Improving Patient-Centered Decision-Making for Stress Urinary Incontinence Treatment in Older Men

项目摘要/摘要 这是比森K76职业发展奖，授予林赛·汉普森博士，他是一名临床研究员，拥有 有伦理学、卫生服务研究和压力性尿失禁(SUI)背景。汉普森医生是 将她的职业生涯转向老龄化，目标是成为全国老年泌尿外科研究的领先者 专注于为患有影响生活质量(QOL)的泌尿系统问题的老年人实现目标一致的护理 通过缩小治疗差距，改善治疗决策。这项建议旨在 通过以下方式改善老年人前列腺切除术后SUI的目标一致性管理：1)确定 老年前列腺摘除术后男性护理差异的驱动因素，2)确定治疗偏好和 患者群体的优先事项；3)促进个性化评估和治疗决策 在老年人知情健康和价值观的背景下。意义：前列腺摘除术后SUI显著 影响生活质量，对老年男性的影响不成比例。尽管重点是减少前列腺癌的治疗 在癌症方面，65-75岁的男性中有四分之一的人被诊断患有前列腺癌，仍将接受前列腺切除术。 据估计，25%-30%的男性正在使用护垫、尿布，或者抱怨自己的尿失禁次数超过1 前列腺切除术后一年，这些比率很可能低估了老年人的可控率 男人。隋建华的手术已被证明可以带来近期生活质量的改善，满意率很高，但事实是 严重未得到充分利用和延误，面临治疗决定的男性有很大的决定遗憾。在……里面 目的1利用退役军人事务和医疗保险数据进行S全国队列研究，目的是确定与之相关的因素 前列腺摘除后，老年男性的SUI治疗不足和治疗延迟。在《目标2》中S离散 老年男性前列腺切除术后的选择性实验调查，我们的目标是确定以患者为中心的SUI治疗 了解优先事项，并了解这些偏好如何根据与获得护理相关的特点而变化。 这些数据将被用来开发前列腺切除术后尿失禁评估和决策支持(I- 港口及机场发展策略)工具，将在目标3通过混合方法研究和可行性/可接受性试验进行评估。 指导团队：汉普森博士卓越的多学科指导团队由路易丝·沃尔特博士领导，她是一名 国际公认的老年人个性化决策专家。这一奖项将支持 汉普森博士通过在1)国家队列中进行专门培训向老龄化研究过渡 对老年人的研究，2)发展衡量治疗偏好的专门知识，3)实施科学 对老年人实施干预的理论和方法，以及4)老年泌尿科的领导力 通过减少治疗差距和减少治疗差距，成为老年人目标一致的泌尿外科护理领域的领导者 改善治疗决策。下一步：这些结果将作为多中心的基础 I-PADS工具的混合实施-有效性研究，以测试其在解决SUI差异方面的效果 前列腺摘除术后SUI的手术、决定和治疗后悔，以及接受目标一致的护理。

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Lindsay Hampson, a clinician investigator with a background in ethics, health services research, and stress urinary incontinence (SUI). Dr. Hampson is pivoting her career towards aging, with a goal of becoming a national leader in geriatric urology research focused on achieving goal-concordant care for older adults with urologic issues that affect quality of life (QOL) through reducing treatment disparities and improving treatment decision-making. This proposal seeks to improve goal-concordant management for post-prostatectomy SUI among older adults by: 1) identifying drivers of disparities in the care of older post-prostatectomy men, 2) determining treatment preferences and priorities of this patient population, and 3) promoting individualized evaluation and treatment decision-making in the context of geriatric-informed health and values. Significance: Post-prostatectomy SUI significantly impacts QOL, disproportionately impacting older men. Despite a focus on reducing treatment of prostate cancer, one quarter of men 65-75 years of age diagnosed with prostate cancer will still undergo prostatectomy. An estimated 25-30% of men are using pads, diapers, or complaining of bothersome incontinence beyond one year following prostatectomy, and these rates likely represent underestimation of continence rates in older men. SUI surgery has been shown to result in near-term QOL improvements with high satisfaction rates, yet is severely underutilized and delayed, and men facing treatment decisions have substantial decisional regret. In Aim 1’s national cohort study using Veterans Affairs and Medicare data, we aim to identify factors associated with post-prostatectomy SUI under-treatment and treatment delays among older men. In Aim 2’s discrete choice experiment survey of older post-prostatectomy men, we aim to identify patient-centered SUI treatment priorities and understand how these preferences vary based on characteristics associated with access to care. These data will be utilized to develop an Incontinence Post-Prostatectomy Assessment & Decision Support (I- PADS) tool which will be evaluated in Aim 3 through a mixed methods study and feasibility/acceptability trial. Mentoring team: Dr. Hampson’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for in older adults. This award will support Dr. Hampson’s transition to aging research through dedicated training in 1) conducting national cohort studies of older adults, 2) developing expertise in measuring treatment preferences, 3) implementation science theory and methods to implement interventions for older adults, and 4) leadership in geriatric urology to become a leader in goal-concordant urologic care among older adults by reducing treatment disparities and improving treatment decision-making. Next Steps: These results will serve as the foundation for a multicenter hybrid implementation-effectiveness study of the I-PADS tool to test its effect on addressing disparities in SUI surgery, decisional and treatment regret, and receipt of goal-concordant care for post-prostatectomy SUI.