Identifying Barriers to Patient-Centered Decision Making for Older Adults with Diverticulitis

项目摘要/摘要 在美国，憩室炎影响着数十万60岁以上的人，是全球第四大 老年人进行紧急手术的常见原因。由于憩室炎的严重后果， 对于这一弱势群体来说，以患者为中心的决策是当务之急。现有的决策框架 对于面临手术的老年人来说，制造是不够的，因为他们未能纳入高风险、不可逆转的 手术决定的性质和老年人的独特考虑(例如，多种合并症， 神经认知变化，以及关于参与决策的不同偏好)。中环 这一建议的假设是，以患者为中心的决策对于患有 憩室炎患者面临着是否继续手术或观察的高风险决定。这个 这项提案的目的是指导面临高风险手术的老年人的管理 通过实现以下特定目标来确定以患者为中心的决策：1)确定 针对患有憩室炎的老年人的决策过程，包括如何结合患者/提供者的目标 进入治疗决策，使用全面和全面的临床评估实时评估 会后与患者及其提供者进行面谈，2)确定障碍和 使用调查工具促进以患者为中心的决策，调查工具由目标1的调查结果提供信息 在多个地点有大量患有憩室炎的老年人。 这是一项创新性的研究，将解决有关手术决策的文献中的重大空白。 适用于患有憩室炎的老年人。这项工作代表了与现有文献的实质性背离，即 重点关注短期发病率和死亡率，通过检查手术决策的复杂性 老年人和他们的供养者。结果将产生实质性的影响，因为它们可以被用来裁剪 现有的决策框架用于老年人做出高风险的手术决定和2)定义 未来要支持的决策支持工具的必要组件。 科恩博士的总体职业目标是成为结直肠手术和衰老相关领域的领军人物 改善以患者为中心的老年人外科护理的研究。该项目包括一个全面的 专业发展计划，包括指导和培训，以支持这一职业目标。这个 导师团队才华横溢，多元化，敬业，涵盖老年病学、外科、决策等学科。 科学和定性研究。拟议的老年科学和混合方法研究培训将 允许Cohan博士对她之前的临床和研究培训进行扩展。共同努力，研究和专业人士 这项GEMSSTAR提案的进展将使科恩博士成为一名专注于结直肠外科医生的领导者 关于改善老年手术患者以患者为中心的护理。其结果将直接影响到人们的健康和生活水平。 患有憩室炎的老年人。

PROJECT SUMMARY/ABSTRACT Diverticulitis affects hundreds of thousands of people over age 60 years in the United States and is the 4th most common reason for emergency surgery in older adults. Due to the substantial consequences of diverticulitis, patient-centered decision making is imperative for this vulnerable population. Existing frameworks for decision making are inadequate for older adults facing surgery because they fail to incorporate the high-risk, irreversible nature of surgical decisions and the unique considerations in older adults (for example, multiple comorbidity, neurocognitive changes, and varying preferences regarding participation in decision making). The central hypothesis of this proposal is that patient-centered decision making is not routinely achieved for older adults with diverticulitis who are faced with a high-stakes decision about proceeding with surgery or observation. The objective of this proposal is to guide the management of older adults facing high-risk surgery through the identification of patient-centered decisions by accomplishing the following specific aims: 1) characterize the decision making process for older adults with diverticulitis, including how patient/provider goals are incorporated into treatment decisions, using a thorough and comprehensive evaluation of “real-time” evaluation of clinical encounters followed by post-encounter interviews with patients and their providers and 2) identify barriers and facilitators to patient-centered decision making using survey instruments informed by the findings of Aim 1 in a large population of older adults with diverticulitis at multiple sites. This is an innovative study that will address significant gaps in the literature regarding surgical decision making for older adults with diverticulitis. This work represents a substantive departure from the existing literature, which focuses on short term morbidity and mortality, by examining the complexity of surgical decision making between older adults and their providers. The results will have a substantial impact because they can be used to 1) tailor existing decision making frameworks for older adults making high-stakes surgical decisions and 2) define the necessary components of a future decision support tool to support. Dr. Cohan’s overall career goal is to become a leader at the intersection of colorectal surgery and aging-related research that improves patient-centered surgical care for older adults. This project includes a comprehensive professional development plan that incorporates mentorship and training to support this career goal. The mentorship team is talented, diverse, and dedicated, spanning the disciplines of geriatrics, surgery, decision science, and qualitative research. The proposed training in geriatric science and mixed-methods research will allow Dr. Cohan to expand upon her prior clinical and research training. Together, the research and professional development in this GEMSSTAR proposal will allow Dr. Cohan to become a colorectal surgeon-leader focused on improving patient-centered care for older surgical patients. The results will directly impact the health and well- being of older adults with diverticulitis.