Developing Tools for Dialysis Decision Support in Older Adults

开发老年人透析决策支持工具

• 批准号: 10450652
• 负责人: MANJULA KURELLA TAMURA
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10450652
• 关键词: Address; Age; Benefits and Risks; Caring; Cessation of life; Chronic Kidney Failure; Clinical; Clinical Data; Clinical Trials; Complex; Computerized Medical Record; Conflict (Psychology); Data; Decision Aid; Decision Making; Dialysis procedure; Effectiveness; Elderly; End stage renal failure; Ensure; Family; Goals; Growth; Healthcare; Hospitals; Informatics; Informed Consent; Intervention; Kidney Diseases; Knowledge; Life; Life Expectancy; Life Style; Maintenance; Medical; Methods; Modeling; Nursing Homes; Older Population; Online Systems; Patient-Focused Outcomes; Patients; Prevalence; Procedures; Public Health; Risk; Testing; Time; Uncertainty; United States; Veterans; Work; disability; effectiveness evaluation; implementation tool; improved; innovation; novel; overtreatment; population based; prognostic; prognostic tool; shared decision making; support tools; tool; treatment effect; treatment strategy; usability

Background: Each year, more than 25,000 patients over the age of 75 start maintenance dialysis treatment in the United States. Although dialysis may prolong life, it entails profound and sometimes burdensome changes in lifestyle, substantial risks for complications, and for older adults, a high likelihood of permanent disability. The quality of dialysis decision making is often poor; few patients receive prognostic information or discuss the option to receive medical management without dialysis. Rather, patients perceive these decisions as a choice between dialysis or death. Significance/Impact: Our overarching goal is to support informed, goal-concordant dialysis decisions by developing decision support tools, addressing HSRD Priority Domain `Healthcare Informatics'. This project will address the information needs of patients and clinicians by generating new tools to support informed decision- making and goal-concordant care for Veterans with advanced chronic kidney disease and end-stage renal disease. Innovation: The project is innovative in several ways. First, it applies causal inference models to estimate treatment effects of dialysis to address an important clinical question for which a clinical trial is not feasible. Second, it incorporates patient-centered outcomes to evaluate the effectiveness of dialysis. Third, it uses novel scenario planning frameworks to address uncertainty with decision support. Specific Aims and Methods: To accomplish this goal, we will (1) compare survival, hospital-free survival, time to nursing home placement and number of dialysis access procedures using causal inference models to illustrate trade-offs from dialysis versus medical management among older Veterans with end-stage renal disease; (2) develop a web-based risk benefit calculator and decision aid based on the framework of scenario planning that incorporates estimates of survival and treatment complications with dialysis initiation compared to medical management; and (3) using mixed methods, evaluate the tools' usability, acceptability and effects on patient knowledge and decisional conflict. Implementation/Next Steps: We will work with operational partners to ensure the tools meet the needs of the end-users, and develop plans for broader testing and dissemination. By the end of the project period, we expect to submit a proposal to test a dialysis decision support intervention incorporating these tools in older Veterans.

背景：每年，超过 25,000 名 75 岁以上的患者开始维持性透析治疗 美国。尽管透析可以延长生命，但它会带来深刻的、有时甚至是繁重的改变 在生活方式上，并发症的风险很大，而对于老年人来说，永久性残疾的可能性很高。 透析决策的质量往往很差；很少有患者收到预后信息或讨论 选择接受不进行透析的医疗管理。相反，患者将这些决定视为一种选择 透析或死亡之间。 意义/影响：我们的首要目标是通过以下方式支持明智的、目标一致的透析决策： 开发决策支持工具，解决 HSRD 优先领域“医疗保健信息学”问题。该项目将 通过生成新工具来支持知情决策，满足患者和临床医生的信息需求 为患有晚期慢性肾病和终末期肾病的退伍军人提供制定和目标一致的护理 疾病。 创新：该项目在多个方面具有创新性。首先，它应用因果推理模型来估计 透析的治疗效果，以解决临床试验不可行的重要临床问题。 其次，它结合了以患者为中心的结果来评估透析的有效性。第三，它使用 新颖的情景规划框架，通过决策支持解决不确定性。 具体目标和方法：为了实现这一目标，我们将 (1) 比较生存率、无住院生存率、时间 使用因果推理模型来确定疗养院的安置和透析访问程序的数量 说明患有终末期肾病的老年退伍军人中透析与医疗管理的权衡 疾病; (2)开发基于场景框架的网络风险收益计算器和决策辅助 计划包括与开始透析相比的生存率和治疗并发症的估计 医疗管理； (3)采用混合方法，评估工具的可用性、可接受性和效果 患者知识和决策冲突。 实施/后续步骤：我们将与运营合作伙伴合作，确保工具满足 最终用户，并制定更广泛的测试和传播计划。到项目期结束时，我们 期望提交一份提案来测试将这些工具纳入老年患者的透析决策支持干预措施 退伍军人。