Developing a framework to individualize surgical decision-making for older adults with primary hyperparathyroidism

开发一个框架，为患有原发性甲状旁腺功能亢进症的老年人提供个性化的手术决策

基本信息

批准号：
10337961
负责人：
Carolyn Dacey Seib
金额：
$ 24.3万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10337961
关键词：
Address Affect Aging Benefits and Risks Caring Characteristics Chronic Kidney Failure Clinical Clinical Trials Comparative Effectiveness Research Counseling Data Decision Making Development Educational workshop Elderly Endocrine System Diseases Endocrinologist Ensure Feedback Focus Groups Fracture Funding Future Goals Health Hybrids Hyperparathyroidism Incidence International K-Series Research Career Programs Kidney Calculi Knowledge Leadership Medical Methodology Methods Morbidity - disease rate Operative Surgical Procedures Outcome Parathyroidectomy Patient Selection Patient-Centered Care Patients Perioperative Population Positioning Attribute Primary Care Physician Procedures Provider Recommendation Research Research Methodology Research Priority Research Training Risk Risk Estimate Risk Reduction Severity of illness Standardization Surgical Management Testing Training Veterans Health Administration Vulnerable Populations career career development comparative effectiveness design effectiveness implementation study effectiveness implementation trial effectiveness trial evidence base expectation experience fracture risk frailty implementation science improved individual patient individualized medicine innovation mortality risk novel operation osteoporosis with pathological fracture patient oriented personalized care personalized decision personalized risk prediction predictive modeling prevent programs risk prediction skills support tools surgical risk tool treatment center treatment choice treatment effect

项目摘要

PROJECT SUMMARY/ABSTRACT This K76 Career Development award will address the large unmet need for patient-specific decision support tools for surgical interventions in older adults and provide a platform for the applicant to become a leader in geriatric surgery. Primary hyperparathyroidism (PHPT) is a common endocrine disorder in older adults that is associated with serious long-term morbidity, including osteoporotic fractures, kidney stones, and chronic kidney disease (CKD). Parathyroidectomy can prevent these morbid sequelae. However, increased surgical risk associated with advanced age and frailty, in addition to the competing risk of death prior to achieving benefit from surgical intervention, raises the question of whether the short-term risks of parathyroidectomy outweigh long-term risk reduction in this group. Identifying older adults likely to benefit from surgical interventions, such as parathyroidectomy, while preventing overuse of surgery in this vulnerable group, is critical to improve patient-centered care. Currently, there is no standardized methodology for developing surgical decision support for older adults that incorporates individualized risk prediction and stakeholder input to facilitate informed, patient-centered decision-making. Therefore, this coordinated research and training proposal aims to: 1) compare the effects of parathyroidectomy vs. medical management on the incidence of fractures, symptomatic kidney stones, and CKD in older adults with PHPT; 2) develop and validate predictive models for the perioperative risks of parathyroidectomy and long-term risks of fractures, kidney stones, and CKD specific to older adults with PHPT; and 3) design and test with stakeholder feedback a PHPT decision support tool that describes the tradeoffs of parathyroidectomy vs. non-operative management. To accomplish these aims, Dr. Seib will obtain training in comparative effectiveness and predictive modeling, qualitative and mixed methods research to develop decision support, and implementation science. Upon completion of this research, Dr. Seib will have a user-tested risk/benefit calculator that will form the basis of a decision support tool to improve individualized, patient-centered treatment recommendations for older adults with PHPT. In addition, this research will establish a framework for developing patient-centered decision support that can be applied to other conditions to promote appropriate surgical management of older adults. This proposal is significant because it directly addresses the gap in decision support tools for PHPT and other surgically managed conditions in older adults. This project is innovative because it proposes a paradigm shift to incorporate geriatric principles to individualize treatment decisions in older adults with PHPT to optimize clinical outcomes. At the end of the proposed research, Dr. Seib will have the data and skills necessary to successfully pursue R01 funding for a hybrid type 1 effectiveness-implementation trial to test this decision support tool and apply this methodology to other conditions with surgical treatment options that affect older adults.

项目摘要/摘要该K76职业发展奖将满足对特定于患者的决策支持的巨大未满足的需求在老年人中进行手术干预的工具，并为申请人提供了一个平台，使其成为领导者老年手术。原发性甲状旁腺功能亢进（PHPT）是老年人的常见内分泌疾病与严重的长期发病率有关，包括骨质疏松性骨折，肾结石和慢性肾脏疾病（CKD）。甲状旁腺切除术可以预防这些病态后遗症。但是，手术增加与高级年龄和脆弱相关的风险，除了在实现之前竞争死亡的风险受益于手术干预，提出了一个问题，即甲状旁腺切除术的短期风险是否存在该组的长期风险降低。确定可能从手术中受益的老年人干预措施，例如甲状旁腺切除术，同时防止该脆弱群体过度使用手术，是对于改善以患者为中心的护理至关重要。目前，没有用于开发的标准化方法对老年人的手术决策支持，包括个性化的风险预测和利益相关者意见促进以患者为中心的知情，以患者为中心的决策。因此，这种协调的研究和培训提案的目的是：1）比较甲状旁腺切除术与医疗管理对发生率的影响 pHPT的老年人的骨折，有症状的肾结石和CKD； 2）发展和验证预测甲状旁腺切除术和骨折，肾结石和长期风险的围手术期风险模型 CKD特定于老年人患有PHPT的CKD； 3）使用利益相关者反馈设计和测试PHPT决定支持甲状旁腺切除术与非手术管理的权衡的支持工具。完成这些目的，SEIB博士将获得比较有效性和预测性建模，定性和混合方法研究以发展决策支持和实施科学。完成此任务后研究，SEIB博士将拥有经过用户测试的风险/福利计算器，这将构成决策支持的基础改善PHPT老年人的个性化，以患者为中心的治疗建议的工具。在此外，这项研究将建立一个以患者为中心的决策支持的框架应用于其他条件，以促进对老年人的适当手术管理。该提议是意义重大，因为它直接解决了PHPT和其他手术的决策支持工具的差距老年人的管理条件。该项目具有创新性，因为它提出了范式转移到将老年原理纳入pHPT的老年人的个性化治疗决策以优化临床结果。在拟议的研究结束时，SEIB博士将拥有成功的数据和技能为Hybrid 1型有效性试验寻求R01资金，以测试此决策支持工具和将此方法应用于其他影响老年人的手术治疗方案。