Project Description
A Communication Tool to Assist Frail Older Adults in Decision Making about Dialysis
Each year, more than 100,000 adults over age 75 with
end-stage renal disease receive dialysis, a therapy with considerable treatment
burden and often limited ability to prolong life. Because these patients
experience significant morbidity, a decision to start dialysis needs to be
contextualized with information about the patient’s overall health status so
patients can make values-concordant treatment decisions and recognize the value
of early access to palliative care. This proposal serves the long-term goal of
improving treatment decision making for frail older adults with life-limiting
illnesses so that treatment choices reflect personal preferences and goals.
“A communication tool to assist frail older adults with
end-stage renal disease” is a two-year NPCRC proposal to support a pilot study
of a communication tool designed to help older patients make decisions about
dialysis and receive earlier access to palliative care. This project has three
aims: Aim 1, to demonstrate that nephrologists can learn to use the
communication tool; Aim 2, to assess the feasibility of study procedures for
later use in a large-scale efficacy study; and Aim 3, to evaluate measured effects
in order to estimate sample size and ensure future study outcomes are
clinically meaningful.
This award will produce data and procedures necessary to
submit a competitive application for a larger-scale efficacy trial. The
research is innovative because it will test a novel, theoretically grounded
intervention in a well-defined outpatient setting. The research is significant
because if it is ultimately found effective, it offers a low-cost, scalable
strategy to improve physician engagement with frail older patients during
treatment decision making and promote earlier access to outpatient palliative
care. The research is feasible because it has been carefully designed to fit
the time frame and budget and will be conducted by investigators with a strong
track record in decision-making, aging-related, health services research.
Bio
Gretchen
Schwarze MD, MPP is an Associate Professor in the Division Vascular of Surgery
at the University of Wisconsin. She received her medical degree from Harvard Medical School
and master’s degree in public policy from the John F. Kennedy School of
Government. She completed residency at
the Massachusetts General Hospital in Boston.
Her fellowship training in vascular surgery and clinical ethics was done at the
University of Chicago Hospital and Clinics.
Her research interests are in patient-doctor decision making for high
risk operations and end-of-life care for surgical patients. She is an alumna of
the Greenwall Faculty Scholars program and currently holds a KL2 award via the
University of Wisconsin CTSA and a GEMSSTAR (R03 NIA)/Jahnigen Award from the
American Geriatrics Society and the Society for Vascular Surgery to test a
communication intervention for older, frail surgical patients. She was recently awarded funding from PCORI
to test a patient-designed and patient-mediated intervention to improve
engagement during high-stakes surgical decisions. Dr. Schwarze has two
daughters, ages 8 and 10.
Email: schwarze@surgery.wisc.edu