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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要这是颁发给 Lindsay Hampson 博士的 Beeson K76 职业发展奖，她是一名临床研究员，拥有汉普森博士拥有伦理学、健康服务研究和压力性尿失禁 (SUI) 方面的背景。将她的职业生涯转向老龄化，目标是成为老年泌尿学研究的全国领导者专注于为患有影响生活质量 (QOL) 的泌尿系统问题的老年人提供目标一致的护理该提案旨在通过减少治疗差异和改善治疗决策。通过以下方式改善老年人前列腺切除术后 SUI 的目标一致管理：1) 确定老年前列腺切除术后男性护理差异的驱动因素，2) 确定治疗偏好和该患者群体的优先事项，以及 3) 促进个体化评估和治疗决策在老年健康和价值观的背景下意义：前列腺切除术后 SUI 显着。影响生活质量，对老年男性的影响尤其严重，尽管重点是减少前列腺的治疗。癌症，四分之一的 65-75 岁诊断患有前列腺癌的男性仍将接受前列腺切除术。据估计，25-30% 的男性正在使用护垫、尿布，或抱怨超过 1 种令人烦恼的尿失禁前列腺切除术后一年，这些比率可能代表了对老年人失禁率的低估男性 SUI 手术已被证明可以改善近期生活质量，且满意度较高，但目前尚不清楚。严重未充分利用和延迟，面临治疗决定的男性对决定有很大的遗憾。 Aim 1 的全国队列研究使用退伍军人事务部和医疗保险数据，我们的目标是确定相关因素 In Aim 2 中老年男性前列腺切除术后 SUI 治疗不足和治疗延迟。对老年前列腺切除术后男性的选择实验调查，我们的目的是确定以患者为中心的 SUI 治疗优先事项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前列腺切除术后失禁评估和决策支持（I- PADS）工具将在目标 3 中通过混合方法研究和可行性/可接受性试验进行评估。指导团队：汉普森博士卓越的多学科指导团队由 Louise Walter 博士领导，她是一位该奖项将支持老年人个性化决策方面的国际公认专家。汉普森博士通过以下方面的专门培训转向老龄化研究：1) 开展全国队列研究对老年人的研究，2) 发展衡量治疗偏好的专业知识，3) 实施科学对老年人实施干预措施的理论和方法，以及 4) 在老年泌尿科领域的领导地位通过减少治疗差异，成为老年人目标一致泌尿科护理的领导者改善治疗决策：这些结果将作为多中心的基础。 I-PADS 工具的混合实施-有效性研究，以测试其在解决 SUI 差异方面的效果前列腺切除术后 SUI 的手术、决策和治疗后悔以及接受目标一致护理。