Developing and Piloting an Implementation Bundle to Improve Goals of Care Conversation Reach for Hospitalized Older Adults with Alzheimer’s Disease and Related Dementias Admitted to Rural Hospitals

About This Grant

PROJECT SUMMARY/ABSTRACT Goals of care conversations (GOCC) are an evidence-based practice and a pillar of high-quality, patient-centered serious illness care. For hospitalized older adults with Alzheimer’s disease and related dementias (AD/ADRD) admitted to rural hospitals, GOCC rarely occur and are particularly infrequently when compared to GOCC for this population in nonrural hospitals. GOCC are vital to provide patients with the positive outcomes associated with documented GOCC such as improved patient quality of life, and to ensure patients’ goals and preferences are understood and respected in the context of possible impaired or uncertain decision-making capacity. Low performance of GOCC in rural hospitals is concerning given that Americans with AD/ADRD residing in rural areas have elevated mortality, prolonged hospitalizations, and limited access to specialized dementia care. The candidate’s long-term career goal is to become an independent investigator who leverages implementation science research methods to promote high-quality, patient-centered serious illness communication. To pursue this goal, the candidate proposes to create an implementation bundle to improve GOCC reach (the proportion of patients receiving GOCC over time) for hospitalized older adults with AD/ADRD admitted to rural hospitals. Her Specific Aims are to 1) identify salient and modifiable facilitators and barriers to GOCC for hospitalized older adults with AD/ADRD admitted to rural hospitals, 2) develop an implementation bundle using human-centered design (HCD) to improve GOCC reach for hospitalized older adults with AD/ADRD admitted to rural hospitals, and 3) pilot test this implementation bundle. This application will be the first to create an implementation bundle to improve GOCC reach for hospitalized older adults with AD/ADRD admitted to rural hospitals using HCD. The candidate is committed to a research career to improve serious illness communication and has strong support from her research mentors and the University of Pittsburgh to pursue her career and research goals. She is an Assistant Professor in the Department of General Internal Medicine, Section of Palliative Care and Medical Ethics. Her institution is committed to providing her with 75% protected time for research and mentored training and 25% to clinical care as a palliative physician to pursue this project. This proposal describes a comprehensive training and mentoring plan including training objectives to 1) develop advanced skills in conducting and analyzing qualitative research data with an emphasis on understanding social relationships of aging families and how this affects decision-making for patients with AD/ADRD, 2) gain in-depth training in applying implementation science research methods to improve serious illness communication, and 3) develop expertise in designing and conducting clinical trials. Her mentorship team, led by Drs. Yael Schenker and Shari Rogal, will provide her with expertise in these areas. This mentorship, along with focused coursework, direct research experiences, and a supportive institution, will prepare the candidate to become a successful independent investigator with the skills and expertise needed to improve serious illness communication.