Colorectoral cancer screening decisions in primary care

初级保健中的结直肠癌筛查决策

• 批准号: 6964855
• 负责人: James G Dolan
• 金额: $ 38.33万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-29 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6964855
• 关键词: attitude; behavioral /social science research tag; clinical research; decision making; disease /disorder proneness /risk; health behavior; health care service utilization; human subject; mass screening; neoplasm /cancer diagnosis; patient care management; primary care physician; attitude; behavioral /social science research tag; clinical research; decision making; disease /disorder proneness /risk; health behavior; health care service utilization; human subject; mass screening; neoplasm /cancer diagnosis; patient care management; primary care physician

DESCRIPTION (provided by applicant): The success of current colorectal cancer prevention efforts depends on screening. In 2000, however, fewer than half of the average risk patients in the United States were in compliance with screening recommendations. Additional research to help overcome barriers to screening has been recognized as an important step toward meeting national colorectal cancer prevention goals. Current screening guidelines for average risk patients endorse 5 options: annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, combined annual fecal occult blood tests and flexible sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years. Patients and physicians are encouraged to compare the options' pros and cons and select the one best suited for individual patient preferences and circumstances. A common element of several theories of health behavior is that a person's attitude toward a proposed intervention affects their behavior and that attitudes are directly influenced by an intervention's perceived risks and benefits. This raises the hypothesis that information about how primary care decision makers view the risks and benefits of colorectal cancer screening tests will help identify and overcome screening barriers. We will use the Analytic Hierarchy Process (AHP), a multi-criteria decision making method, to examine how 650 average risk patients and their primary care physicians view the trade-offs between the advantages and disadvantages of the 5 currently recommended colorectal screening options. The patients and physicians will be from diverse primary care settings in Rochester NY, Birmingham AL, Indianapolis IN, and the Alabama practice-based CME network. The data will be analyzed using descriptive and multivariable analysis to address 5 specific aims: 1) to describe the range of priorities average risk patients assign to decision criteria that describe strengths and weaknesses of the five currently recommended colorectal cancer screening options; 2) to describe the range of priorities primary care physicians assign to the same decision criteria when making screening recommendations for study patients; 3) to see if patient or physician decision priorities are associated with patient or physician specific factors ; 4) to compare patient and physician priorities; and 5) to determine subsequent colorectal cancer screening outcomes and the validity and acceptability of an AHP-based decision priority assessment.

描述（由申请人提供）： 当前的结直肠癌预防工作的成功取决于筛查。然而，在2000年，美国不到一半的风险患者符合筛查建议。有助于克服筛查障碍的其他研究已被认为是实现国家大肠癌预防目标的重要一步。平均风险患者的当前筛查指南认可5种选择：年度粪便神秘血液检查，每5年的柔性乙状结肠镜检查，每年5年的年度粪便神秘血液测试和柔性乙状结肠镜检查，每5年每5年进行双重对比钡灌肠和每10年结肠镜检查。鼓励患者和医生比较选项的优点和缺点，并选择最适合个人患者的偏好和情况的选择。几种健康行为理论的一个共同元素是，一个人对拟议干预的态度会影响其行为，并且态度直接受到干预措施的风险和利益的影响。这提出了这样一个假设，即有关初级保健决策者如何看待结直肠癌筛查测试的风险和好处的信息将有助于识别和克服筛查障碍。我们将使用一种多标准决策方法的分析层次结构过程（AHP）来研究650名平均风险患者及其初级保健医生如何看待目前建议的5种建议的结直肠筛查选项的优点和缺点之间的权衡。这些患者和医生将来自纽约州罗切斯特，伯明翰AL，印第安纳波利斯IN的各种初级保健环境和基于阿拉巴马州实践的CME网络。将使用描述性和多变量分析对数据进行分析，以解决5个具体目的：1）描述优先级的平均风险患者分配给决策标准的平均风险范围，以描述当前推荐的近直肠癌筛查选项的五种优势和劣势； 2）描述在为研究患者提出筛查建议时，初级保健医师分配了相同决策标准的优先级范围； 3）查看患者或医师的决策优先级是否与患者或医师的特定因素有关； 4）比较患者和医师的优先事项； 5）确定随后的结直肠癌筛查结果以及基于AHP的决策优先级评估的有效性和可接受性。