All elders will eventually face end-of-life treatment decisions; however, these complex decisions may be compounded by limited literacy. My long-term goal is to improve end-of-life decision making for elders with limited literacy. I have trained in clinical geriatrics, obtained advanced NIA-funded geriatrics research training, designed an incremental research agenda for this application, and conducted the initial studies for that agenda. I seek a K23 award to conduct mentored research in health literacy and end-of life decision making in the elderly and to develop the research skills to become an independent investigator. ? The mean reading level of US elders is < 5th grade, and limited literacy has been associated with impaired decision-making. Most end-of-life decision tools are written beyond the 12th grade level. Also, most do not elicit patients' values concerning treatment outcomes (e.g. whether, after treatment, being severely demented is acceptable or unacceptable), though this approach is thought to result in care more consistent with patients' goals. In this application, I address the need for a values tool (i.e., a tool that elicits patient values about treatment outcomes) that meets the literacy needs of most U.S. elders.
The aims of this application are to (1) adapt a values tool to meet the literacy needs of most US elders; (2) assess the preferred format (questionnaire vs. story format); (3) adapt a values tool into a video medium; and (4) assess the preferred medium (written vs. video) to present the values tool. All subjects will be recruited from a county hospital in San Francisco with a diverse patient mix and a limited literacy prevalence of 40%.
For Aims 1 -4, I will assess elder's satisfaction with the written, story or video values tool.
For Aims 1 -3, I will assess the tool's psychometric properties (reliability and validity).
Aims 2 and 4 will assess satisfaction, knowledge, and preference between the two formats and mediums of the values tool. ? I have assembled a strong mentoring team with expertise in geriatrics, health literacy, and psychometric analysis. I have also designed a strong career development plan in which I will obtain training in psychometric and qualitative methods, trial design, and adult learning technologies and complete a series of mentored research projects where I will gain the skills to become a leader in aging research. ? The proposed work will lead to my development as an independent investigator in aging research, and to the development of a literacy level-appropriate tool to elicit elders' values about treatment outcomes that is reliable and valid. This application will lead to independent research to test my hypothesis that the values tool I develop will result in value-concordant medical care and improved satisfaction for elders and their families. ? ? ?

National Institute of Health (NIH)
National Institute on Aging (NIA)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute on Aging Initial Review Group (NIA)
Program Officer
Nielsen, Lisbeth
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca et al. (2011) Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Making 31:151-73
Sudore, Rebecca L; Schillinger, Dean; Knight, Sara J et al. (2010) Uncertainty about advance care planning treatment preferences among diverse older adults. J Health Commun 15 Suppl 2:159-71
Schickedanz, Adam D; Schillinger, Dean; Landefeld, C Seth et al. (2009) A clinical framework for improving the advance care planning process: start with patients' self-identified barriers. J Am Geriatr Soc 57:31-9
Sudore, Rebecca L; Schillinger, Dean (2009) Interventions to Improve Care for Patients with Limited Health Literacy. J Clin Outcomes Manag 16:20-29
Sudore, Rebecca L; Landefeld, C Seth; PĂ©rez-Stable, Eliseo J et al. (2009) Unraveling the relationship between literacy, language proficiency, and patient-physician communication. Patient Educ Couns 75:398-402
Sudore, Rebecca L; Schickedanz, Adam D; Landefeld, C Seth et al. (2008) Engagement in multiple steps of the advance care planning process: a descriptive study of diverse older adults. J Am Geriatr Soc 56:1006-13
Sudore, Rebecca L; Landefeld, C Seth; Pantilat, Steven Z et al. (2008) Reach and impact of a mass media event among vulnerable patients: the Terri Schiavo story. J Gen Intern Med 23:1854-7
Sudore, Rebecca L; Landefeld, C Seth; Barnes, Deborah E et al. (2007) An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns 69:165-95