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.

项目摘要 当前小肾肿瘤（≤4cm）的治疗范例导致总生存率较差 尽管较早进行了手术切除术的检测和积极治疗。缺乏改善的结果可能 由于大多数肾脏肿瘤的懒惰和手术危害在这个通常老年人中。 尽管这些小肾脏中的大多数是恶性的，但少数肿瘤转移和 切除的肿瘤约20％是良性的。由于当前的准则建议合并症应 选择治疗时会加权，并且患有慢性肾脏疾病的患者尤其有 手术后的生存恶化，决策必须包括平衡的讨论，以减少过度治疗。 作为腹部放射科医生和健康成果研究人员，我获得了我的MD和大师 科学学位集中在比较有效性研究方法中。人口部门 纽约大学医学中心的健康和放射学提供了心理和资源来定位 我作为独立研究者的肾脏肿瘤管理成功进行健康服务研究。一个 医疗决策，决策辅助，放射学，肿瘤学和泌尿科专家团队 继续指导我的项目和职业发展。在拟议的支持期间，我将完成 在定性分析中测量患者偏好和教程的患者偏好方面的课程工作， 为这个项目和我的职业发展提供服务。我还将完成授予写作的培训活动， 临床试验设计的目的是将拟议的工作直接转化为测试的R01应用 针对小肾脏肿瘤患者的拟议决策辅助工具的有效性。 在当前的建议中，我将为小肾脏肿瘤建立一个新的基于网络的患者决策工具 员工比小册子更有效，完整的教育技术和决策支持功能 格式。我们将将已发布的决策分析模型嵌入基于Web的工具中，并启用 根据患者合并症（例如慢性肾脏疾病）和肿瘤的治疗选择评估 影响每种选项的益处和危害的功能。代表的管理策略包括 部分肾切除术的最常见治疗方法，以及侵入性经皮消融较少的监测 成像和活检。这种互动工具将有助于理解早期肾脏肿瘤，交流 个性化危害/福利，并引起患者对治疗属性的偏好。循证风险 沟通技术和专家委员会审查将确保其设计用于共享决策， 根据国际患者决策标准。然后，我们将完成一项试点研究 有关可用性，改善患者知识和共享决策的初步数据。最终，这个 及时的工具可能有助于实现以患者为中心的决策来管理小型肾脏肿瘤。