Diverticulitis affects hundreds of thousands of people over age 60 years in the United States and is the 4th most common reason for emergency surgery in older adults. Due to the substantial consequences of diverticulitis, patient-centered decision making is imperative for this vulnerable population. Existing frameworks for decision making are inadequate for older adults facing surgery because they fail to incorporate the high-risk, irreversible nature of surgical decisions and the unique considerations in older adults (for example, multiple comorbidity, neurocognitive changes, and varying preferences regarding participation in decision making). The central hypothesis of this proposal is that patient-centered decision making is not routinely achieved for older adults with diverticulitis who are faced with a high-stakes decision about proceeding with surgery or observation. The objective of this proposal is to guide the management of older adults facing high-risk surgery through the identification of patient-centered decisions by accomplishing the following specific aims: 1) characterize the decision making process for older adults with diverticulitis, including how patient/provider goals are incorporated into treatment decisions, using a thorough and comprehensive evaluation of ?real-time? evaluation of clinical encounters followed by post-encounter interviews with patients and their providers and 2) identify barriers and facilitators to patient-centered decision making using survey instruments informed by the findings of Aim 1 in a large population of older adults with diverticulitis at multiple sites. This is an innovative study that will address significant gaps in the literature regarding surgical decision making for older adults with diverticulitis. This work represents a substantive departure from the existing literature, which focuses on short term morbidity and mortality, by examining the complexity of surgical decision making between older adults and their providers. The results will have a substantial impact because they can be used to 1) tailor existing decision making frameworks for older adults making high-stakes surgical decisions and 2) define the necessary components of a future decision support tool to support. Dr. Cohan?s overall career goal is to become a leader at the intersection of colorectal surgery and aging-related research that improves patient-centered surgical care for older adults. This project includes a comprehensive professional development plan that incorporates mentorship and training to support this career goal. The mentorship team is talented, diverse, and dedicated, spanning the disciplines of geriatrics, surgery, decision science, and qualitative research. The proposed training in geriatric science and mixed-methods research will allow Dr. Cohan to expand upon her prior clinical and research training. Together, the research and professional development in this GEMSSTAR proposal will allow Dr. Cohan to become a colorectal surgeon-leader focused on improving patient-centered care for older surgical patients. The results will directly impact the health and well- being of older adults with diverticulitis.
/ RELEVANCE TO PUBLIC HEALTH Diverticulitis in older adults is a major public health concern because it is common and causes substantial morbidity. Patient-centered decision making for older adults with diverticulitis is important because treatment decisions are high-stakes and irreversible. By identifying barriers and facilitators to patient-centered decision making, there is the potential to improve the health and well-being of older adults with diverticulitis.
