Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies

描述(由申请人提供)：这是第一次提交NIA K23保罗·B·比森奖(RFA-AG-11-009)，由丹·D·马特洛克医学博士，公共卫生硕士。马特洛克博士的首要职业目标是成为一名研究领导者，从根本上改变和改善老年人围绕侵入性技术做出决策的方式。他在这里提出的研究使用植入式心脏复律除颤器(ICD)作为模型来研究如何改善老年人决策这一更大的问题。候选人：马特洛克博士是一名获得董事会认证的老年病学家，也是科罗拉多大学丹佛分校(UCD)普通内科医学助理教授。他完成了公共卫生硕士学位，并进行了一系列研究，重点是ICD的地区差异和决策。他与他的主要导师Jean Kutner博士，医学博士，公共卫生硕士密切合作。他还作为科罗拉多州心血管结果研究小组(CCOR)的成员接受了他的合作者(包括弗雷德·马苏迪博士，医学博士，MSPH)的指导，科罗拉多州心血管结果研究小组是美国领先的心血管结果研究小组之一。培训：拟议的K23职业发展计划建立在团契和早期职业发展的先前经验基础上，侧重于需要额外培训的三个领域：1)观察性数据分析；2)定性研究；3)共同决策/决策辅助开发。因此，马特洛克博士建议通过拟议的研究进行密集的专题指导、重点课程、研讨会和情景学习。这些培训活动将使马特洛克博士能够学习如何最好地开发适合老年人需求的决策支持干预措施。导师/环境：马特洛克博士和他的主要导师库特纳博士已经组建了一个强大的当地导师团队，他们将指导马特洛克博士完成拟议的培训和研究活动。为了加强这一团队，马特洛克博士和库特纳博士组建了一个由国内和国际顾问组成的小组，他们在老年人决策的各个方面具有专业知识，以监督马特洛克博士通过职业发展计划取得的进展，并在他们的专业领域提供指导。此外，马特洛克博士是CCOR中唯一的老年病学家，这使马特洛克博士成为与衰老相关的项目的天然领导者。研究：迫切需要挑战陈旧的家长式作风，这种作风普遍存在于医疗决策中，尤其是老年人的决策中。这项研究将产生与那些在临床实践中工作的人直接相关的信息。目标1将提供ICD治疗的风险和生存的真实世界估计，这是为决策提供信息的基本知识。AIM 2将以马特洛克博士之前的研究为基础，回答有关老年人及其家庭成员ICD决策的重要方面的其他问题。围绕ICDS的一个特别具有挑战性的问题是如何讨论心脏性猝死与进行性心力衰竭可能延长寿命之间的权衡。这项研究将提供对ICD决策的清楚理解，因为它适用于老年人，并将直接导致ICD决策辅助工具的开发。AIM 3将使用已建立的决策支持框架和决策辅助开发指南来开发和试行基于网络的ICD决策辅助。摘要：这项工作的最大创新可能是它是与心脏病专家合作完成的，允许充分理解决策背景，并最大限度地促进未来的实施和传播。这种合作还服务于将老年学原理传播到医学子专业的更大目标。这项有指导的研究和培训提案“植入式除颤器和老年人：决策和技术的模型”的实施，将促进马特洛克博士发展成为一名全国公认的独立研究员和领导者，进行从根本上改变和改善老年人对侵入性技术做出决策的研究。

DESCRIPTION (provided by applicant): This is a first submission for an NIA K23 Paul B. Beeson award (RFA-AG-11-009) by Dan D. Matlock, MD, MPH. Dr. Matlock's overarching career goal is to be a leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies. His research proposed herein uses Implantable Cardioverter-Defibrillators (ICDs) as a model to study the larger question of how to improve decision making for older adults. Candidate: Dr. Matlock is a board-certified geriatrician and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Denver (UCD). He has completed a Master's in Public Health and has conducted a host of studies focused on regional variations and decision making for ICDs. He works closely with his primary mentor; Dr. Jean Kutner, MD, MPH. He also receives mentorship from his collaborators (including Dr. Fred Masoudi, MD, MSPH) as a member the Colorado Cardiovascular Outcomes Research Group (CCOR), one of the leading cardiovascular outcomes research groups in the country. Training: The proposed K23 career development plan builds on prior experience from fellowship and early career development to focus on three areas that require additional training: 1) Observational data analysis; 2) Qualitative research; and 3) Shared decision making/decision aid development. Accordingly, Dr. Matlock proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. These training activities will enable Dr. Matlock to learn how to best develop decision support interventions tailored to the needs of older adults. Mentors/Environment: Dr. Matlock and his primary mentor, Dr. Kutner have assembled a strong local mentorship team who will guide Dr. Matlock through the proposed training and research activities. To augment this team, Drs. Matlock and Kutner have assembled a panel of national and international advisors with expertise in various aspects of decision making among older adults to monitor Dr. Matlock's progress through the career development program and provide mentorship within their areas of expertise. Additionally, Dr. Matlock is the sole geriatrician in the CCOR making Dr. Matlock the natural lead for projects related to aging. Research: There is a pressing need to challenge the antiquated paternalism that persists in medical decision making in general and decision making for older adults in particular. This study will produce information of direct relevance to those working in clinical practice. Aim 1 will provide real world estimates of the risks and survival for ICD therapy which are essential knowledge to inform decision making. Aim 2 will build upon Dr. Matlock's prior research to answer additional questions about important aspects of ICD decision making for older adults and their family members. A particularly challenging question around ICDs is how to discuss the trade-off between sudden cardiac death versus potentially living longer with progressive heart failure. This study will provide a clear understanding of ICD decision making as it applies to older adults and will lead directly to the development of an ICD decision aid. Aim 3 will use an established framework for decision support and decision aid development guidelines to develop and pilot test a web based ICD decision aid. Summary: Perhaps the biggest innovation of this endeavor is that it is done in collaboration with cardiologists allowing for full understanding of the decision context and maximizing future implementation and dissemination. This collaboration also serves larger goals of spreading geriatric principles into the subspecialties of medicine. Conduct of this mentored research and training proposal, "Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies", will facilitate Dr. Matlock's development into a nationally-recognized independent investigator and leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies.