This doctoral program of study and dissertation research will provide me the necessary foundation for a research career in nursing. My long term goal is to carry out a program of research dedicated to enhancing the delivery of patient-centered care in older adults diagnosed with cancer. This goal is strongly aligned with the area of research emphasis of the National Institute of Nursing Strategic Plan calling for research studies on self management strategies that could lead to improved quality of life. Specifically, this study will be seminal for developing an intervention to promote active health care participation by older adults newly diagnosed with multiple myeloma. PROBLEM: Multiple myeloma is a B-cell malignancy of the plasma cells primarily affecting older adults with median age of diagnosis at 65. There is considerable evidence that patients want to be informed and consulted with regard to the impact of treatment on not only survival but also quality of life. However, no data exist regarding the process of treatment decision-making and degree of control preferences over treatment decisions in older adults diagnosed with multiple myeloma. The increasing number of treatment options for patients newly diagnosed with myeloma also complicates the decision making process requiring in-depth examination of various factors affecting treatment decisions. PURPOSE: To examine treatment decision-making in older adults aged 60 years and above with newly diagnosed multiple myeloma.
The specific aims of the study are to 1) Describe physicians'perspectives on the decision-making process and patients'preferences for participation in decision-making.2) Examine patients'perspectives on the decision-making process including personal values, preferences for participation, and past experiences relevant to treatment decision-making.3) Describe information needs and preferences for participation in decision-making of patients newly diagnosed with multiple myeloma. 4) Explore the association of socio-demographic variables with information needs priorities and preferences for participation in decision-making. DESIGN AND METHOD: This study will employ a multi-method, cross-sectional survey and interview design. Physicians and patients will be interviewed separately to describe how treatment decisions are made from both perspectives. After the interview, patients will be asked to report their degree of preferred control over treatment decisions using the Control Preference Scale (CPS) and complete the Information Need questionnaire to assess their information priorities for participation in the decision-making process.
My overall training and career goals are directed toward the development of a program of geriatric research dedicated to enhancing the delivery of patient-centered care to older adults and improving their quality of life (QOL) when diagnosed with cancer. My long-term goals are to 1. Develop an efficient, cost-effective intervention for older patients with newly diagnosed myeloma that can improve patient satisfaction with treatment decisions. 2. Collaborate with a multidisciplinary research team in developing tools that can improve self-management strategies in older adults with cancer. 3. Develop a collaborative, interdisciplinary program of geriatric research dedicated to enhancing the delivery of patient-centered care. Based on findings from an in-depth conceptual analysis of decision-making in oncology settings (Figure 1), I plan to begin my research program with an exploration of treatment decision-making practices and patients'preferences for decisional control. During this pre-doctoral fellowship training, I will examine how treatment decisions are made by older adults with newly diagnosed myeloma and the clinicians with whom they have consulted. Additionally, I will examine patients'needs for information to support their participation in the decision making process. The model of decision making in oncology settings presented below provides a conceptual framework for the development of this research proposal. The study will focus on examining the values, beliefs, preferences for participation, and information needs in older adults diagnosed with myeloma and the clinicians'perspectives on the decision making process, as reflected in the highlighted sections in Figure 1. Due to the limited studies in older adults with cancer, these specific aspects of decision-making have not been previously explored.
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