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The overarching goal of our research is to improve opioid analgesic safety and efficacy by optimizing opioid risk recognition, informed analgesic decision-making, and drug storage/disposal behaviors among parents of youth who are prescribed these agents for home use. With this proposal, we aim to demonstrate that our Scenario-Tailored Opioid Messaging Program (STOMP?) will: 1) Improve parents' opioid risk understanding and their analgesic decision-making; 2) Enhance parents' analgesic self-efficacy, analgesic use, storage behaviors and their children's pain outcomes, and 3) To demonstrate that the STOMP? plus provision of a method to get rid of left-over medications will effectively nudge parents to safely dispose of left-over opioid analgesics.

By identifying the specific role of physician and patient knowledge and attitudes toward thyroid cancer treatment, we will be able to create tailored educational interventions to personalize surgical and medical care for thyroid cancer patients, thus minimizing overtreatment and its inherent risks and costs. As the rising incidence, low mortality, and pattern of intensive treatment make thyroid cancer arguably the best cancer model for overtreatment, this proposed study will also serve as a model to understand overtreatment in other malignancies.

Although the US spends far more on health care than other high-income countries, older Americans are sicker and have shorter lives than older adults in many other high-income countries, even after controlling for individual-level factors such as education and behavioral risks. Reasons for the US health disadvantage are not well understood. However, local amenities and resources have not been examined systematically in efforts to understand difference in older adults' health status across countries.

This project will assess the extent to which local contextual characteristics explain the worse health status of older Americans compared to their counterparts in England using data from the Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA). We will identify comparable local geographic areas in the HRS and ELSA and create a comparable contextual dataset to be linked to the ELSA at each geographic boundary. We will then assess the extent to which area-level contextual measures explain key health and mortality differences between the US and England, including comprehensive self-reported health measures, measures of physical performances (e.g., gait speed) and cognitive functioning, and biomarkers (e.g., HbA1c). We will also examine health gaps by age, education, and economic groups before and after the adjustments of local contextual characteristics.

CBSSM Researchers: 

Because health care institutions are increasingly reliant on philanthropic fundraising from grateful patients, it is essential to understand public and patient perspectives about the ethical considerations in this context, including privacy and confidentiality, patient vulnerability, and physicians' conflicts of obligations.  The research team will conduct a survey to illuminate where current practices may diverge from public expectations, to focus deliberation on where policy changes may be needed.

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CBSSM Researchers: 

Matthew Corriere is developing a tool for doctors to understand patient goals, and improve shared decision-making in vascular treatment. He is working to understand the benefits of increasing patient participation and engagement in their own care.

CBSSM Researchers: 

Funded by NIH - National Institute Of Nursing Research

The project aims are 1) To develop a tailored web-based decision support intervention to prepare stroke surrogates to make decisions on use of life sustaining treatments; and 2) To pilot test the tailored decision support intervention in surrogate decision makers of hospitalized stroke patients. Key features of the tool will include an advanced statistical prognostic calculator that presents customized outcome data in a tailored and accessible fashion; an exercise to assist the surrogate in clarifying values most important to the patient, and questions to ask the health care team to empower surrogates to communicate more effectively. Information obtained in this R21 is critically important to the development of a novel tool that can be tested in a future definitive R01 study in order to better match treatment plans to patient wishes, reduce adverse outcomes among surrogates, and limit unwanted variability in end-of life treatment.

Funded by Accreditation Council for Graduate Medical Education (ACGME)

PI: Andrew Shuman, MD

CBSSM Co-I: Janice Firn, PhD, MSW

The clinical management of patients with cancer does not entail a "one size fits all" approach. In fact, studies of the genomic landscape of human cancers have demonstrated that cancers can have a multitude of mutations, a subset of which may be "actionable" with current drugs. Thus, the personalization of therapy for cancer will require molecular characterization of unique and shared genetic aberrations.

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