Pilot and Exploratory Studies Core

Pepper Center

The Pilot and Exploratory Studies Core facilitates the development and progress of innovative research relating to the Pepper Center focus on the predictors, characteristics, and outcomes of late-life disability, especially in vulnerable older populations.

Core Leaders:

Christine Ritchie, MD, MSPH

Highlighted Pepper Center Pilot Awardees

Emily Finlayson, MD, MS
Associate Professor, UCSF Department of Surgery

Pilot: Functional Outcomes after Breast Cancer Surgery in Older Nursing Home Residents

Dr. Finlayson was initially a Pepper Center awardee who leveraged her award into a NIA R01.  Her R01 uses MDS and Medicare data to compare the effectiveness of different treatment options for cholecystitis in nursing home patients.  The Pepper Center’s RDAC has provided statistical support as she has developed analyses for this project.  In addition, our OAIC continues to support her development of the UCSF Center for Geriatric Surgery.  The DMAC helped her design the research component of her center, including the development of Geriatric measures that will be incorporated into surgical assessment at UCSF.  We are working with her on plans to develop these assessments into a research database.

Dr. Finlayson also recently received a NIH R21 to develop tools to support the appropriate use of surgery for frail older adults.
She has been appointed core member and lead of outcomes assessment on the American College of Surgeons Geriatric Verification Program Committee.  Dr. Finlayson also serves as mentor to Anne Suskind in the UCSF Department of Urology, who recently submitted a GEMSSTAR proposal to examine outcomes after urologic procedures in nursing home residents. Dr. Finlayson now serves as a mentor for junior investigators within and external to UCSF, including Pepper Center investigator Dr. Vicky Tang.

Eleni Linos, MD, DrPH, MPH
Assistant Professor, Division of Dermatology

Pilot: Involving Older Adults in Decision Making for Skin Cancer

More patients are diagnosed with basal and squamous cell carcinoma (collectively termed non-melanoma skin cancer or NMSC) in the US than all other cancers combined: more than 3.6 million NMSCs vs. 1.7 million other cancers each year. Over a quarter of patients report problems related to treatment of NMSC and over 100,000 NMSCs are treated annually in persons who ultimately die within one year. The central hypothesis of this research was that there is significant procedure overuse for NMSC in patients with limited life expectancy, and that patients want to know the risks and benefits associated with management options including active surveillance. The rationale underlying this research is that these are ubiquitous, slow-growing tumors, and that patients should be informed of the risks and benefits of all management options, in order to make choices consistent with their clinical characteristics, values and preferences. This study aimed to understand expert and practicing physicians’ perspectives on skin cancer care at the end of life in order to lay the groundwork for future funding to develop and test the effect of decision tools on treatment utilization and patient-reported outcomes in patients with limited life expectancy.

Dr. Linos published eight papers related to her Pepper work and has had numerous grants funded: a Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76), a R21 by National Cancer Institute on Social Media for Cancer Prevention 2017-2019, and a UCSF Cancer Center Impact grant.  She has also been selected to serve as Vice President, American Dermatology Epidemiology Network and as Director of Diversity in the UCSF Department of Dermatology.

Rebecca Sudore, MD
Assistant Professor, Division of Geriatrics
UCSF Pepper Center Co-Director of Diversity

Pilot: Piloting a Guide to Prepare Older Adults to Make Informed Decisions for Disability and Serious Illness

The goal of this pilot study was to obtain preliminary data about the efficacy of an interactive, multi-media web-based intervention, called PREPARE, to improve decision making for diverse, older adults over the course of disability and serious illness (www.inetsite1.com). This pilot generated data to test the efficacy of PREPARE among diverse older adults with disability (≥ 1 dependence in instrumental activity of daily living) and < 2 years life expectancy (determined by physicians) in a county healthcare system.

Dr. Sudore published four first-author and five senior-author publications related to this pilot project.  She continues to gain national recognition for her research, and subsequent to her Pepper funding, she has been awarded a K23 and R01 grants from the NIA, as well as two foundation grants, a PCORI grant, and the AGS Outstanding Scientific Achievement for Clinical Investigation Award.