Advancing patient-centered decision making in older adults with lung cancer: Incorporating risk of functional decline into treatment discussions

促进老年肺癌患者以患者为中心的决策：将功能下降的风险纳入治疗讨论

• 批准号: 9973181
• 负责人: Melisa L Wong
• 金额: $ 24.26万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9973181
• 关键词: Affect; Age; Aging; Award; Cancer Center; Cancer Etiology; Cancer Patient; Caregivers; Caring; Characteristics; Clinic; Clinical; Clinical Trials; Clinical Trials Design; Cluster randomized trial; Cohort Studies; Communication; Communication Tools; Complex; Data; Decision Making; Elderly; Enrollment; Environment; Feedback; Focus Groups; Foundations; Frail Elderly; Funding; Future; Geriatric Assessment; Goals; Immunotherapy; Impaired cognition; Individual; International; Intervention; Judgment; K-Series Research Career Programs; Knowledge; Lead; Leadership; Life; Longevity; Malignant Neoplasms; Malignant neoplasm of lung; Measures; Medical Oncology; Mentors; Modeling; Multicenter Studies; Older Population; Oncologist; Oncology; Operative Surgical Procedures; Outcome; Participant; Patient Recruitments; Patients; Physical Performance; Pilot Projects; Positioning Attribute; Quality of life; Reporting; Research; Research Personnel; Risk; Risk Factors; Screening for cancer; Site; Structure; Testing; Thoracic Oncology; Toxic effect; Training; Translating; Treatment outcome; Uncertainty; base; cancer care; cancer therapy; care outcomes; career development; chemotherapy; functional adaptation; functional decline; functional disability; functional status; high risk; human old age (65+); improved; innovation; instrumental activity of daily living; mortality; multidisciplinary; novel; patient oriented; personalized decision; primary outcome; shared decision making; skills; tool; treatment choice; treatment risk

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Melisa Wong, a thoracic oncology clinician- investigator dually trained in medical oncology and aging research. Dr. Wong’s long-term goal is to become a national leader in geriatric oncology research, improving cancer care for older adults by aligning treatments with individualized patient goals. More than 72% of older adults with cancer report that they would not choose a treatment that results in functional impairment, even if it improves survival. Yet, oncologists traditionally make treatment decisions based on cancer characteristics, often without discussing how treatment might affect function or eliciting patients’ goals and values. To move from cancer-centered to patient-centered decision making, oncologists must both predict which older adults are at highest risk for functional decline and communicate complex information about benefits and harms to patients in a way that aligns treatments with their goals for function, quality of life, longevity, and other priorities. This proposal aims to 1) identify risk factors for functional decline in daily activities, physical performance, and life-space mobility during chemotherapy and/or immunotherapy in older adults with metastatic lung cancer; 2A) adapt the Best Case/Worst Case (BC/WC) communication tool; and 2B) test its feasibility for use during treatment discussions with older adults with lung cancer. In Aim 1’s multi-site cohort study, patients age 65 and older with metastatic lung cancer will undergo serial geriatric assessments to measure functional status during chemotherapy and/or immunotherapy. In Aim 2A’s focus group study, older adults with lung cancer, caregivers, and oncologists will participate in focus groups to elicit feedback aimed at adapting the BC/WC tool to incorporate function and other patient priorities into patient-centered decision making. In Aim 2B’s pre-post pilot study, oncologists will be trained to use the adapted BC/WC tool; treatment discussions with older adults with lung cancer before and after training will be analyzed. Dr. Wong’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for cancer screening in older adults. This award will support Dr. Wong’s transition to research independence through dedicated training in 1) longitudinal modeling and risk prediction for functional decline in older adults with cancer; 2) shared decision making and decision-making interventions for older adults with functional or cognitive impairment; 3) clinical trial design to test decision-making interventions for older adults with cancer; and 4) leadership skills to direct multicenter research to transform geriatric oncology care. The results from this proposal will serve as the foundation for a multicenter cohort study to develop and validate a risk prediction score for functional decline during lung cancer treatment in older adults and a cluster-randomized trial to test the effect of the adapted BC/WC tool on communication, shared decision making, and receipt of goal-concordant care.

项目摘要/摘要 这是Beeson K76职业发展奖Melisa Wong博士，这是一种胸部肿瘤学临床 - 研究人员接受了医学肿瘤学和衰老研究的双重培训。黄博士的长期目标是成为一个 老年肿瘤学研究的国家领导者，通过对齐治疗来改善老年人的癌症护理 具有个性化的患者目标。超过72％的癌症老年人报告说他们不会选择 即使它提高了生存率，也会导致功能障碍。然而，肿瘤学家传统上使 基于癌症特征的治疗决策通常不讨论治疗可能如何影响 功能或引发患者的目标和价值观。从以癌症为中心到以患者为中心的决定 制作，肿瘤学家都必须预测哪些老年人的功能下降风险最高，并且 以使治疗与治疗与患者的益处和危害的复杂信息传达 他们的职能，生活质量，寿命和其他优先事项的目标。该建议的目的是1）确定风险因素 在化学疗法期间的日常活动，身体性能和寿命流动性的功能下降 在转移性肺癌的老年人中，/或免疫疗法； 2a）适应最佳案例/最坏情况 （BC/WC）通信工具；和2b）测试其在与老年人的治疗讨论中使用的可行性 患有肺癌。在AIM 1的多站点队列研究中，年龄在65岁及65岁以上的转移性肺癌的患者将 经过串行的老年评估，以衡量化学疗法期间的功能状态和/或 免疫疗法。在AIM 2A的焦点小组研究中，患有肺癌，看护人和肿瘤学家的老年人将 参加焦点小组以引起旨在调整BC/WC工具以合并功能和 其他患者优先事项以患者为中心的决策。在AIM 2B的前试点研究中，肿瘤学家将 接受培训以使用改编的BC/WC工具；之前与老年人患有肺癌的治疗讨论， 训练后将进行分析。 Wong博士的卓越多学科指导团队由Louise博士领导 沃尔特（Walter）是国际公认的针对年龄较大癌症筛查的个性化决策的专家 成年人。该奖项将通过1中的专门培训来支持Wong博士对研究独立的过渡） 癌症老年人功能下降的纵向建模和风险预测； 2）共同决定 对功能或认知障碍的老年人进行干预和决策干预措施； 3）临床 试验设计以测试癌症老年人的决策干预措施； 4）指导领导技能 多中心研究以改变老年肿瘤学护理。该提议的结果将作为 多中心队列研究的基础，以发展和验证功能下降的风险预测评分 在老年人的肺癌治疗期间和一项聚类随机试验，以测试适应的效果 BC/WC工具有关通信，共享决策和接收目标协有护理的工具。