Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement

优化肺癌筛查的依从性：将理论和实施科学应用于参与者的参与

基本信息

批准号：
10470376
负责人：
Erin Hirsch
金额：
$ 3.48万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10470376
关键词：
Address Adherence Affect Algorithms Benefits and Risks Cancer Etiology Cervical Cancer Screening Cessation of life Characteristics Clinical Clinical Trials Cognitive Colorectal Cancer Computerized Medical Record Consumption Counseling Data Development Diagnosis Effectiveness Effectiveness of Interventions Exposure to Goals Guideline Adherence Guidelines Health Health Benefit Health behavior Human Resources Hybrids Image Individual Intervention Intervention Studies Interview Malignant Neoplasms Malignant neoplasm of lung Measures Medical Mentors Methods Outcome Outcome Measure Parents Participant Patients Phase Process Provider Reminder Systems Reporting Research Research Design Research Methodology Research Personnel Research Training Scanning Scientist Screening for cancer Smoker Specialist Surveys System Testing Time Training Training Programs Visit acceptability and feasibility base cancer diagnosis care providers career clinically significant computed tomography screening cost design dissemination science effective intervention effectiveness evaluation effectiveness implementation study effectiveness implementation trial effectiveness outcome evidence base experience former smoker health application high risk implementation outcomes implementation research implementation science improved informant information processing innovation intervention program low dose computed tomography lung cancer screening malignant breast neoplasm mortality patient engagement person centered population based population health programs protective behavior risk perception routine screening screening screening guidelines screening program shared decision making skills social social health determinants social stigma theories therapy development tool user centered design

项目摘要

PROJECT SUMMARY Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective and feasible interventions to improve LCS adherence and achieve optimal individual and population health benefits. Research during the F99 phase will leverage an innovative, multi-phase, mixed methods design to describe how LCS patients process health information regarding health protective behavior and utilize this information to develop and evaluate reminder messages with individuals eligible for LCS. Using a four-step process, data collected in a survey of LCS program participants (step 1) will inform the development of a pool of candidate reminder messages (step 2). In the final two steps, the reminder messages will be evaluated by LCS experts (step 3) and further evaluated and refined with LCS program participants (step 4) using mixed methods, including surveys and interviews. Differences between health information processing constructs by demographic or clinical characteristics found to be significant from step 1 will be the focus for message targeting (group level) and/or tailoring (individual level). At the conclusion of the F99 phase, I will have a formalized set of clear, engaging, and efficient messages to support LCS annual adherence, ready to be evaluated in a clinical setting. Research proposed in the K00 phase will focus on gaining real-world experience with hybrid effectiveness implementation study designs and pragmatic outcome measures to simultaneously assess effectiveness and implementation outcomes. Specifically, I propose a mentored pre-post type 1 hybrid effectiveness- implementation trial, within a parent trial, that will allow concurrent assessment of effectiveness and implementation outcomes of the F99 reminder strategy in real-world LCS programs. Effectiveness will be tested using a pre-post design, comparing percent screening participants adherent to annual screening guidelines before and after implementation of the reminder strategy. Secondary implementation outcomes (i.e., acceptability and feasibility) will be assessed with surveys and key informant interviews of personnel involved in the reminder system implementation (e.g., LCS program directors, navigators, coordinators). This body of research will prepare me for a career as an independent cancer-focused intervention scientist with expertise in the development and implementation of effective, low-burden interventions aimed at improving LCS adherence, maximizing screening benefit, and reducing lung cancer mortality.

项目概要肺癌是美国癌症死亡的主要原因，大多数肺癌确诊时已是晚期阶段。对高危人群进行低剂量 CT 筛查是唯一可用于诊断的循证工具当存在可治愈的治疗选择时的早期肺癌。有望降低死亡率的益处由于基于人口的欠佳，目前肺癌筛查（LCS）绝大多数未实现遵守年度筛查指南。在研究环境之外，每年 LCS 的遵守率低于改变实践的里程碑式临床试验中观察到的比率的一半。迫切需要有效的以及可行的干预措施，以提高 LCS 依从性并实现最佳的个人和群体健康好处。 F99 阶段的研究将利用创新、多阶段、混合方法设计描述 LCS 患者如何处理有关健康保护行为的健康信息并利用该信息与有资格参加 LCS 的个人一起制定和评估提醒消息的信息。使用四步法过程中，在对 LCS 计划参与者的调查中收集的数据（步骤 1）将为开发一个池提供信息候选人提醒消息（步骤 2）。在最后两步中，LCS 将评估提醒消息专家（步骤 3）并使用混合方法与 LCS 项目参与者（步骤 4）进一步评估和完善，包括调查和访谈。按人口统计的健康信息处理结构之间的差异或步骤 1 中发现的重要临床特征将成为消息定位的重点（群体级别）和/或剪裁（个人水平）。在 F99 阶段结束时，我将拥有一套正式的、明确的、引人入胜且高效的信息可支持 LCS 年度依从性，并准备好在临床环境中进行评估。 K00 阶段提出的研究将侧重于获得混合有效性的实际经验实施研究设计和务实的结果措施，以同时评估有效性和实施成果。具体来说，我提出了一种指导性的前后类型 1 混合有效性—— 在父试验中进行实施试验，这将允许同时评估有效性和 F99提醒策略在现实世界的濒海战斗舰项目中的实施结果。有效性将得到检验使用前后设计，比较遵守年度筛查指南的筛查参与者百分比实施提醒策略之前和之后。次要实施成果（即可接受性和可行性）将通过调查和对参与人员的关键知情人访谈进行评估提醒系统的实施（例如濒海战斗舰项目主管、领航员、协调员）。这个身体的研究将为我成为一名独立的癌症干预科学家做好准备，该科学家拥有以下方面的专业知识制定和实施有效、低负担的干预措施，旨在提高 LCS 依从性，最大限度地提高筛查效益并降低肺癌死亡率。