A communication tool to assist older adults facing difficult surgical decisions

一种沟通工具，可帮助面临困难手术决定的老年人

• 批准号: 8753796
• 负责人: Margaret Schwarze
• 金额: $ 11.48万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8753796
• 关键词: Address; Adherence; Affect; Age; American; Award; Bioethics; Blood Vessels; Budgets; Caring; Chronic Disease; Clinical; Clinical Sciences; Communication; Communication Tools; Critical Illness; Data; Data Collection; Decision Making; Educational process of instructing; Elderly; Event; Feasibility Studies; Feedback; Frail Elderly; Frail Older Adults; Future; Goals; Health Services Research; Healthcare; Hospitalization; In Vitro; Informed Consent; Inpatients; Intensive Care; Intervention; Intervention Studies; Interview; Learning; Life; Manuals; Measures; Medical; Modeling; Nursing Homes; Online Systems; Operative Surgical Procedures; Outcome; Paper; Participant; Patients; Pilot Projects; Population; Postoperative Period; Procedures; Process; Protocols documentation; Quality of life; Recruitment Activity; Research; Risk; Stress; Structure; Surgeon; Symptoms; Testing; Time; Training; Training Support; Translational Research; age related; clinical practice; cost; design; efficacy testing; efficacy trial; end of life; experience; high risk; improved; in vivo; innovation; novel; older patient; operation; phrases; post intervention; preference; public health priorities; public health relevance; skills; tool; trend

DESCRIPTION (provided by applicant): A communication tool to assist older adults facing difficult surgical decisions ABSTRACT Surgery can frequently burden older frail patients with aggressive treatments they do not want1 and often has limited ability to prolong survival or return these patients to the quality of life they had before surgery.2,3 The number of operations performed on older patients with chronic illness is significant and increasing4 such that 25 percent of older Americans undergo a surgical procedure within the last three months of life.5 Because these patients are more likely to require intensive care and prolonged hospitalization, a decision to proceed with surgery can start a frail elderly patient along a care trajectory that may be inconsistent with his or her personal preferences and goals. This proposal serves the long-term goal of improving the decision-making process for frail older adults who are considering surgery, so that their treatment choices reflect their personal preferences and goals. "A communication tool to assist older adults facing difficult surgical decisions" is a two-year R03, GEMSSTAR proposal to support a feasibility study of a decision support intervention, a communication tool, to help older patients make surgical decisions that align with their personal preferences. This project has three aims: Aim 1, to demonstrate that surgeons can learn to use the communication tool to describe treatment choices to patients; Aim 2, to assess acceptability of the communication tool for patients in a clinical setting; and Aim 3, to develop recruitment and data collection standard operating procedures for a future study. This award will produce the data and the procedures necessary to submit a competitive R34 application for a larger-scale efficacy trial. The research is innovative because it tests a novel, theoretically grounded intervention in both an in vitro (with standardized patients) and an in vivo (in clinical practice) setting where surgeons would be most likely to use it. The research is significant because if it is ultimately found effective, it offers a low-cost strategy to improve surgeon engagement with older frail patients during difficult surgical decisions. The research is feasible because it has been carefully designed to fit the time frame and budget and will be guided by a team of experts in aging-related, decision-making and health services research.

描述（由申请人提供）：一种沟通工具，可帮助面临困难手术决策的老年人 摘要 手术常常会给年老体弱的患者带来他们不想要的积极治疗的负担1，并且通常延长患者生存或恢复生活质量的能力有限他们在手术前接受过手术。2,3 对患有慢性病的老年患者进行的手术数量很大，而且还在不断增加4，因此 25% 的美国老年人在生命的最后三个月内接受了外科手术。5 因为这些患者更有可能需要重症监护和长期住院，进行手术的决定可以让体弱的老年患者沿着可能的护理轨迹开始 与他或她的个人喜好和目标不一致。该提案的长期目标是改善正在考虑手术的体弱老年人的决策过程，以便他们的治疗选择反映他们的个人喜好和目标。 “帮助老年人面临困难手术决定的沟通工具”是一项为期两年的 R03、GEMSSTAR 提案，旨在支持决策支持干预的可行性研究，这是一种沟通工具，可帮助老年患者做出符合其个人喜好的手术决定。该项目有三个目标： 目标 1，证明外科医生可以学会使用沟通工具向患者描述治疗选择；目标 2，评估临床环境中患者对沟通工具的可接受性；目标 3，发展招聘和 为未来的研究收集数据的标准操作程序。该奖项将产生提交竞争性 R34 申请以进行更大规模功效试验所需的数据和程序。这项研究具有创新性，因为它在体外（标准化患者）和体内（临床实践）中测试了一种新颖的、有理论依据的干预措施 外科医生最有可能使用它的环境。这项研究意义重大，因为如果 最终发现它是有效的，它提供了一种低成本策略，可以改善外科医生在困难的手术决策过程中与年老体弱患者的接触。这项研究是可行的，因为它经过精心设计，适合时间框架和预算，并将由老龄化相关、决策和卫生服务研究领域的专家团队指导。