This is an initial submission by Hillary Lum, MD, PhD for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76). Dr. Lum is committed to being a leader in advance care planning (ACP) research, policy initiatives, and healthcare system change to improve care for older adults. She is an internist, geriatrician, and palliative medicine physician in the Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine. Dr. Lum's research focuses on refining an Advance Care Planning Group Visit (ACP-GV) intervention to engage older adults in ACP. This proposed 4-year training plan accelerates Dr. Lum's career development as a patient-oriented researcher and leader in aging through training in: 1) advanced qualitative analysis; 2) implementation science; and 3) pragmatic clinical trials in older adults. She will acquire these skills through intensive interactions with her mentoring team, advanced coursework, guided research, and integrated leadership development, both institutionally and as a Health and Aging Policy Fellow. Dr. Lum's mentorship team and institutional resources are exceptional. As Dr. Lum's primary mentor, Cari Levy, MD, PhD is a nationally recognized researcher and leader in geriatric palliative care and will supervise Dr. Lum's research, career, and leadership development. Dr. Lum is co-mentored by Jean Kutner, MD, MSPH, a skilled leader and expert in palliative care research, including clinical trials in older adults. With funding from the National Palliative Care Research Center and The Colorado Health Foundation, Dr. Lum demonstrated that a novel ACP-GV intervention prototype increased ACP discussions and documentation among older adults in primary care. In order to conduct a real-world clinical trial and ultimately implement this intervention, the next research steps are to standardize the intervention for a general population and adapt the intervention to clinical settings by prioritizing input from patients, clinicians, staff, and health system leaders. Thus, the study objectives are to: 1) develop and refine the ACP-GV intervention to be standardized to the essential intervention components, to be adaptable across clinic settings, and to prioritize ACP outcomes important to key primary care stakeholders, and 2) conduct a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of the refined ACP-GV intervention. The culmination of this career development award will assure that Dr. Lum gains the advanced research skills and knowledge to conduct a full-scale effectiveness-implementation trial of an ACP-GV intervention for older adults on patient- centered outcomes. Additionally, she will be specifically positioned to assume expanded and influential national leadership roles to lead policy initiatives to improve ACP with local, regional, and national impact and improve healthcare system delivery of care that is aligned with patient goals.

Public Health Relevance

Primary care settings need effective systems of care to help older adults discuss their preferences for future medical care. The Advance Care Planning Group Visit intervention is a new intervention that uses the strengths of group visits to promote advance are planning conversations and documentation. This study will standardize, adapt, and pilot test the Advance Care Planning Group Visit intervention to improve opportunities for older adults to receive medical care that is consistent with their values, goals, and preferences.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Project #
1K76AG054782-01
Application #
9228224
Study Section
Special Emphasis Panel (ZAG1-ZIJ-6 (A1))
Program Officer
Onken, Lisa
Project Start
2016-09-15
Project End
2020-05-31
Budget Start
2016-09-15
Budget End
2017-05-31
Support Year
1
Fiscal Year
2016
Total Cost
$169,426
Indirect Cost
$12,520
Name
University of Colorado Denver
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
041096314
City
Aurora
State
CO
Country
United States
Zip Code
80045
Zapata, Carly; Lum, Hillary D; Wistar, Emily et al. (2018) Feasibility of a Video-Based Advance Care Planning Website to Facilitate Group Visits among Diverse Adults from a Safety-Net Health System. J Palliat Med 21:853-856
Sudore, Rebecca L; Heyland, Daren K; Lum, Hillary D et al. (2018) Outcomes That Define Successful Advance Care Planning: A Delphi Panel Consensus. J Pain Symptom Manage 55:245-255.e8
Somes, Elizabeth; Dukes, Joanna; Brungardt, Adreanne et al. (2018) Perceptions of trained laypersons in end-of-life or advance care planning conversations: a qualitative meta-synthesis. BMC Palliat Care 17:98
Kant, Rebecca E; Vejar, Maria; Parnes, Bennett et al. (2018) Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program. Geriatr Nurs 39:574-579
Lum, Hillary D; Barnes, Deborah E; Katen, Mary T et al. (2018) Improving a Full Range of Advance Care Planning Behavior Change and Action Domains: The PREPARE Randomized Trial. J Pain Symptom Manage 56:575-581.e7
Breathett, Khadijah; Jones, Jacqueline; Lum, Hillary D et al. (2018) Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis. J Racial Ethn Health Disparities 5:1215-1229
Sable-Smith, Alex; Arnett, Kelly R; Nowels, Molly A et al. (2018) Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. Fam Pract 35:307-311
Lum, Hillary D; Dukes, Joanna; Church, Skotti et al. (2018) Teaching Medical Students About ""The Conversation"": An Interactive Value-Based Advance Care Planning Session. Am J Hosp Palliat Care 35:324-329
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
Lum, Hillary; Obafemi, Oluyomi; Dukes, Joanna et al. (2017) Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities. J Am Med Dir Assoc 18:885-890

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