Communication in the Hospital: Impact on the Patient and Surrogate

脆弱的老年人及其家人在医疗决策、健康和医疗保健方面面临多重挑战。 沟通，以及面临严重疾病和死亡的情绪困扰。Alexia Torke博士 研究的重点是沟通，道德，宗教和精神方面的决策， 那些丧失行为能力，需要家庭代理人为他们做决定的病人。K24 该奖项将为Torke博士的研究计划提供支持，并将允许她额外的受保护时间， 追求她对指导他人的热情。 该K24奖项的具体目标是：培养未来的老龄化研究人员进行高质量的研究 重点关注弱势老年人及其家庭成员的决策和结果;研究 家庭代理决策者的经验，包括沟通质量对决策的影响 质量和家庭结果，如焦虑，抑郁和创伤后压力;并衡量 代理人的宗教和精神经历，以确定这些因素是否与医疗 决策和病人在生命结束时接受的医疗护理。 博士Torke的研究课题很重要，因为近一半的住院老年人无法使他们的生活质量得到改善。 自己的医疗决定，并要求家庭成员或其他代理人为他们做出决定。她以前 研究表明，许多代理人在高度紧张的情况下做出有关生死问题的决定。 压力很大，而且往往得不到临床医生的支持。代理人依赖于各种情感支持来源， 作出医疗决定的价值来源，包括个人、宗教和精神信仰。但无论 代理人和临床医生报告说，由于情感和沟通方面的挑战， 替别人做决定尽管有来自病人研究的证据表明宗教与 在生命结束时更积极的护理偏好，这还没有被研究为代理人， 为别人做决定。随着人口老龄化，越来越多的老年人面临认知障碍的风险， 在这种情况下，代理决策的重要性只会增加。了解机制 潜在的高质量决策将使我们能够最好地支持家庭成员，并提供最好的 照顾老年人的可能。 该奖项中提出的项目将利用359名老年住院患者及其 Torke博士通过国家R 01赠款资助开发的替代决策者 老龄化研究所。来自印第安纳州大学健康价值补助金和绿墙的额外资金 基金会允许Torke博士也收集关于代理人认可的护理目标的数据， 在生命的尽头收到的，以及代理人的宗教和精神体验。项目1将探索 沟通质量对决策质量和代理人福祉的影响，例如 创伤后压力项目2将检查代理人和遗嘱的宗教和精神层面 研究这些是否影响医疗决策以及我们40%的人所接受的实际护理。 在6个月研究观察期内死亡的入组患者。这些项目的结果将 为制定干预措施提供信息，以提高残疾患者的医疗护理质量， 以及他们家庭成员的幸福 博士Torke是印第安纳州大学的终身副教授。她的临床实践涉及姑息治疗 为年老体弱的成年人提供护理和初级保健。她指导了超过16名研究员，居民，研究生 和初级教师在研究有关的医疗决策，沟通和健康结果， 老年人她在印第安纳州大学的领导作用，包括她被任命为副主任， IU老龄化研究中心（IUCAR），使她能够指导早期职业调查人员，重点是 以病人为导向的研究该奖项将为她提供受保护的时间，以进一步发展自己的研究 计划和扩大她的指导活动的范围。 印第安纳州大学为这项工作提供了一个理想的地点。Torke博士的主要任命是在IUCAR， 有10名研究人员在进行老龄化研究。该研究所提供了基础设施， 为托克博士的研究提供资金和空间她正在承担越来越多的责任， 研究员和初级教员。通过在IU Health的领导角色，Torke博士指导牧师 研究员，并指导了许多道德研究员，包括医生和博士准备的科学家，他们 开始从事研究工作其他资源，如印第安纳州临床和翻译 科学研究所（CTSI）丰富了学员通过临床获得研究培训的机会 调查和翻译教育（CITE）计划和通过KL 2职业生涯的资金支持 发展奖。

Vulnerable older adults and their families face multiple challenges in medical decision making, health communication, and the emotional distress involved in facing serious illness and death. Dr. Alexia Torke's research has focused on the communication, ethical, religious and spiritual aspects of decision making for those patients who are incapacitated and require a family surrogate to make decisions for them. This K24 award will provide support for Dr. Torke's program of research and will allow her additional protected time to pursue her passion for mentoring others. The specific aims of this K24 award are to: train future aging researchers to conduct high quality research focused on decision making and outcomes for vulnerable older adults and their family members; to study the experience of family surrogate decision makers, including the impact of communication quality on decision quality and family outcomes such as anxiety, depression, and posttraumatic stress; and to measure surrogates' religious and spiritual experiences to determine whether these factors are associated with medical decision making and the medical care that patients receive at the end of life. Dr. Torke' research topic is important because nearly half of hospitalized older adults are unable to make their own medical decisions and require a family member or other surrogate to make decisions for them. Her prior research has shown that many surrogates make decisions about life and death issues under conditions of high stress and often with poor support from clinicians. Surrogates rely on various sources of emotional support and sources of value to make medical decisions, including personal, religious and spiritual beliefs. However, both surrogates and clinicians report high levels of distress due to the emotional and communication challenges of making decisions for others. Although there is evidence from patient studies that religion is associated with preferences for more aggressive care at the end of life, this has not been studied for surrogates making decisions for others. As the population ages and a greater number of older adults are at risk for cognitive impairment, the importance of surrogate decision making will only increase. Understanding the mechanisms underlying high quality decision making will allow us to best support family members and to provide the best possible care to older adults. The projects proposed in this award will leverage a database of 359 older hospitalized adults and their surrogate decision makers that Dr. Torke has developed through funding from an R01 grant from the National Institute on Aging. Additional funding from the Indiana University Health Values Grant and the Greenwall Foundation allowed Dr. Torke to also collect data on the goals of care endorsed by the surrogate, care received at the end of life, and the religious and spiritual experiences of the surrogates. Project 1 will explore the impact of communication quality on decision making quality and surrogate well-being, such as posttraumatic stress. Project 2 will examine the religious and spiritual dimensions of the surrogates and will study whether these impact medical decision making as well as the actual care received by the 40% of our enrolled patients who died within the 6-month study observation period. The findings from these projects will inform the development of interventions to improve both the quality of medical care for incapacitated patients and the well-being of their family members. Dr. Torke is a tenured Associate Professor at Indiana University. Her clinical practice has involved palliative care and primary care for older, frail adults. She has mentored over 16 fellows, residents, graduate students and junior faculty in research related to medical decision making, communication and health outcomes for older adults. Her leadership roles at Indiana University, including her appointment as Associate Director of the IU Center for Aging Research (IUCAR), put her in a position to mentor early career investigators focused on patient oriented research. This award will provide her with protected time to further develop her own research program and expand the scope of her mentoring activities. Indiana University provides an ideal location for this work. Dr. Torke's primary appointment is in IUCAR, where there are 10 investigators conducting aging research. The institute has provided infrastructure, intramural funding and space for Dr. Torke's research. She is taking on increasing responsibilities in the mentorship of research fellows and junior faculty. Through leadership roles at IU Health, Dr. Torke mentors a chaplain researcher and has mentored numerous ethics fellows, including physicians and PhD-prepared scientists who are embarking on research careers. Additional resources such as the Indiana Clinical and Translational Sciences Institute (CTSI) enrich opportunities for mentees to obtain research training through the Clinical Investigation and Translational Education (CITE) program and funding support through the KL2 career development awards.