Improving Patient-Centered Decision-Making for Stress Urinary Incontinence Treatment in Older Men

改善老年男性压力性尿失禁治疗中以患者为中心的决策

• 批准号: 10729838
• 负责人: Lindsay Ann Hampson
• 金额: $ 24.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729838
• 关键词: Academic Medical Centers; Address; Adoption; Affect; Age Years; Aging; Award; Caring; Characteristics; Cohort Studies; Complex; Data; Decision Making; Dedications; Diagnosis; Disease; Disparity; Elderly; Equity; Ethics; Evaluation; Experimental Designs; Face; Foundations; Funding; Future; Geographic Locations; Geriatrics; Goals; Guidelines; Health; Health Services Accessibility; Health Services Research; Health system; Healthcare Systems; Incontinence; Individual; Institution; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Leadership; Link; Malignant neoplasm of prostate; Measures; Medicare; Mental Depression; Mentors; Mentorship; Methods; Operative Surgical Procedures; Patient Preferences; Patients; Prostate Cancer therapy; Prostatectomy; Protocols documentation; Quality of life; Race; Radical Prostatectomy; Regrets; Reporting; Research; Research Personnel; Risk; Rural; Shame; Site; Social isolation; Socioeconomic Factors; Stress Urinary Incontinence; Structure; Surveys; Testing; Time; Training; United States Department of Veterans Affairs; Urinary Incontinence; Urologist; Urology; career; career development; clinical practice; cohort; cost; design; effectiveness/implementation study; effectiveness/implementation trial; experience; experimental study; feasibility trial; functional decline; health care disparity; health related quality of life; implementation outcomes; implementation science; improved; individual patient; individualized medicine; innovation; male; men; multidisciplinary; older men; patient oriented; patient population; personalized decision; pilot test; preference; prototype; recruit; satisfaction; support tools; theories; treatment disparity; urinary; urologic; usability; young man

PROJECT SUMMARY/ABSTRACT This is a Beeson K76 career development award for Dr. Lindsay Hampson, a clinician investigator with a background in ethics, health services research, and stress urinary incontinence (SUI). Dr. Hampson is pivoting her career towards aging, with a goal of becoming a national leader in geriatric urology research focused on achieving goal-concordant care for older adults with urologic issues that affect quality of life (QOL) through reducing treatment disparities and improving treatment decision-making. This proposal seeks to improve goal-concordant management for post-prostatectomy SUI among older adults by: 1) identifying drivers of disparities in the care of older post-prostatectomy men, 2) determining treatment preferences and priorities of this patient population, and 3) promoting individualized evaluation and treatment decision-making in the context of geriatric-informed health and values. Significance: Post-prostatectomy SUI significantly impacts QOL, disproportionately impacting older men. Despite a focus on reducing treatment of prostate cancer, one quarter of men 65-75 years of age diagnosed with prostate cancer will still undergo prostatectomy. An estimated 25-30% of men are using pads, diapers, or complaining of bothersome incontinence beyond one year following prostatectomy, and these rates likely represent underestimation of continence rates in older men. SUI surgery has been shown to result in near-term QOL improvements with high satisfaction rates, yet is severely underutilized and delayed, and men facing treatment decisions have substantial decisional regret. In Aim 1’s national cohort study using Veterans Affairs and Medicare data, we aim to identify factors associated with post-prostatectomy SUI under-treatment and treatment delays among older men. In Aim 2’s discrete choice experiment survey of older post-prostatectomy men, we aim to identify patient-centered SUI treatment priorities and understand how these preferences vary based on characteristics associated with access to care. These data will be utilized to develop an Incontinence Post-Prostatectomy Assessment & Decision Support (I- PADS) tool which will be evaluated in Aim 3 through a mixed methods study and feasibility/acceptability trial. Mentoring team: Dr. Hampson’s exceptional multidisciplinary mentoring team is led by Dr. Louise Walter, an internationally recognized expert on individualized decision making for in older adults. This award will support Dr. Hampson’s transition to aging research through dedicated training in 1) conducting national cohort studies of older adults, 2) developing expertise in measuring treatment preferences, 3) implementation science theory and methods to implement interventions for older adults, and 4) leadership in geriatric urology to become a leader in goal-concordant urologic care among older adults by reducing treatment disparities and improving treatment decision-making. Next Steps: These results will serve as the foundation for a multicenter hybrid implementation-effectiveness study of the I-PADS tool to test its effect on addressing disparities in SUI surgery, decisional and treatment regret, and receipt of goal-concordant care for post-prostatectomy SUI.

项目摘要/摘要 这是Beeson K76职业发展奖，他是Lindsay Hampson博士，他是 伦理，卫生服务研究和压力尿失禁的背景（SUI）。汉普森博士是 将她的职业生涯转向衰老，目的是成为老年泌尿外科研究的国家领导者 专注于为影响生活质量的泌尿外科问题的老年人实现目标符合护理（QOL） 通过减少治疗差异并改善治疗决策。该提议试图 改善老年人后期切除术的目标治疗方法：1）确定 较老后切除术男子的分布驱动因素，2）确定治疗偏好和 该患者人群的优先级，以及3）促进个性化评估和治疗决策 在老年人的健康和价值观的背景下。意义：后期切除术明显 影响QoL，不成比例地影响老年男性。尽管专注于减少前列腺的治疗 癌症，有四分之一的男性在65-75岁的前列腺癌年龄诊断中仍将进行前列腺切除术。 估计有25-30％的男性正在使用垫子，尿布或两者的尿失禁抱怨 前列腺切除术后的一年，这些速度可能表示较老的持续率的低估 男人。 SUI手术已显示可带来近期QoL的改善，并具有高满意度，但 严重未充分利用和延迟，面临治疗决策的男性具有巨大的决策遗憾。在 AIM 1使用退伍军人事务和Medicare数据的国家队列研究，我们旨在确定相关因素 在遗产后切除术SUI治疗和治疗延迟中，老年男性的延迟。在AIM 2的离散 选择实验的旧后切除术男性，我们旨在确定以患者为中心的SUI治疗 优先级并了解这些偏好如何根据与获得护理相关的特征而变化。 这些数据将用于开发遗传后切除术评估和决策支持（I-） PADS）工具，将通过混合方法研究和可行性/可接受性试验在AIM 3中进行评估。 指导团队：汉普森博士的卓越多学科指导团队由路易丝·沃尔特博士领导 国际认可的老年人的个性化决策专家。该奖项将支持 汉普森博士通过专门的培训过渡到1）进行国家队列 对老年人的研究，2）培养衡量治疗偏好的专业知识，3）实施科学 为老年人实施干预措施的理论和方法，以及4）老年泌尿科的领导 通过减少治疗分布和 改善治疗决策。下一步：这些结果将成为多中心的基础 I-PADS工具的混合实施效应研究，以测试其对SUI分布的影响 手术，决策和治疗遗憾，并接受protectato术后切除术的目标符合护理。