A communication tool to assist older adults facing difficult surgical decisions

描述（申请人提供）：一种帮助老年人做出困难的手术决定的沟通工具摘要手术经常会给年老体弱的患者带来他们不想要的积极治疗的负担1，并且通常无法延长这些患者的生存期或使其恢复到手术前的生活质量。3对患有慢性病的老年患者进行手术的数量很大，而且还在增加，25%的美国老年人在生命的最后三个月内接受了手术。这些患者更可能需要重症监护和延长住院时间，进行手术的决定可能会使虚弱的老年患者沿着护理轨迹开始， 与他或她的个人偏好和目标不一致。这项建议有助于改善正在考虑手术的体弱老年人的决策过程的长期目标，使他们的治疗选择反映他们的个人偏好和目标。“一种帮助老年人做出困难手术决策的沟通工具”是一项为期两年的R 03，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，旨在帮助老年患者做出符合其个人偏好的手术决策。该项目有三个目标：目的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;目的2，评估沟通工具在临床环境中对患者的可接受性;目的3，开发招募和 数据收集的标准操作程序，为今后的研究。该奖项将产生必要的数据和程序，以提交竞争性R34申请进行更大规模的疗效试验。这项研究是创新的，因为它测试了一种新的，理论上接地干预在体外（与标准化的患者）和体内（在临床实践中） 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 最终发现有效，它提供了一种低成本的策略，以改善外科医生在困难的手术决策期间与年老体弱患者的接触。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，并将由一个与老龄化有关的决策和保健服务研究专家小组指导。

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.