Cancer Treatment Disparities in the HIV Population: Exploring the Impact of HIV on Physician and Patient Decision-Making

HIV 人群中的癌症治疗差异：探索 HIV 对医生和患者决策的影响

• 批准号: 10224133
• 负责人: Gita Suneja
• 金额: $ 24.04万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224133
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Area; Award; Cancer Patient; Caring; Cessation of life; Clinical; Communication; Complement; Consultations; Data; Decision Making; Development; Development Plans; Elements; Ensure; Environment; Evaluation; Faculty; Funding; General Population; Goals; Guidelines; HIV; HIV Infections; HIV diagnosis; Health Services Research; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Malignant Neoplasms; Measures; Mentorship; Observational Study; Oncologist; Outcome; Patient Preferences; Patients; Phase; Physicians; Population; Population Study; Positioning Attribute; Process; Public Health; Radiation Oncology; Recommendation; Research; Research Design; Research Methodology; Research Personnel; Research Priority; Research Proposals; Resources; Sampling; Science; Structure; Surveys; Testing; Training; United States National Institutes of Health; Universities; Visit; Vulnerable Populations; Work; antiretroviral therapy; cancer care; cancer survival; cancer therapy; career; career development; clinical decision support; clinical encounter; design; evidence base; health disparity; improved; insight; member; mortality; multidisciplinary; patient oriented; population based; preference; prospective; prototype; shared decision making; support tools; therapy design; treatment comparison; treatment disparity

PROJECT ABSTRACT The overall goal of this NCI K08 proposal is to facilitate Dr. Gita Suneja's development into an independent investigator focused on improving cancer treatment rates and outcomes among HIV-infected cancer patients. Cancer is now the leading cause of non-AIDS death in the HIV population. Cancer survival is significantly worse in people living with HIV compared with the general population, in part because they frequently do not receive appropriate cancer treatment. Dr. Suneja's prior work revealed that oncologists are less likely to offer cancer treatment to HIV-infected patients; however, empiric data on how the diagnosis of HIV affects cancer treatment decision-making by physicians and patients is lacking. The research objectives of this application are to (1) develop a comprehensive understanding of the decision-making process, (2) evaluate the impact of HIV on cancer treatment decision-making, and (3) design a decision support tool for oncologists to promote evidence-based cancer treatment and shared decision-making with HIV-infected patients. The long-term goal is to reduce cancer treatment disparities in the HIV population. To achieve these goals, Dr. Suneja will capitalize on the resources available at Duke University, where she is a faculty member in the Department of Radiation Oncology. Her career development plan incorporates training in mixed methods research, decision- making science, and intervention design - nested within a structured environment of strong multidisciplinary mentorship - that will uniquely position her for an academic career in cancer health services research. In Aim 1 of the proposed study, the investigators will directly observe oncologist-patient interactions to generate a unique and detailed understanding of the cancer treatment decision-making process and the impact of HIV on treatment decision-making. In Aim 2, they will survey a national sample of oncologists identified from the population-based HIV/AIDS Cancer Match Study to systematically identify determinants of cancer treatment decision-making and solicit input on parameters for a clinical decision support tool. Together, data from Aims 1 and 2 will produce detailed and generalizable knowledge on the key elements of the decision- making process that are appropriate intervention targets. In Aim 3, the investigators will utilize a User-Centered Participatory Design framework to develop a clinical decision support tool for oncologists to promote the delivery of evidence-based, patient-centered cancer care to HIV-infected patients. This study will fill a critical void in our understanding of cancer treatment disparities in a population living longer due to effective antiretroviral therapy. In addition, the career development award will provide Dr. Suneja with the analytic training and research deliverables necessary to compete for an R01 award to measure the real world impact of the intervention on cancer treatment rates in the HIV population.

项目摘要 NCI K08 提案的总体目标是促进 Gita Suneja 博士发展成为独立的 研究人员专注于提高感染艾滋病毒的癌症患者的癌症治疗率和结果。 目前，癌症是艾滋病毒人群中非艾滋病死亡的主要原因。癌症生存率显着 与一般人群相比，艾滋病毒感染者的情况更糟，部分原因是他们经常不 接受适当的癌症治疗。 Suneja 博士之前的工作表明，肿瘤学家不太可能提供 对艾滋病毒感染者进行癌症治疗；然而，关于艾滋病毒诊断如何影响癌症的经验数据 医生和患者缺乏治疗决策。本申请的研究目标是 (1) 全面了解决策过程，(2) 评估艾滋病毒的影响 癌症治疗决策，以及（3）为肿瘤学家设计决策支持工具，以促进 基于证据的癌症治疗以及与艾滋病毒感染者的共同决策。长期目标 旨在减少艾滋病毒人群中癌症治疗的差异。为了实现这些目标，Suneja 博士将 她是杜克大学科学系的教员，利用杜克大学的可用资源 放射肿瘤学。她的职业发展计划包括混合方法研究、决策方面的培训 科学创造和干预设计——嵌套在强大的多学科结构化环境中 指导——这将使她在癌症健康服务研究的学术生涯中处于独特的地位。 在拟议研究的目标 1 中，研究人员将直接观察肿瘤医生与患者之间的相互作用，以 对癌症治疗决策过程及其影响产生独特而详细的了解 HIV 对治疗决策的影响。在目标 2 中，他们将调查全国肿瘤学家样本 基于人群的艾滋病毒/艾滋病癌症匹配研究，系统地确定癌症的决定因素 治疗决策并征求临床决策支持工具参数的输入。一起，数据 目标 1 和 2 将产生有关决策关键要素的详细且可概括的知识 - 制定适当的干预目标的过程。在目标 3 中，研究人员将利用以用户为中心的 参与式设计框架，为肿瘤学家开发临床决策支持工具，以促进 向艾滋病毒感染者提供循证、以患者为中心的癌症护理。这项研究将填补一个关键的 我们对由于有效治疗而寿命较长的人群中的癌症治疗差异的理解是无效的 抗逆转录病毒治疗。此外，职业发展奖将为 Suneja 博士提供分析 竞争 R01 奖项所需的培训和研究成果，以衡量现实世界的影响 对艾滋病毒人群中癌症治疗率的干预。