PROJECT SUMMARY/ABSTRACT The purpose of this K76 career development award is to support Dr. Fullard’s long-term career goal of becoming an independent clinician-scientist focused on improving shared decision-making for older adults with neurologic disease, including those with mild cognitive impairment (MCI). MCI is common in older adults and can present unique challenges to shared decision-making. In this proposal, we will examine decision-making in MCI using Deep Brain Stimulation (DBS) surgery in people with Parkinson’s disease (PD) and MCI as a model. MCI is common in PD and is especially pertinent to decision-making because it affects executive function, verbal memory and processing speed, domains that are associated with the ability to weigh risks and benefits and appreciate the consequences of a decision. In addition, people with MCI exhibit higher decisional conflict and report more decision regret compared to their healthy counterparts, making this an ideal population for a decision support intervention. The overall objective of this proposal is to examine the approach to decision-making for PD patients with MCI and to improve decisional outcomes using a decision aid that addresses cognitive weaknesses. The central hypothesis is that decisional conflict and decision quality will improve after exposure to the decision aid. The specific aims for this proposal are to: 1) adapt and refine a DBS decision aid for PD patients with MCI considering DBS surgery, 2) evaluate the feasibility, acceptability and preliminary effectiveness of the decision aid for PD patients referred for DBS evaluation, and 3) evaluate implementation of the decision aid guided by the RE-AIM framework. To achieve these aims, semi-structured interviews will be performed with 30 dyads of patients with and without MCI and their care partners who have gone through the DBS evaluation process in order to gain an in-depth understanding of the decision-making process and MCI-specific decisional needs. Insights from these interviews will be used to adapt and refine our existing DBS decision aid to address cognitive weaknesses in MCI. A pragmatic, randomized controlled pilot trial will evaluate the feasibility and acceptability of the decision aid for PD patients undergoing DBS evaluation. The research aims are accompanied by a training plan designed to address gaps in the candidate’s knowledge and prepare her to become an independent clinician-scientist and leader in shared decision-making interventions for older adults with neurologic disease. The training aims for this proposal are to: 1) gain expertise in mixed methods, 2) become proficient in pragmatic clinical trial design, and 3) gain experience in implementation science. These aims will be achieved through didactic coursework, workshops, attendance at scientific meetings, practical experience, and direct mentoring. The candidate is mentored by experts in shared decision-making, mixed methods, neuropsychology, pragmatic cli...