Shared Decision Making: Prostate Cancer Screening

共同决策：前列腺癌筛查

• 批准号: 6894908
• 负责人: MICHAEL S WILKES
• 金额: $ 64.99万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6894908
• 关键词: Internet; audiotape; behavioral /social science research tag; cancer risk; clinical research; communication behavior; computer assisted instruction; computer assisted medical decision making; computer human interaction; decision making; education evaluation /planning; health behavior; health care quality; human subject; interactive multimedia; male; mass screening; neoplasm /cancer diagnosis; neoplasm /cancer education; patient care personnel relations; patient oriented research; primary care physician; prostate neoplasms; prostate specific antigen; questionnaires

DESCRIPTION (provided by applicant): The utility of routine screening for prostate cancer with prostate specific antigen (PSA), remains highly controversial, and is not recommended by the United States Preventive Services Task Force, although it may be justified at the individual patient level. Many primary care physicians (PCPs) order PSA without helping patients understand the associated risks, benefits and downstream consequences. Shared decision-making (SDM) is an important component of high quality care which correlates with positive health outcomes, consumer demand, and a moral imperative to consider patients as persons. Ways to improve SDM include (1) "patient activation" interventions to increase patient participation in care and (2) physician interventions to improve the consultation process. We will test whether an intervention to improve SDM will improve physician and patient knowledge, skills and attitudes about PSA screening, and change PCP PSA screening practices. In a unique public-private partnership, we will recruit 145 PCPs across four health systems in California (UC Los Angeles, UC Davis, Rural Health Network, Kaiser Permanente). We will sample PCPs and patients from all major socio-demographic areas across the state. PCPs will be randomized by practice site to control (paper curriculum) or active intervention with an interactive web-based curriculum previously developed with funding from the CDC. This curriculum utilizes visual tools, video clip vignettes, and other interactive content to illustrate key points about risk assessment, PSA screening, and SDM.. In addition, patients at intervention sites will be randomized to receive either the same brochure as patients at control sites, or a further active intervention consisting of a CD-funded interactive curriculum covering similar content from a patient perspective. Both intervention groups (PCPonly or physician and patient intervention) will be compared to controls regarding knowledge, skills and attitudes. The primary endpoint will be changes in physician SDM behavior (Kaplan scale). Pre.-and post-test changes in PCP knowledge and attitudes will also be assessed, and post-intervention PCP SDM skills will be assessed using unannounced standardized patients, who present to PCP offices with a request for PSA testing. Post-test patient changes in knowledge and attitudes will also be assessed. Finally, any change in actual PSA ordering behaviors will be assessed. In summary, we will evaluate the ability of an educational intervention to improve the care of patients, both by activating/informing patients, and by providing PCPs with tools to engage patients more effectively. If proven effective, these web-based tools can be easily disseminated around the country, and internationally, to improve knowledge and attitudes about PSA screening among physicians and patients.

描述（由申请人提供）：使用前列腺特异性抗原（PSA）对前列腺癌进行常规筛查的实用性仍然很有争议，尽管在个别患者水平上可能是合理的，但美国预防服务工作队不建议使用。许多初级保健医生（PCP）订购PSA，而无需帮助患者了解相关的风险，收益和下游后果。共同的决策（SDM）是高质量护理的重要组成部分，它与积极的健康结果，消费者需求以及将患者视为患者的道德要求相关。改善SDM的方法包括（1）“患者激活”干预措施，以增加患者参与护理的参与以及（2）医师干预以改善咨询过程。我们将测试改善SDM的干预措施是否会改善医生以及对PSA筛查的技能和态度，并更改PCP PSA筛查实践。在独特的公私合作伙伴关系中，我们将在加利福尼亚州的四个卫生系统中招募145个PCP（加州大学洛杉矶分校，加州大学戴维斯分校，农村卫生网络，Kaiser Permanente）。我们将采样来自全州所有主要社会人口统计学领域的PCP和患者。 PCP将通过实践站点随机分配以控制（纸课程）或通过以前通过CDC资助开发的基于Web的交互式课程的主动干预措施。该课程利用视觉工具，视频剪辑小插图和其他交互式内容来说明有关风险评估，PSA筛查和SDM的关键点。此外，干预站点的患者将随机分配，以接收与对照部位的患者相同的小册子，或者在对照部位的患者进行相同的手册，或者是由CD资助的互动互动式培训的患者覆盖类似患者的进一步的积极干预措施。将两个干预组（PCPONLY或医师和患者干预）与知识，技能和态度的对照进行比较。主要终点将是医师SDM行为（Kaplan量表）的变化。还将评估PCP知识和态度的测试前和测试后的变化，并将使用未经通知的标准化患者评估干预后PCP SDM技能，他们在PCP办公室提出PSA测试。测试后患者的知识和态度变化也将被评估。最后，将评估实际PSA排序行为的任何变化。总而言之，我们将通过激活/通知患者以及为PCP提供更有效吸引患者的工具来评估教育干预措施改善患者护理的能力。如果被证明有效，这些基于网络的工具很容易在全国范围内以及国际上传播，以改善医生和患者对PSA筛查的知识和态度。