Development of an intervention to ensure the goals of surgical treatment are valuable to older adults

PROJECT SUMMARY/ABSTRACT This is a 5-year K23 career development award for Dr. Jessica Cohan, a board-certified general and colorectal surgeon and early career investigator whose research focus is optimizing person-centered surgical care for older adults. As the population ages, an increasing number of older adults will face major, non-urgent surgery, associated with significant risk of cognitive, functional, and physical decline. Traditional surgical consultations do not include a discussion of the goals for surgery, i.e., what surgery can and cannot accomplish for the patient. Only by identifying clear, realistic goals for surgery can patients and families meaningfully deliberate about whether surgery is worth its burdens and risks. This proposal addresses a critical need to support older adults, families, and surgeons in discussing the goals for surgery during outpatient consultations. Dr. Cohan has developed a prototype intervention that consists of question prompts used by older adults, families, and surgeons to identify clear, realistic goals for surgery during consultations. In this proposal, Dr. Cohan will use the NIH Stage Model to 1) refine the intervention with input from key stakeholders, 2) adapt the intervention to the clinical context through field testing, and 3) measure the efficacy of the intervention on treatment goal documentation during surgical consultations. This work aligns with Dr. Cohan’s career development plan, which provides a clear path to independence by providing the means to develop expertise in 1) stakeholder engagement, 2) clinical intervention design, 3) intervention testing for aging populations using the NIH Stage Model, and 4) leadership in aging research. The proposed research will provide novel insights into how person- centered surgical care can be achieved for older adults and will result in a novel clinical intervention ready for a multi-center trial. Thus, this work will directly impact the health and wellbeing of the growing population of older adults facing major, non-urgent surgery. To accomplish these endeavors, Dr. Cohan is supported by a highly skilled, multidisciplinary team of mentors with expertise in geriatrics and aging-related research (Dr. Supiano), behavioral intervention development and clinical trials (Dr. Ozanne), and patient-surgeon communication and stakeholder engagement (Dr. Schwarze). The mentor team is complemented by three skilled and dedicated advisors with expertise in biostatistics, caregiver research, and pragmatic clinical trials. The proposal leverages the rich research and clinical resources of the University of Utah and provides a clear path by which Dr. Cohan will fulfill her career goal of becoming a leader at the intersection of surgery and aging research, developing and disseminating clinical interventions that advance high-quality, person-centered surgical care for older adults.