The aims of this proposal are to (1) enable the candidate to further develop her research program focused on improving advance care planning (ACP) and informed medical decision making for vulnerable older adults and (2) use her research program as a platform for mentoring junior investigators interested in patient-oriented aging research, both within Geriatrics and other medical subspecialties. The candidate is a Geriatrician and Palliative Medicine physician who has established a high-impact independent clinical research program that is well funded with an outstanding publication record. In the 10 years since completing her Geriatrics fellowship, she has established herself as a successful mentor of students, fellows, and junior faculty who have published high-impact aging research, become successfully funded, and continue to participate in patient-oriented research in aging. The candidate has developed an extensive research portfolio focused on creating and testing literacy- and culturally appropriate health education materials to improve ACP and medical decision making for older adults. She developed a broader paradigm of ACP that focuses not only on one-time treatment decisions, such as for cardiopulmonary resuscitation (CPR), but also on the process of preparing patients to communicate their wishes and to participate with clinicians in making real-time, complex medical decisions over the course of illness. She operationalized this paradigm into an easy-to-understand, patient- centered website called PREPARE that teaches patients, through videos, how to identify their wishes and communicate with surrogates and clinicians. The candidate received R01 funding from the NIA to test the efficacy of the PREPARE website to engage diverse, vulnerable older adults from an urban, county hospital in ACP using validated patient questionnaires. This K24 proposal will provide the candidate with protected time to expand her research in a new direction focused on direct observation (i.e., audio recording) of patient-clinician communication within primary care encounters in response to the PREPARE intervention. This new research will determine whether a patient-centered ACP website can empower and activate patients to discuss ACP and to facilitate communication with their primary care providers. The candidate will also develop her formal mentoring program with plans for the recruitment, selection, development, and evaluation of mentees who will become leaders in aging research. She will work with each mentee to establish a focused career development plan in which they complete research projects and develop the skills needed to become independent investigators. These plans will make full use of the outstanding clinical research training environment at UCSF. She will leverage her leadership positions at UCSF to recruit more mentees interested in research on ACP and aging in vulnerable populations.

Public Health Relevance

This proposal will have unique public health importance because (1) it will increase mentoring of new clinical investigators interested in conducting patient-oriented research to improve advance care planning and patient- clinician communication for the rapidly growing elderly population, and (2) it will inform interventions to improve patient-clinician communication in the primary care setting, reduce health disparities in ACP, and result in diverse, older adults who are prepared for complex medical decision making.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
Application #
Study Section
Clinical Aging Review Committee (NIA-C)
Program Officer
Onken, Lisa
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
Zip Code
Quartuccio, Michael; Simonsick, Eleanor M; Langan, Susan et al. (2017) The relationship of health literacy to diabetes status differs by sex in older adults. J Diabetes Complications :
O'Hare, Ann M; Szarka, Jackie; McFarland, Lynne V et al. (2017) ""Maybe They Don't Even Know That I Exist"": Challenges Faced by Family Members and Friends of Patients with Advanced Kidney Disease. Clin J Am Soc Nephrol 12:930-938
Wong, Theresa W; Lang-Brown, Sean; Romo, Rafael D et al. (2017) Prognosis Communication in Late-Life Disability: A Mixed Methods Study. J Am Geriatr Soc 65:2496-2501
Walker, Evan; McMahan, Ryan; Barnes, Deborah et al. (2017) Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety. J Pain Symptom Manage :
Sudore, Rebecca L; Heyland, Daren K; Barnes, Deborah E et al. (2017) Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey. J Pain Symptom Manage 53:669-681.e8
Bekelman, David B; Johnson-Koenke, Rachel; Ahluwalia, Sangeeta C et al. (2017) Development and Feasibility of a Structured Goals of Care Communication Guide. J Palliat Med 20:1004-1012
Sudore, Rebecca L; Boscardin, John; Feuz, Mariko A et al. (2017) Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial. JAMA Intern Med 177:1102-1109
Sudore, Rebecca L; Lum, Hillary D; You, John J et al. (2017) Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage 53:821-832.e1
Ahalt, Cyrus; Sudore, Rebecca; Bolano, Marielle et al. (2017) ""Teach-to-Goal"" to Better Assess Informed Consent Comprehension among Incarcerated Clinical Research Participants. AMA J Ethics 19:862-872
Tang, Victoria L; Sudore, Rebecca; Cenzer, Irena Stijacic et al. (2017) Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med 32:153-158

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