Optimizing the End-of-Life Care Needs of Older Adults Undergoing Surgery

优化接受手术的老年人的临终护理需求

• 批准号: 10265468
• 负责人: Pasithorn Suwanabol
• 金额: $ 14.13万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265468
• 关键词: Optimizing; End; Life; Care; Needs

ABSTRACT By 2030, adults older than 65 years will exceed 20% of the U.S. population. In parallel to this rapidly changing demographic, rates of surgery in this population are expected to increase by as much as 30%. Such patients account for a disproportionately higher share of postsurgical morbidity and mortality. Although substantial efforts have been made to reduce postsurgical complications and death, far less attention has been aimed at end-of-life care in older adults undergoing surgery or being considered for surgery (i.e., surgical patients). High quality end-of-life care among older adult surgical patients is seldom informed by the patient and family perspective. Further, elements of this care are poorly defined and largely understudied. Through our unique and robust collaborative infrastructure of surgical programs, the Michigan Surgical Quality Collaborative (MSQC), we will evaluate perceived satisfaction with and quality of end-of-life care following surgery using a previously validated Bereaved Family Survey and validated quality measures across hospitals in Michigan (Aim 1), and develop an in-depth understanding of the key elements necessary for improved end- of-life care for older adults at high risk of postsurgical death or poor outcomes (Aim 2). Informed from findings in Aims 1 and 2, we will then develop and pilot test an intervention aimed at improving end-of-life care for surgical patients and their families (Aim 3). The MSQC is the largest population-based surgical quality improvement collaborative in the U.S. comprising 73 hospitals and representing over 50,000 patients per year. This study will have an immediate impact on local and national initiatives by revealing how surgeons and hospitals can better anticipate and manage older adult surgical patients and their families’ end-of- life care needs. Results from this study will provide essential preliminary data for future studies aimed at interventions that improve end-of-life care for older adults at risk of postsurgical death or poor outcomes. Further, this research plan will lead to a unique data infrastructure through the MSQC that can be used for future studies. The project, the multidisciplinary mentorship team, and educational plan are ideally suited to address the career and leadership needs of the candidate, Pasithorn A. Suwanabol, MD, MS. Dr. Suwanabol is board-certified in general and colorectal surgery with a clinical and research interest in palliative and end-of-life care for older adult surgical patients. Her prior research experience understanding variation in surgical and palliative care, as well as the surgeon’s role in the provision of palliative care, has prepared her for this proposal. However, in order to achieve her goal of becoming a leader in improving care for older adults at high risk of postsurgical death or poor outcomes, she requires additional training in engaging patients and families into research through advanced survey and qualitative methods, clinical exposure to palliative care and geriatrics, and leadership development.

抽象的 到2030年，65岁以上的成年人将超过美国人口的20％。与这种快速变化的平行 人口统计学，该人群的手术率预计将增加30％。这样的患者 在术后发病率和死亡率上占比例不成比例的。虽然很重要 已经努力减少术后并发症和死亡，针对 老年人接受手术或正在接受手术的老年人（即手术患者）的临终护理。高的 老年人外科患者的质量终身护理很少被患者告知 家庭观点。此外，这种护理的要素的定义很差，并且在很大程度上被理解了。通过 我们独特而强大的手术计划协作基础设施，密歇根州的手术质量 协作（MSQC），我们将评估对终止护理的感知满意度和质量 使用先前验证的丧亲家庭调查并验证了医院的质量措施的手术 在密歇根州（AIM 1），并深入了解改善最终所需的关键要素 - 对年龄较大的老年人的生活护理，其术后死亡或结果不佳的高风险（AIM 2）。从发现中获悉 在目标1和2中，我们将开发和试点测试一种旨在改善寿命终止护理的干预措施 手术患者及其家人（AIM 3）。 MSQC是最大的基于人群的手术质量 在美国的改善合作培训完成了73家医院，每年代表50,000多名患者。 这项研究将通过揭示外科医生的方式对地方和国家倡议产生直接影响 医院可以更好地预测和管理老年人外科患者及其家人的结束 生命护理需求。这项研究的结果将为以后的研究提供基本的初步数据 改善患有术后死亡或结果不佳的老年人的临终关怀的干预措施。 此外，该研究计划将通过MSQC导致独特的数据基础架构 未来的研究。该项目，多学科心态团队和教育计划非常适合 满足候选人的职业和领导需求，马里兰州马里兰州Pasithorn A. Suwanabol。 Suwanabol博士是 董事会认证一般和有色手术，对姑息和寿命终止具有临床和研究兴趣 照顾老年人外科患者。她先前的研究经验理解了手术和 姑息治疗以及外科医生在提供姑息治疗中的作用，为此做好了准备 提议。但是，为了实现她成为改善高年轻人护理的领导者的目标 术后死亡或结局不佳的风险，她需要对患者和家庭的培训进行额外的培训 通过高级调查和定性方法进行研究，临床暴露于姑息治疗和 老年医学和领导力发展。