This is a proposal for a Mentored Patient-Oriented Research Career Development Award (K23) for Alexia Torke. Dr. Torke began her medical career as a clinician educator in general internal medicine with a focus on medical ethics. After five years as a faculty member at Emory University, she went back into training to complete a fellowship in ethics and primary care. She is currently an Assistant Professor of Medicine at Indiana University and a Research Scientist at the Indiana University Center for Aging Research. Her research now focuses on both medical and ethical aspects of decision making for older adults. Dr. Torke's long term goalis to improve the medical care ofhospitalized older adults who are unable to make their own decisions. This Career Development Award would provide her with the training and protected time needed to accomplish a crucial step toward that goal: characterizing the decision making process as it occurs for these patients. Dr. Torke proposes to conduct a prospective, observational study of older adults and their surrogate decision makers.
The specific aims ofthis study are to describe the frequency, characteristics, and clinical context of surrogate decisions, and to identify important determinants of successful communication and high quality decision making from the surrogate's perspective. Patients 65 and older will be identified on admission and followed during their hospital stay. Data will be collected from treating physicians, from medical record review and from in-depth interviews with surrogate decision makers. These results will serve as the basis for future interventions to improve the care of older adults who are unable to make their own medical decisions. Dr. Torke has also designed an educational plan that will further her development as an independent investigator. The plan focuses on four areas that Dr. Torke and her mentors have identified as crucial to her career development: aging and clinical geriatrics; communication theory;grant writing;and clinical trial design. Dr. Torke will attend relevant national conferences and complete formal course work related to each ofthese four areas. She will also expand her knowledge of clinical geriatrics by participating in the Acute Care for the Elders Unit and the memory care practice located within Indiana University.

Public Health Relevance

(See Instructions): As the population ages, the number of patients who face serious illness but are unable to make their own medical decisions will rise. Care at the end of life Is often inconsistent with what patients or families want, and laws that guide surrogate decision making may be out of step with clinical practice. In spite of this, very little research is available that explores the process of decision making as it occurs in the clinical setting.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG031323-05
Application #
8531093
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Gerald, Melissa S
Project Start
2009-09-15
Project End
2014-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
5
Fiscal Year
2013
Total Cost
$154,507
Indirect Cost
$7,602
Name
Indiana University-Purdue University at Indianapolis
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
Torke, Alexia M; Sachs, Greg A; Helft, Paul R et al. (2014) Scope and outcomes of surrogate decision making among hospitalized older adults. JAMA Intern Med 174:370-7
Torke, Alexia M; Schwartz, Peter H; Holtz, Laura R et al. (2013) Older adults and forgoing cancer screening: "I think it would be strange". JAMA Intern Med 173:526-31
Fritsch, Jenna; Petronio, Sandra; Helft, Paul R et al. (2013) Making decisions for hospitalized older adults: ethical factors considered by family surrogates. J Clin Ethics 24:125-34
Torke, Alexia M; Schwartz, Peter H; Holtz, Laura R et al. (2013) Caregiver perspectives on cancer screening for persons with dementia: "why put them through it?". J Am Geriatr Soc 61:1309-14
Torke, Alexia M; Petronio, Sandra; Sachs, Greg A et al. (2012) A conceptual model of the role of communication in surrogate decision making for hospitalized adults. Patient Educ Couns 87:54-61
Torke, Alexia M; Sachs, Greg A; Helft, Paul R et al. (2011) Timing of do-not-resuscitate orders for hospitalized older adults who require a surrogate decision-maker. J Am Geriatr Soc 59:1326-31
Bosslet, Gabriel T; Torke, Alexia M; Hickman, Susan E et al. (2011) The patient-doctor relationship and online social networks: results of a national survey. J Gen Intern Med 26:1168-74
Torke, Alexia M; Holtz, Laura R; Hui, Siu et al. (2010) Palliative care for patients with dementia: a national survey. J Am Geriatr Soc 58:2114-21