Understanding and Improving Surgical Decision-Making for Persons Living with Dementia, their Family Caregivers, and their Providers: A Mixed Methods Study

项目总结/摘要 手术通常有好处，如减轻症状或延长生命，但并非没有风险。 患者对症状和手术风险的耐受性各不相同。分享的概念，耐心 偏好一致的手术决策可能有助于患者实现他们的目标。 痴呆症患者（PLWD）的手术决策具有挑战性。虽然 种族和民族的影响已经在病人-医生 沟通和隐性偏见，这方面的文献大多集中在黑人白人的差异，而不是 比西班牙裔和非西班牙裔的人要多为了更好地了解这些因素和关系， 影响西班牙裔PLWD的手术决策，反过来，制定有效的协议， 为了减少负面结果，重要的是我们要了解所有人的观点， 参与的利益相关者，包括患者，家庭成员和护理提供者。 本附录旨在通过探索外科手术方法来填补文献中的一个重要空白。 从这些角度为西班牙裔痴呆症患者做出决策。提出的混合 方法研究旨在了解PLWD手术的流行病学，以及患者， 护理者和提供者的实践和临床环境中手术决策的挑战。 研究目标1：我们将深入探讨如何手术护理提供者，西班牙裔患者与 老年痴呆症患者和患者家庭成员接近手术决策过程。具体地说， 我们试图了解促进者和障碍，使病人的目标一致的护理决策 通过检查1）潜在的种族偏见，2）患者和家庭价值观， 文化; 3）沟通与语言。 研究目的2：探讨患者对医院体验的感知 失智症患者出院后及其家人照顾者。具体来说，我们将 检查出院途径、感知的沟通质量和对医院的感知 环境，以揭示未来的研究，干预和医院政策改进的途径。

Project Summary/Abstract Surgery often has benefits, such as reducing symptoms or extending life, but it is not without risk. Patients vary both in their tolerance of symptoms and of surgical risk. The concept of shared, patient preference-concordant surgical decision making potentially helps patients achieve their goals. Surgical decision-making for persons living with dementia (PLWD) is challenging. Although the influence of race and ethnicity has been examined in such contexts as patient-physician communication and implicit bias, much of this literature focuses on Black-White disparities, rather than Hispanic-Non-Hispanic. To gain a better understanding of the factors and relationships influencing surgical decision-making for Hispanic PLWDs, and, in turn, develop effective protocols to mitigate negative outcomes, it is important that we understand the perspectives of all the stakeholders involved, including patients, family members, and care providers. This supplement seeks to fill a significant gap in the literature by exploring approaches to surgical decision-making for Hispanic patients with dementia from these perspectives. The proposed mixed methods study is designed to understand the epidemiology of surgery for PLWD, as well as patient, caregiver, and provider practices and challenges of surgical decision-making in clinical settings. Research Aim 1: We will explore in-depth how surgical care providers, Hispanic patients with dementia, and patient family members approach the surgical decision-making process. Specifically, we seek to understand the facilitators and barriers for making patient goal-concordant care decisions by examining the perceived relevance of 1) potential racial bias, 2) patient and family values and culture, and 3) communication and language. Research Aim 2: We will explore the perceived hospital experiences of persons living with dementia and their family caregivers after the patients have been discharged. Specifically, we will examine discharge pathways, perceived communication quality, and perceptions of hospital environments to uncover future avenues for research, intervention, and hospital policy improvement.