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Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies

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This is a first submission for an NIA K23 Paul B. Beeson award (RFA-AG-11-009) by Dan D. Matlock, MD, MPH. Dr. Matlock's overarching career goal is to be a leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies. His research proposed herein uses Implantable Cardioverter-Defibrillators (ICDs) as a model to study the larger question of how to improve decision making for older adults. Candidate: Dr. Matlock is a board-certified geriatrician and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Colorado Denver (UCD). He has completed a Master's in Public Health and has conducted a host of studies focused on regional variations and decision making for ICDs. He works closely with his primary mentor; Dr. Jean Kutner, MD, MPH. He also receives mentorship from his collaborators (including Dr. Fred Masoudi, MD, MSPH) as a member the Colorado Cardiovascular Outcomes Research Group (CCOR), one of the leading cardiovascular outcomes research groups in the country. Training: The proposed K23 career development plan builds on prior experience from fellowship and early career development to focus on three areas that require additional training: 1) Observational data analysis; 2) Qualitative research; and 3) Shared decision making/decision aid development. Accordingly, Dr. Matlock proposes intensive topical mentorship, focused coursework, seminars, and contextual learning through the proposed research. These training activities will enable Dr. Matlock to learn how to best develop decision support interventions tailored to the needs of older adults. Mentors/Environment: Dr. Matlock and his primary mentor, Dr. Kutner have assembled a strong local mentorship team who will guide Dr. Matlock through the proposed training and research activities. To augment this team, Drs. Matlock and Kutner have assembled a panel of national and international advisors with expertise in various aspects of decision making among older adults to monitor Dr. Matlock's progress through the career development program and provide mentorship within their areas of expertise. Additionally, Dr. Matlock is the sole geriatrician in the CCOR making Dr. Matlock the natural lead for projects related to aging. Research: There is a pressing need to challenge the antiquated paternalism that persists in medical decision making in general and decision making for older adults in particular. This study will produce information of direct relevance to those working in clinical practice. Aim 1 will provide real world estimates of the risks and survival for ICD therapy which are essential knowledge to inform decision making. Aim 2 will build upon Dr. Matlock's prior research to answer additional questions about important aspects of ICD decision making for older adults and their family members. A particularly challenging question around ICDs is how to discuss the trade-off between sudden cardiac death versus potentially living longer with progressive heart failure. This study will provide a clear understanding of ICD decision making as it applies to older adults and will lead directly to the development of an ICD decision aid. Aim 3 will use an established framework for decision support and decision aid development guidelines to develop and pilot test a web based ICD decision aid. Summary: Perhaps the biggest innovation of this endeavor is that it is done in collaboration with cardiologists allowing for full understanding of the decision context and maximizing future implementation and dissemination. This collaboration also serves larger goals of spreading geriatric principles into the subspecialties of medicine. Conduct of this mentored research and training proposal, Implanted Defibrillators and Older Adults: A Model of Decisions and Technologies, will facilitate Dr. Matlock's development into a nationally-recognized independent investigator and leader conducting research that fundamentally changes and improves how older adults make decisions around invasive technologies.
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