Improving Decision Making in Patients with Rheumatic Disease

 描述(申请人提供)：建议的研究活动的目标有三个：1)支持我作为导师的持续影响，2)进一步发展我所在机构风湿科的临床研究培训计划，以及3)在医疗决策方面继续推进我自己的以患者为中心的研究(POR)计划。我对指导的承诺是我申请续签K24奖的主要原因。对指导的要求继续增加，这一奖项的续期将确保我有足够的时间继续鼓励、支持、教授不同背景的学员，并为他们提供建议，这些学员对未来涉及POR的职业感兴趣。虽然我的主要兴趣是决策领域，但我的培训和培训使我成为对风湿病研究其他方面感兴趣的学员的有效导师。K24奖在风湿科建立临床研究培训计划方面起到了至关重要的作用。我们现在有一个系统的方法来帮助不同级别的受训人员制定个性化的发展计划，参与适当的教学和体验式研究活动，并监测他们朝着特定目标的进展。已经接受过基本培训的学员有机会参加更高级的课程，并获得健康科学硕士学位或调查医学博士学位。新获得的资源包括由AHRQ资助的耶鲁大学以患者为中心的结果研究学者计划跨学科导师K12职业发展计划，该计划专注于培养对比较有效性研究方法感兴趣的研究人员。风湿病POR培训计划包括对学员和导师进行评估的正式流程。根据我们过去四年的经验，我们将启动几项重要的改革，以改进该计划，包括将教学培训推进到团契第一年，减少团员在团契第二年的临床责任，并增加两项活动：1)同行主导的基本技能审查(例如，制定具体目标、摘要演示) 2)正式的拨款模拟审查。除了指导年轻的研究人员，我的一个重要的长期目标是推进我自己的研究议程，这样我就可以继续进行科学严谨和有意义的POR。在过去的四年里，我发表了一些论文，强调了临床实践中糟糕决策的后果，描述了患者和医生在处理关键决策方面的差异，并在随机对照试验中展示了基于理论的决策支持工具的有效性。我最近的工作也证明了总体上与报告偏好相关的限制，以及低计算能力对风险认知的影响。在我职业生涯的下一阶段，我的目标是开发更好的方法来1)测量和报告患者偏好的异质性，以及2)开发新的方法，通过获得进一步的培训和进行新的研究，有效地向患者传达风险-益处信息。

 DESCRIPTION (provided by applicant): The goals of the proposed research activities are 3-fold: 1) to support my continued impact as a mentor, 2) to further grow the clinical research training program in the Section of Rheumatology at my institution, and 3) to continue to advance my own patient-oriented research (POR) program in medical decision making. My commitment to mentoring is the primary reason I am applying for a renewal of the K24 Award. Requests for mentoring continue to increase, and a renewal of this award would ensure that I have the protected time to be able to continue to encourage, support, teach, and advise trainees from various backgrounds interested in a future career involving POR. While my primary interest is in the field of decision making, my training and has allowed me to be an effective mentor for trainees interested in other aspects of rheumatologic research. The K24 award has been critical in the establishment a clinical research training program in the Section of Rheumatology. We now have a systematic approach to help trainees at various levels develop an individualized development plan, engage in the appropriate didactic and experiential research activities and monitor their progression towards their specific goals. Trainees who have already undergone basic training have the opportunity to take more advanced courses and to obtain a Masters' degree in Health Sciences or PhD in Investigative Medicine. Newly acquired resources include The Yale Patient-Centered Outcomes Research Scholars Program interdisciplinary mentored K12 career development program funded by AHRQ, which focuses on developing investigators with an interest in comparative effectiveness research methods. The Rheumatology POR training program includes formal processes for evaluation of both trainees and mentors. Based on our experience over the past four years, we will initiate several important changes to improve the program including advancing didactic training to the first year of fellowship, decreasing fellows' clinical responsibilities during their second year of fellowship, and adding two activitie: 1) peer led review of essential skills (e.g., development of specific aims, abstract presentations) and 2) formal grant mock reviews. In addition to mentoring young investigators, one of my important long-term goals is to advance my own research agenda so that I can continue to conduct scientifically rigorous and meaningful POR. Over the past four years, I have published papers which highlight the consequences of poor decision making in clinical practice, describe the differences in how patients and physicians approach critical decisions, and demonstrate the efficacy of a theory-based decision support tool in a randomized controlled trial. My recent work has also demonstrated the limitations associated with reporting preferences in the aggregate and the impact of low numeracy on risk perceptions. My goals during the next phase of my career are to develop better methods to 1) measure and report heterogeneity in patient preferences, and 2) develop novel approaches to effectively communicate risk-benefit information to patients by obtaining further training and conducting novel research.