Individualizing surveillance mammography for older breast cancer survivors

对老年乳腺癌幸存者进行个体化监测乳房X光检查

• 批准号: 9889945
• 负责人: Rachel Ann Freedman
• 金额: $ 19.25万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9889945
• 关键词: Address; Age; Attitude; Benefits and Risks; Breast; Breast Cancer Patient; Breast Cancer survivor; Cancer Etiology; Cancer Survivor; Caring; Communication; Communication Tools; Conflict (Psychology); Consensus; Data; Data Collection; Decision Making; Diagnosis; Discipline; Discipline of Nursing; Feedback; Focus Groups; Geography; Geriatrics; Goals; Guidelines; Intervention; Intervention Studies; Interview; Knowledge; Lead; Learning; Life Expectancy; Longevity; Mammary Gland Parenchyma; Mammographic screening; Mammography; Mission; National Health Interview Survey; Older Population; Oncologist; Oncology; Outcome Measure; Patient advocacy; Patients; Perception; Population; Practice Guidelines; Primary Health Care; Provider; Quality of Care; Radiology Specialty; Randomized; Recommendation; Recording of previous events; Recurrence; Research; Residual state; Risk; Side; Specialist; Standardization; Telephone; Testing; Thinking; United States; United States National Institutes of Health; Variant; Woman; Work; aged; base; breast cancer diagnosis; cancer recurrence; care coordination; clinical practice; cognitive testing; evidence base; follow-up; improved; malignant breast neoplasm; medical specialties; novel; older patient; older women; patient population; post intervention; prospective; risk minimization; screening; surveillance strategy; surveillance study; tool

PROJECT SUMMARY/ABSTRACT The long-term goals of this work are to optimize surveillance mammography use for older breast cancer survivors and decrease overscreening for a group in critical need of evidence-based, unified approaches for follow-up care. The proposed study will address significant knowledge gaps through expert consensus and prospective data collection. This study will provide a framework for discussions on how/when to stop mammography in older breast cancer survivors with limited life expectancy (who typically have a low risk for in- breast recurrences with rates similar to that of screening populations) and how to optimally discuss life expectancy with patients, with the goal to enhance communication between patients and clinicians as well as between primary care clinicians (PCs) and specialists. In this unique, multilevel proposal, we will build on our prior work to develop consensus on mammography and follow-up care for breast cancer survivors aged ≥75 by (a) refining expert-panel recommendations, (b) examining clinician and patient attitudes towards these recommendations and discussing life expectancy, and (c) testing a communication tool to facilitate decision- making, all through direct engagement of clinicians and patients. In Aim 1, we will convene experts and patients to refine recommendations for mammography and follow-up care for breast cancer survivors age ≥75 and further develop and cognitively test a communication tool that summarizes recommendations for clinicians and patients with a focus on how to comfortably include conversations on life expectancy comfortably. We will then conduct 30 telephone-based patient interviews and 4-6 focus groups with oncologists and PCs to obtain their opinions about the communication tool, how to communicate the benefits/risks of mammography, and optimal strategies for discussing life expectancy and cessation of mammography and coordination of care. In Aim 2, we will test the communication tool with 45 older breast cancer survivors age ≥75 and their oncologists using a pre-post intervention study. Here, we will examine the feasibility and acceptability of the tool and the effect of using the tool on women's intentions for mammography. We will also explore communication strategies across medical specialties. We hypothesize that our communication tool will be feasible, acceptable for patients and providers, and lead to fewer women intending to receive mammography in the next year. This study will provide preliminary data for a larger pilot and eventual, prospective, randomized study, with the overarching goal to further assess impact, improve coordination of care, and disseminate our novel and urgently needed intervention. The goals of this study are undoubtedly in line with the missions set forth by the NIH and NCI to address the research gaps in older patients. Further, with approximately 70,000 women age ≥75 per year diagnosed with breast cancer in the United States and a growing population of older breast cancer patients, efforts to improve and equalize the quality of follow-up care we deliver will become increasingly important.

项目概要/摘要 这项工作的长期目标是优化老年乳腺癌监测乳房 X 光检查的使用 幸存者并减少对迫切需要基于证据的统一方法的群体的过度筛查 拟议的研究将通过专家共识和后续护理来解决重大知识差距。 这项研究将为讨论如何/何时停止提供一个框架。 对预期寿命有限的老年乳腺癌幸存者（通常患乳腺癌的风险较低）进行乳房 X 光检查 乳房复发率与筛查人群相似）以及如何最佳地讨论生活 与患者的期望，旨在加强患者与圣人以及圣人之间的沟通 初级保健附属机构 (PC) 和专家之间的合作 在这一独特的多层次提案中，我们将建立在我们的基础上。 之前的工作是就年龄≥75岁的乳腺癌幸存者的乳房X光检查和后续护理达成共识 (a) 完善专家小组的建议，(b) 检查临床医生和患者对这些建议的态度 建议并讨论预期寿命，以及（c）测试通信工具以促进决策 制作，全部通过人群和患者的直接参与。 在目标 1 中，我们将召集专家和患者完善乳房 X 光检查和治疗的建议 对年龄≥75岁的乳腺癌幸存者进行后续护理，并进一步发展和认知测试沟通 该工具总结了对唱诗班男孩和患者的建议，重点是如何舒适地参与 然后，我们将进行 30 次电话访谈，并进行有关预期寿命的对话。 与肿瘤科医生和 PC 进行 4-6 个焦点小组，以获取他们对沟通工具、如何使用的意见 传达乳房 X 光检查的好处/风险，以及讨论预期寿命和健康状况的最佳策略 停止乳房 X 光检查和协调护理 在目标 2 中，我们将与 45 人测试通信工具。 年龄≥75 岁的老年乳腺癌幸存者及其肿瘤学家使用前后干预研究。 审查该工具的可行性和可接受性以及使用该工具对妇女生育意愿的影响 我们还将探索跨医学专业的沟通策略。 我们的沟通工具将是可行的，可以为患者和提供者所接受，并减少女性的数量 打算在明年接受乳房X光检查，这项研究将为更大规模的试点提供初步数据。 最终的前瞻性随机研究，总体目标是进一步评估影响，改善 协调护理，并传播我们新颖且迫切需要的干预措施。 这项研究的目标无疑与 NIH 和 NCI 制定的使命一致： 此外，每年约有 70,000 名年龄≥75 岁的女性。 在美国被诊断出患有乳腺癌并且老年乳腺癌患者人数不断增加， 改善和均衡我们提供的后续护理的质量工作将变得越来越重要。