Advancing patient-centered decision making in older adults with venous thromboembolism
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PROJECT SUMMARY/ABSTRACT Although venous thromboembolism (VTE) is a disease of aging, the current evidence base neglects older adults’ priorities, which prevents patients and clinicians from making individualized VTE treatment decisions. VTE and its treatment are associated with substantial morbidity and mortality for older adults, yet existing data offer few insights into real-world VTE outcomes in older adults, and the current age-agnostic decision framework does not incorporate their unique experiences or values. Aging-focused evidence on VTE that expands beyond disease-focused predictors and outcomes would guide a new paradigm for treatment and improved quality of care. My overarching goal is to build a backbone of data to support individualized treatment decisions among older adults with VTE using qualitative methods to elucidate core decision-making priorities, high-quality existing data to detail how VTE is associated with aging-related characteristics and outcomes, and risk prediction modeling to estimate bleeding risk specific to older adults on long-term anticoagulants to prevent recurrent VTE. These insights will inform subsequent interventions to align VTE treatment with current best practices from geriatrics and older adults’ values. We propose the following Aims: Aim 1) Engage stakeholders to identify core components of individualized VTE treatment decision-making for older adults, Aim 2) Use two powerful and complementary existing data sources to describe the presentation, treatment, and outcomes of VTE in two large cohorts of older adults with VTE, and Aim 3) Develop and externally validate a clinical risk model incorporating geriatric syndromes to predict anticoagulation-related bleeding in older adults after VTE. This proposal will have a significant impact because it will produce evidence to guide a paradigm for VTE treatment that is founded on older adults’ experiences and priorities and will result in improved care. Through this award, I will obtain advanced training in stakeholder engagement, user-centered design and clinical trials of design aids, experience building a real-world cohort and advanced causal inference methods, and risk prediction modeling, along with mentorship from national leaders in the field. This research and training will provide a foundation for my long-term goal of transitioning to an independent researcher to develop interventions to improve the health and well-being of older adults with non-malignant hematologic diseases.
