Randomized trial of community health worker-led decision coaching to promote shared decision making for prostate cancer screening among Black male patients and their providers

社区卫生工作者主导的决策辅导随机试验，以促进黑人男性患者及其提供者在前列腺癌筛查方面的共同决策

• 批准号: 9768546
• 负责人: DANIL V. MAKAROV
• 金额: $ 75.13万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-22 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768546
• 关键词: Adoption; Advisory Committees; Affect; Area; Attitude; Behavior; Clinical; Communication; Community Health Aides; Conflict (Psychology); Control Groups; Cost Measures; Counseling; Decision Aid; Decision Making; Elements; Federally Qualified Health Center; Goals; Healthcare; Intervention; Interview; Judgment; Knowledge; Literature; Malignant Neoplasms; Malignant neoplasm of prostate; Modeling; Outcome; Participant; Patient Care; Patient Preferences; Patients; Perception; Physicians; Population; Population Heterogeneity; Preventive healthcare; Preventive service; Primary Health Care; Procedures; Process; Prostate-Specific Antigen; Provider; Public Health; Randomized; Research; Screening for Prostate Cancer; Self Efficacy; Structure; Structure of base of prostate; Sum; Testing; Time; United States; Vulnerable Populations; base; community clinic; cost; cost effective; cost effectiveness; cost outcomes; design; efficacy testing; evidence base; experience; group intervention; health care model; high risk; improved; intervention cost; literacy; low socioeconomic status; male; men; patient-clinician communication; preference; primary care setting; program costs; programs; prostate cancer risk; randomized trial; satisfaction; screening; shared decision making

Prostate cancer is the most common non-cutaneous malignancy among men in the United States and affects Black men disproportionately. Experts agree prostate-specific antigen (PSA)–based prostate cancer screening is a preference-sensitive decision and recommend Shared Decision Making (SDM). The US Preventative Services Task Force (USPSTF) recently proposed a revision of their Prostate Cancer Screening Statement, now encouraging that screening decisions happen within a SDM framework based on professional judgment and patient preference. USPSTF has also recognized SDM is underutilized in practice, especially among Black men, and has emphasized the need for research to understand how best to implement and adapt SDM programs within diverse populations. We seek to optimize, evaluate and disseminate a program to help Black men understand their increased risk of prostate cancer and receive guidance sensitive to their values and preferences when deciding about PSA screening. Our group demonstrated the utility of employing a community health worker (CHW) to help Black men decide about PSA screening. Several critical knowledge gaps remain in the literature: 1) will CHW Decision Coaching improve decisions among Black men considering PSA screening? 2) will CHW Decision Coaching improve providers’ experience with PSA counseling? 3) how much will a CHW Decision Coach intervention cost? We propose a CHW-led Decision Coaching program to facilitate SDM for prostate cancer screening among Black men from a primary care Federally Qualified Health Center (FQHC). Patients will be randomized either to 1) receiving a decision aid along with CHW-led Decision Coaching on PSA screening or 2) receiving a decision aid along with CHW-led interaction on an unrelated healthcare topic. Among patients we will assess decision quality and use of PSA screening. Among providers we will assess perceptions of the acceptability and feasibility of the intervention. We will explore communication in both groups. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured in-depth interviews and thematic analysis of clinical encounters. Through a conceptual model that combines elements of the Preventative Health Care Model (PHM) and Informed Decision Making Model, we hypothesize that the decision coaching intervention will positively impact factors that empower preference clarification, decision context, knowledge, and attitudes that will ultimately result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction. Our results will enhance understanding of the efficacy, cost-effectiveness, and sustainability of CHW intervention in a community clinic setting. Findings will inform the subsequent design of a scalable intervention to promote adoption and integration of SDM across contexts and empower high-risk, vulnerable populations.

前列腺癌是美国男性中最常见的非皮肤恶性肿瘤，影响 专家们不成比例地同意基于前列腺特异性抗原（PSA）的前列腺癌筛查。 是一个偏好敏感的决策，建议采用美国预防性决策 (SDM)。 服务工作组 (USPSTF) 最近提议修订其前列腺癌筛查声明， 现在鼓励根据专业判断在 SDM 框架内做出筛选决策 USPSTF 还认识到 SDM 在实践中并未得到充分利用，尤其是在黑人中。 男性，并强调需要进行研究以了解如何最好地实施和调整 SDM 我们寻求优化、评估和传播帮助黑人的计划。 男性了解自己患前列腺癌的风险增加，并接受对其价值观敏感的指导，并且 我们小组证明了使用 PSA 筛查时的偏好。 社区卫生工作者 (CHW) 帮助黑人决定 PSA 筛查的几个关键知识。 文献中仍然存在差距：1）考虑到 CHW 决策辅导是否会改善黑人男性的决策 PSA 筛查？ 2) CHW 决策辅导能否改善提供者的 PSA 咨询体验？ CHW 决策教练干预的费用是多少？ 我们建议实施由 CHW 主导的决策辅导计划 促进 SDM 对初级保健联邦合格健康机构的黑人男性进行前列腺癌筛查 中心 (FQHC) 患者将被随机分配到 1) 接受决策援助以及 CHW 主导的决策。 PSA 筛查指导或 2) 接受决策援助以及社区卫生工作者主导的不相关的互动 我们将在患者中评估医疗保健提供者的决策质量和 PSA 筛查的使用情况。 我们将评估对干预措施的可接受性和可行性的看法。 这些结果将通过客观、经过验证的方式进行定量分析。 通过半结构化深度访谈和临床主题分析进行量表和定性分析 通过结合了预防性医疗保健模型要素的概念模型。 （PHM）和知情决策模型，我们致力于决策辅导干预将 对偏好澄清、决策背景、知识和态度产生积极影响的因素 最终将导致偏好一致的决策和决策满意度。 这种干预措施将提高医生的满意度，我们的结果将增强对疗效的理解， 社区诊所环境中社区卫生工作者干预的成本效益和可持续性。调查结果将为大家提供参考。 随后设计可扩展的干预措施，以促进跨环境和跨环境的 SDM 的采用和集成 增强高风险、弱势群体的能力。