Patient-Centered Decision-Making for Management of Small Renal Tumors

以患者为中心的小肾肿瘤治疗决策

基本信息

批准号：
9321209
负责人：
Stella Kang
金额：
$ 18.02万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9321209
关键词：
Abdomen Ablation Academic Medical Centers Adopted Aftercare Anatomy Area Award Benign Biopsy Caring Characteristics Chronic Kidney Failure Communication Comorbidity Complex Cystic Lesion Decision Aid Decision Making Decision Modeling Detection Development Diagnosis Diagnostic Diagnostic Imaging Early Diagnosis Elderly Evaluation Excision Functional Magnetic Resonance Imaging Goals Health Health Services Research Histology Image Imaging Techniques Incidence Incidental Findings Indolent Interview Kidney Neoplasms Knowledge Learning Lesion Life Expectancy Magnetic Resonance Imaging Malignant - descriptor Malignant Neoplasms Master of Science Medical Medical Imaging Mentors Minority Modeling Neoplasm Metastasis Nephrectomy New York Operative Surgical Procedures Outcome Outcomes Research Papillary Patient Preferences Patient observation Patients Performance Population Positioning Attribute Practice Guidelines Radiology Specialty Renal Cell Carcinoma Renal Mass Renal carcinoma Renal function Research Research Methodology Research Personnel Research Project Grants Resources Risk Factors Role Selection for Treatments Specificity Structure Surveys Testing Time Translating Treatment outcome Unnecessary Surgery Urology Work alternative treatment base cancer imaging cancer subtypes career career development comparative effectiveness effective therapy improved improved outcome innovation novel oncology patient oriented population health prevent public health relevance radiologist randomized trial shared decision making standard of care tool treatment as usual treatment center treatment strategy trend tumor

项目摘要

DESCRIPTION (provided by applicant): The current treatment paradigm for small renal 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 renal tumors and harms of surgery in this generally elderly population. Although the majority of these small renal masses are malignant, a small minority of tumors metastasize and approximately 20% are benign. Less aggressive treatment alternatives must be more widely adopted into decision-making to prevent unnecessary surgeries in patients with indolent or benign tumors, or risk factors for poor post-surgical outcomes. As an abdominal radiologist and health outcomes researcher, I have obtained my MD and am pursuing a Master of Science concentrated in comparative effectiveness research methods. I am PI on a radiology outcomes research grant to evaluate recently developed functional magnetic resonance imaging (MRI) techniques to characterize renal masses and aid in treatment selection. 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 renal mass management as an independent investigator. A team of experts in medical decision-making, decision aids, radiology, oncology and urology will guide my project and career development. I will complete coursework in advanced decision-analytic modeling, decision aid development, and survey research to build the skillset required for my project, as well as my career. In the proposed work, I will summarize performance characteristics of diagnostic imaging tests for renal tumor characterization. I will construct a decision-analytic model to assess downstream oncologic and post- treatment outcomes of tumor imaging features, incorporating patient comorbidities (e.g. chronic kidney disease) that may impact long-term survival. Tested treatment strategies include the current standard of care partial nephrectomy, as well as less invasive percutaneous ablation and watchful waiting. I will then embed the decision model in an interactive decision aid to improve patients' knowledge of small renal tumors, communicate personalized harms/benefits, and elicit patient preferences in treatment selection. I hypothesize that 1) MRI will perform with higher specificity than CT for detection of benign renal tumors and indolent malignancies; 2) incorporation of small renal tumor histology and anatomy, and patient comorbidities (including renal function) in treatment selection improves life expectancy compared with standard management; and 3) watchful waiting and ablation are non-inferior strategies for survival compared with the current standard of surgery in most patients who are not currently offered these strategies. These contributions will provide a timely and novel tool to determine the most effective treatment and increase patient-centered decision-making for management of small renal tumors.

描述（由适用提供）：针对小肾脏肿瘤的当前治疗范例（≤4cm）导致整体生存期更早的较早检测和通过手术切除的积极治疗。这种缺乏改善的结果可能是由于大多数肾肿瘤的懒惰和在这个总体人口中的手术伤害的痛苦所致。尽管这些小肾脏中的大多数是恶性的，但少数肿瘤转移和约20％是良性的。较不积极的治疗替代方法必须更广泛地采用决策，以防止患有懒惰或良性肿瘤患者的不必要的手术，或者是疗法较差的术后结果。作为一名腹部放射科医生和健康成果研究人员，我获得了MD，并追求专注于比较有效性研究方法的科学硕士。我是放射学结果研究赠款的PI，最近开发了功能性磁共振成像（MRI）技术来表征肾脏肿块并有助于治疗选择。纽约大学医学中心的人口健康和放射学部门为我提供了精神和资源，使我成为肾脏大规模管理的成功卫生服务研究，成为独立研究者。医疗决策，决策辅助，放射学，肿瘤学和泌尿科专家团队将指导我的项目和职业发展。我将完成高级决策建模，决策援助开发和调查研究的课程，以建立我的项目所需的技能以及我的职业。在拟议的工作中，我将总结肾脏肿瘤表征的诊断成像测试的性能特征。我将构建一个决策分析模型，以评估肿瘤成像特征的下游肿瘤学和治疗后的治疗结果，从而增加患者合并症（例如慢性肾脏病），这可能会影响长期生存。经过测试的治疗策略包括当前的护理标准部分肾切除术，以及侵入性的经皮消融和注意等待。然后，我将把决策模型嵌入互动决策援助中，以提高患者对小肾脏肿瘤的了解，传达个性化危害/益处，并在治疗选择中引起患者的偏好。我假设1）MRI的特异性比CT更高，以检测良性的肾脏肿瘤和畏缩的恶性肿瘤； 2）与标准管理相比，在治疗选择中结合了小肾肿瘤组织学和解剖学以及患者合并症（包括肾功能）可提高预期寿命； 3）与当前尚未提供这些策略的患者的当前手术标准相比，注意等待和消融是生存的非内部策略。这些贡献将为及时而新颖的工具提供确定最有效的治疗方法，并增加以患者为中心的决策，以治疗小肾脏肿瘤。