Patient-Centered Decision-Making for Management of Small Renal Tumors - Supplement

以患者为中心的小肾肿瘤治疗决策 - 补充

• 批准号: 10393960
• 负责人: Stella Kang
• 金额: $ 13.01万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10393960
• 关键词: Abdomen; Ablation; Academic Medical Centers; Affect; Benign; Biopsy; Chronic Kidney Failure; Clinical Trials Design; Communication; Comparative Effectiveness Research; Data; Decision Aid; Decision Making; Diagnosis; Early Diagnosis; Educational Technics; Ensure; Excision; Goals; Grant; Guidelines; Health; Health Services Research; Image; International; Kidney Neoplasms; Knowledge; Lesion; Malignant - descriptor; Master of Science; Measurement; Medical; Mentors; Minority; Modeling; Neoplasm Metastasis; Nephrectomy; New York; Older Population; Oncology; Online Systems; Operative Surgical Procedures; Outcome; Pamphlets; Patient Preferences; Patient observation; Patients; Pilot Projects; Positioning Attribute; Publishing; Radiology Specialty; Renal Mass; Renal carcinoma; Research Methodology; Research Personnel; Resected; Resources; Review Committee; Risk; Risk Factors; Techniques; Testing; Time; Training Activity; Translating; Urology; Work; Writing; aggressive therapy; career development; common treatment; comorbidity; design; effectiveness testing; evidence base; improved outcome; interactive tool; models and simulation; overtreatment; patient oriented; population health; radiologist; shared decision making; surgery outcome; surveillance imaging; tool; tumor; usability; web-based tool

Project Summary The current treatment paradigm for small kidney tumors (≤ 4 cm) has resulted in worsened overall survival despite earlier detection and aggressive treatment with surgical resection. This lack of improved outcomes may be due to the indolence of most kidney tumors and harms of surgery in this generally older population. Although the majority of these small kidney masses are malignant, a small minority of tumors metastasize and approximately 20% resected tumors are benign. Since current guidelines recommend that comorbidities should be weighed when selecting treatment, and that patients with chronic kidney disease are particularly at risk of worsened survival after surgery, decision-making must include balanced discussions to reduce over-treatment. As an abdominal radiologist and health outcomes researcher, I have obtained my MD and a Master of Science degree concentrated in comparative effectiveness research methods. The Departments of Population Health and Radiology within New York University Medical Center offer the mentoring and resources to position me for successful health services research in kidney tumor management as an independent investigator. A team of experts in medical decision-making, decision aids, radiology, oncology and urology have and will continue to guide my project and career development. During the proposed period of support, I will complete coursework in measurement of patient preferences for decision making and tutorials in qualitative analysis, serving both this project and my career development. I will also complete training activities for grant writing and clinical trials design toward the goal of directly translating the proposed work to an R01 application that tests the effectiveness of the proposed decision aid for patients with small kidney tumors. In the current proposal, I will build a new web-based patient decision tool for small kidney tumors that employs more effective and complete educational techniques and decision support features than a pamphlet format. We will embed our published decision-analytic model within the web-based tool, and enable assessment of treatment options according to patient comorbidities (e.g. chronic kidney disease) and tumor features that affect the benefits and harms of each option. Represented management strategies include the most common treatment of partial nephrectomy, as well as less invasive percutaneous ablation, surveillance imaging, and biopsy. This interactive tool will aid understanding of early stage kidney tumors, communicate personalized harms/benefits, and elicit patient preferences for treatment attributes. Evidence-based risk communication techniques and expert committee review will ensure it is designed for shared decisions, pursuant to the International Patient Decision Aids Standards. We will then complete a pilot study for preliminary data on usability, improvement in patient knowledge, and shared decision making. Ultimately, this timely tool may help actualize patient-centered decision-making for management of small kidney tumors.

项目概要 当前小肾肿瘤（≤ 4 cm）的治疗模式导致总体生存率恶化 尽管进行了手术切除，但早期发现和积极治疗可能无法改善结果。 这是由于大多数肾脏肿瘤的惰性以及手术对老年人群的危害。 尽管这些小肾脏肿块大多数是恶性的，但也有一小部分肿瘤会转移并 大约 20% 的切除肿瘤是良性的，因为目前的指南建议应排除合并症。 选择治疗方法时应权衡，慢性肾病患者尤其面临以下风险： 由于手术后生存率恶化，决策必须包括平衡的讨论，以减少过度治疗。 作为一名腹部放射科医生和健康结果研究员，我获得了医学博士学位和硕士学位 科学学位集中于比较有效性研究方法。 纽约大学医学中心的健康和放射科提供指导和资源来定位 我作为独立研究者在肾肿瘤管理方面取得了成功的健康服务研究。 医疗决策、决策辅助、放射学、肿瘤学和泌尿学专家团队已经并将 继续指导我的项目和职业发展 在建议的支持期间，我将完成。 测量患者决策偏好的课程和定性分析教程， 我还将完成资助写作和职业发展的培训活动。 临床试验设计的目标是直接将提议的工作转化为测试的 R01 应用程序 所提议的决策辅助对小肾肿瘤患者的有效性。 在当前的提案中，我将为小型肾肿瘤构建一个新的基于网络的患者决策工具 采用比小册子更有效、更完整的教育技术和决策支持功能 我们将把我们发布的决策分析模型嵌入到基于网络的工具中，并启用。 根据患者合并症（例如慢性肾病）和肿瘤评估治疗方案 影响每个选项的好处和坏处的特征包括： 最常见的治疗方法是肾部分切除术以及微创经皮消融术、监测 这种交互式工具将有助于了解早期肾脏肿瘤、进行交流。 个性化的危害/益处，并引起患者对基于证据的风险的偏好。 沟通技术和专家委员会审查将确保其设计用于共同决策， 然后，我们将根据国际患者决策辅助标准完成一项试点研究。 关于可用性、患者知识改进和共享决策的初步数据。 及时的工具可能有助于实现以患者为中心的小肾肿瘤治疗决策。