Shared Decision-Making for Colorectal Cancer Screening

结直肠癌筛查的共同决策

• 批准号: 6676028
• 负责人: PAUL C SCHROY
• 金额: $ 40.23万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6676028
• 关键词: Internet; behavioral /social science research tag; belief; cancer risk; clinical research; colorectal neoplasms; comprehension; decision making; education evaluation /planning; educational resource design /development; health behavior; health care personnel; health care personnel education; health care service utilization; health services research tag; human middle age (35-64); human subject; interactive multimedia; mass screening; motivation; neoplasm /cancer education; outpatient care; preference; satisfaction; therapy compliance

DESCRIPTION: Colorectal cancer (CRC) is a leading cause of cancer-related death in the U.S. Screening is a cost-effective strategy for reducing both CRC incidence and mortality but has yet to have a major impact on disease burden partly because of poor patient adherence. Shared decision-making is a potentially effective yet unproven strategy for increasing CRC screening rates. The overall objective of this proposal is to develop an interactive, web-based decision aid and evaluate its impact on shared decision-making and patient adherence to CRC screening recommendations. During Phase 1 (Year 1), an interactive, web-based decision aid will be developed that employs state-of-the-art technology to educate patients about the five recommended CRC screening strategies, heighten risk perception, and empower patients to participate in the decision-making process. Content will be developed using a critical review of relevant literature and existing decision aids, expert opinion, and decision-making theory. A personalized risk assessment tool plus pre-/post-test modules to assess demographics, knowledge, beliefs, desire, barriers, and patient preferences will be incorporated. Tailored feedback will also be provided. Once developed, the aid will be subjected to external review by an outside advisory committee for content validity and pre-tested for usability. During Phase 2 (Year 1), an optimal strategy will be defined for implementation of the decision aid in two ambulatory care settings. The research team will interact with physicians and office staff to identify potential logistical barriers and to conjointly develop a tailored strategy for implementation at the targeted ambulatory care sites. Issues to be addressed include resource needs, space allocation, patient identification and scheduling, and tracking. Physician and staff educational seminars will be conducted before implementation. During Phase 3 (Years 2 to 5), a randomized controlled clinical trial will be conducted to evaluate the impact of the decision aid on shared decision-making and adherence to CRC screening recommendations. Eligible patients will be randomized to review the decision aid, the personalized risk assessment tool alone or a control condition. The primary outcome will be patient adherence to CRC screening recommendations using computerized tracking systems; secondary outcomes will include patient knowledge and patient satisfaction using evaluation components of the decision aid or validated instruments.

描述：结直肠癌 (CRC) 是美国癌症相关死亡的主要原因。筛查是降低结直肠癌发病率和死亡率的一种具有成本效益的策略，但尚未对疾病负担产生重大影响，部分原因是患者依从性差。 共同决策是提高结直肠癌筛查率的一种潜在有效但未经证实的策略。 该提案的总体目标是开发一种交互式、基于网络的决策辅助工具，并评估其对共同决策和患者遵守 CRC 筛查建议的影响。 在第一阶段（第一年），将开发一种基于网络的交互式决策辅助工具，采用最先进的技术来教育患者关于五种推荐的 CRC 筛查策略，提高风险认知，并授权患者参与决策过程。 将通过对相关文献和现有决策辅助工具、专家意见和决策理论的批判性审查来开发内容。 将纳入个性化风险评估工具以及用于评估人口统计、知识、信仰、愿望、障碍和患者偏好的前/后测试模块。 还将提供量身定制的反馈。 一旦开发完成，该辅助工具将接受外部咨询委员会的外部审查，以确保其内容有效性并对其可用性进行预先测试。 在第二阶段（第一年），将制定最佳策略以在两个门诊护理机构中实施决策辅助。 研究团队将与医生和办公室工作人员互动，以确定潜在的后勤障碍，并共同制定在目标流动护理地点实施的定制策略。 要解决的问题包括资源需求、空间分配、患者识别和调度以及跟踪。 实施前将举办医师和工作人员教育研讨会。 在第 3 阶段（第 2 至第 5 年），将进行随机对照临床试验，以评估决策辅助对共同决策和遵守 CRC 筛查建议的影响。 符合条件的患者将被随机分配以审查决策辅助工具、单独的个性化风险评估工具或控制条件。 主要结果将是患者遵守使用计算机跟踪系统的 CRC 筛查建议；次要结果将包括使用决策辅助或经过验证的工具的评估组件的患者知识和患者满意度。