龄化研究中心的研究科学家。她的研究现在集中在这两个方面 老年人决策的医学和伦理方面。托克博士的长期目标是改善 医疗照顾住院的老年人谁是无法作出自己的决定。职业发展 奖励将为她提供完成关键一步所需的培训和保护时间 目标：描述这些患者的决策过程。Torke博士建议进行一次 对老年人及其代理决策者的前瞻性观察研究。其具体目标是 研究的目的是描述替代决策的频率、特征和临床背景，并确定 成功沟通和高质量决策的重要决定因素，从代理人的 perspective. 65岁及以上的患者将在入院时被确定，并在住院期间接受随访。数据 将从治疗医生、病历审查和与以下人员的深入访谈中收集 代理决策者这些结果将作为未来干预措施的基础，以改善 老年人无法自己做出医疗决定。托克博士还设计了一个教育 这将进一步推动她作为一名独立调查员的发展。该计划的重点是四个领域，博士。 Torke和她的导师们认为对她的职业发展至关重要的是：老龄化和临床老年医学; 沟通理论;赠款写作;和临床试验设计。Torke博士将参加相关的国家 会议和完成正式的课程工作，涉及到这四个领域。她还将扩大她的 参加长者急症护理部及记忆护理，以加深对临床老人医学的认识 位于印第安纳州大学的实践。 相关性（见说明）： 随着人口老龄化，面临严重疾病但无法自己解决问题的患者人数 医疗决定将上升。临终关怀往往与病人或家属的愿望不一致， 指导代孕决定的法律可能与临床实践不一致。尽管如此，非常 很少有研究探讨决策过程，因为它发生在临床设置。

This is a proposal for a Mentored Patient-Oriented Research Career Development Award (K23) for Alexia Torke. Dr. Torke began her medical career as a clinician educator in general internal medicine with a focus on medical ethics. After five years as a faculty member at Emory University, she went back into training to complete a fellowship in ethics and primary care. She is currently an Assistant Professor of Medicine at Indiana University and a Research Scientist at the Indiana University Center for Aging Research. Her research now focuses on both medical and ethical aspects of decision making for older adults. Dr. Torke's long term goalis to improve the medical care ofhospitalized older adults who are unable to make their own decisions. This Career Development Award would provide her with the training and protected time needed to accomplish a crucial step toward that goal: characterizing the decision making process as it occurs for these patients. Dr. Torke proposes to conduct a prospective, observational study of older adults and their surrogate decision makers. The specific aims ofthis study are to describe the frequency, characteristics, and clinical context of surrogate decisions, and to identify important determinants of successful communication and high quality decision making from the surrogate's perspective. Patients 65 and older will be identified on admission and followed during their hospital stay. Data will be collected from treating physicians, from medical record review and from in-depth interviews with surrogate decision makers. These results will serve as the basis for future interventions to improve the care of older adults who are unable to make their own medical decisions. Dr. Torke has also designed an educational plan that will further her development as an independent investigator. The plan focuses on four areas that Dr. Torke and her mentors have identified as crucial to her career development: aging and clinical geriatrics; communication theory; grant writing; and clinical trial design. Dr. Torke will attend relevant national conferences and complete formal course work related to each ofthese four areas. She will also expand her knowledge of clinical geriatrics by participating in the Acute Care for the Elders Unit and the memory care practice located within Indiana University. RELEVANCE (See Instructions): As the population ages, the number of patients who face serious illness but are unable to make their own medical decisions will rise. Care at the end of life Is often inconsistent with what patients or families want, and laws that guide surrogate decision making may be out of step with clinical practice. In spite of this, very little research is available that explores the process of decision making as it occurs in the clinical setting.