Incorporating Veterans' Preferences into Lung Cancer Screening Decisions

将退伍军人的偏好纳入肺癌筛查决策

• 批准号: 10180890
• 负责人: MARILYN M SCHAPIRA
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10180890
• 关键词: Advisory Committees; Age; Anxiety; Area; Assessment tool; Attitude; Behavior; Breast; Cancer Control; Cancer Etiology; Car Phone; Caring; Cervical; Cessation of life; Clinical; Clinical Pathways; Clinical Trials; Colorectal; Conflict (Psychology); Connecticut; Data; Decision Aid; Decision Making; Development; Diagnosis; Eligibility Determination; Evaluation; Focus Groups; Future; General Population; Goals; Grant; Guidelines; Health; Health Personnel; Health Promotion; Intervention; Interview; Knowledge; Lung; Malignant neoplasm of lung; Measures; Medical; Medical center; Methods; Modeling; Online Systems; Outcome; Pathway interactions; Patient Preferences; Patients; Pennsylvania; Phase; Philadelphia; Pilot Projects; Positioning Attribute; Preventive service; Primary Health Care; Principal Investigator; Process; Promoting Action on Research Implementation in Health Services framework; Provider; Quality of life; Randomized; Recommendation; Regrets; Reporting; Research; Risk; Science; Site; Smoke; Smoker; Smoking; Smoking History; Structure; Tablets; Target Populations; Technology; Technology Assessment; Testing; Training Support; United States; United States Department of Veterans Affairs; Veterans; Work; X-Ray Computed Tomography; anxiety states; behavioral outcome; care systems; clinical practice; comorbidity; disorder prevention; efficacy evaluation; efficacy testing; experimental study; follow-up; high risk; improved; insight; laptop; low dose computed tomography; lung cancer screening; military veteran; mortality; patient engagement; patient oriented; phase 3 study; practice setting; preference; primary care setting; primary outcome; programs; randomized trial; routine screening; satisfaction; screening; shared decision making; smoking cessation; support tools; tool; trait; treatment as usual; uptake; usability; web app; web-based tool

Lung cancer is the leading cause of cancer deaths in the United States. Recent clinical trials provide evidence that screening with low dose CT scans will decrease lung cancer and all cause mortality among older heavy smokers. Clinical guidelines have been issued with the USPSTF recommending annual screening from age 55 to 80 for those with 30 pack years or more of smoking or who quit less than 15 years ago. Evidence clearly delineates both the benefits (mortality reduction) and harms (false positives, follow-up testing, risk of invasive testing, and risk of overdiagnosis) of lung cancer screening. Preliminary data from an HSR&D pilot grant finds that some Veterans are highly reluctant to enter the care pathway associated with lung cancer screening due to its potential harms. Additional preliminary data using Best Worst Scaling in older smokers demonstrate groups of patients who place greater importance on harms than benefit when considering lung cancer screening. Preference assessment methods can help Veterans to weigh benefits and harms, consider the clinical pathway they are entering, anticipate future health states, and communicate these values to their health care providers. Although basic educational tools to inform lung cancer decision-making have been developed, there is a lack of validated preference assessment tools that can be integrated into the clinical setting. Building upon preference assessment methods developed and validated in an HSR&D pilot grant (PI-Schapira) and using a trans-disciplinary approach, this team is positioned to advance the science and practice of decision support for lung cancer screening in the Veteran population. The objectives of this study are to 1) elicit patient and provider stakeholder input to inform the development of a lung cancer screening decision tool, 2) develop a web based Lung Cancer Screening Decision Tool (LCSDecTool) that incorporates patient and provider input, and 3) evaluate the impact of the LCSDecTool compared to usual care on the decision process, clinical outcomes, and quality of life. The study will be conducted in 3 phases. In phase 1, mixed methods will be used to assess usability of preference assessment methods and perceived usefulness of a web based lung cancer screening decision support tool among patient and provider stakeholders. In phase 2, an interactive web based decision support program will be developed that incorporates preference assessment methods. In phase 3, a pilot RCT will be conduced to evaluate the efficacy of the web based decision support program. Outcomes evaluated will include decision quality as indicated by knowledge, decisional conflict, and decision regret; screening behavior, clinical outcomes as indicated by anxiety, and quality of life. The study will be conducted across two VA sites; West Haven-VA in Connecticut and Corporal Michael J. Crescenz VA in Philadelphia, Pennsylvania. Results of this study will provide tools that can be used to integrate lung cancer screening into clinical practice at VA Medical Centers in a patient centered approach. Lung cancer screening is fundamentally different from existing screening paradigms in several respects; eligibility is defined by a behavior (smoking), a high rate of false positive findings is expected, and the target population is older with higher comorbidity than the target population for cervical, breast, or colorectal screening. Given these unique aspects of lung cancer screening, there is a critical need to develop and test tools for preference assessment and informed decision making that are applicable for the VA setting. The current proposal provides a mechanism to accomplish these goals. The Principal Investigator is working closely with the US Department of Veterans Affairs National Center for Health Promotion and Disease Prevention to integrate the tools and paradigm developed to primary care in the VA Medical Care System. The work builds directly upon a recently completed HSR&D pilot support in the area of lung cancer and shared decision making.

肺癌是美国癌症死亡的主要原因。最近的临床试验提供了证据 低剂量CT扫描的筛查将减少肺癌，所有这些都会导致老年重量的死亡率 吸烟者。 USPSTF已发布临床准则，建议从55岁开始进行年度筛查 对于有30年或以上的吸烟或不到15年前退出的人来说，到80岁。证据清楚 描述益处（降低死亡率）和危害（误报，后续测试，侵入性风险 肺癌筛查的测试和过度诊断的风险。来自HSR＆D Pilot Grant的初步数据找到 一些退伍军人高度不愿进入与肺癌筛查相关的护理途径 它的潜在危害。使用年龄较大的吸烟者使用最佳缩放的其他初步数据证明 在考虑肺癌时，对危害更重要的危害的患者组 筛选。偏好评估方法可以帮助退伍军人权衡福利和危害，请考虑 他们进入的临床途径，预测未来的健康状况，并将这些价值传达给其健康 护理提供者。尽管已经开发了用于告知肺癌决策的基本教育工具，但 缺乏可将良好的偏好评估工具集成到临床环境中。建筑 根据偏好评估方法在HSR＆D Pilot Grant（Pi-Schapira）中开发和验证 使用跨学科的方法，该团队有能力提高科学和决策的实践 支持退伍军人人口中的肺癌筛查。这项研究的目标是1） 患者和提供商利益相关者的意见为开发肺癌筛查决策工具的开发，2） 开发基于Web的肺癌筛查决策工具（LCSDectool），该工具纳入患者和 提供者的输入和3）评估LCSDectool的影响与通常的护理对决策过程相比 临床结果和生活质量。该研究将分为3个阶段。在第1阶段，混合方法将 用于评估偏好评估方法的可用性和基于Web的肺的可用性 癌症筛查决策支持工具，提供者和提供者利益相关者。在第2阶段，交互式 将开发基于Web的决策支持计划，其中包含偏好评估方法。在 第3阶段，将抑制试点RCT来评估基于Web的决策支持计划的功效。 评估的结果将包括知识，决策冲突和决策所表明的决策质量 后悔;筛查行为，焦虑表明的临床结果以及生活质量。该研究将是 在两个VA站点进行；康涅狄格州的West Haven-VA和下士Michael J. Crescenz VA 费城，宾夕法尼亚州。这项研究的结果将提供可用于整合肺癌的工具 以以患者为中心的方法在VA医疗中心进行临床实践。肺癌筛查 在几个方面与现有的筛查范例有根本不同。资格由 行为（吸烟），期望高阳性发现率很高，目标人群年龄较大， 用于宫颈，乳房或结直肠筛查的目标群体的合并症高。考虑到这些独特 肺癌筛查的各个方面，需要开发和测试偏好评估工具 以及适用于VA设置的知情决策。当前的建议提供了 实现这些目标的机制。首席调查员正在与美国部门紧密合作 退伍军人事务国家健康促进与疾病预防中心，以整合工具和 在VA医疗系统的初级保健中发展了范式。这项工作直接建立在最近的 在肺癌领域完成了HSR＆D飞行员支持，并共享决策。