Adults >75 years are the fastest growing segment of the US population and are increasingly receiving medical
interventions from which they often have little chance to benefit, such as cancer screening. Few of the
randomized trials of cancer screening tests included adults >75 years and thus the benefits of screening are
uncertain; yet, there are important harms which include anxiety, complications as a result of false positive tests
and/or work-up of cancer, and overdiagnosis (detection of non-lethal tumors) leading to overtreatment.
Guidelines recommend that cancer screening decisions for adults >75 years be individualized based on their
risk for cancer, 10-year life expectancy, and values and preferences. Yet, many older adults are screened for
cancer with little knowledge of the harms, including many with <10 year life expectancy who are very unlikely
to benefit. Since engaging patients in shared decision making (SDM) improves care, patient satisfaction, and
outcomes, my research program aims to improve SDM around cancer screening between older adults and
their clinicians through: 1) improving estimation of older adults' long-term prognosis; 2) developing prediction
models for late-life cancer; and 3) creating decision aids to help older adults make more informed, preference-
sensitive, screening decisions. With a K24 and the supportive environment and resources at Beth Israel
Deaconess Medical Center and Harvard Medical School, I aim to continue to build my patient oriented
research program in SDM around cancer screening for older adults, to expand my mentorship program to
prepare the next generation of aging researchers in SDM, and to expand my own research skills and mentor-
ship program by developing new expertise in implementation science. My Specific Aims are: 1)To continue to
conduct high quality research that will lead to improved SDM around cancer screening for older adults, with an
emerging focus on implementation science. This will be accomplished through my newly funded 5-year NIA
R01 project that aims to develop and test a quick and easy-to-use web-based conversation aid to support SDM
between PCPs, women >75 years, and their involved family members during a visit and through my ongoing
research projects. 2) To use my research as a platform to mentor new investigators in research on improving
SDM around medical interventions for older adults, especially for cancer screening, and to help them become
independent investigators. This aim will be accomplished by: i. direct involvement of trainees in my research
projects, ii. completion of ancillary studies related to my new R01, iii. leveraging my research program's
infrastructure to enable my mentees' investigations, and iv. ongoing recruitment and retention of high caliber
mentees. Impact: As more medical interventions, like cancer screening, with uncertain benefit but important
harms for older adults become available, there is great need for high quality decision tools to support SDM
between PCPs and older adults. With mentees I will develop and test novel decision tools to support SDM. A
focus on implementation science will ensure these tools are widely implemented thus improving patient care.