Improving cancer screening in older adults with limited life expectancy

改善预期寿命有限的老年人的癌症筛查

• 批准号: 9926798
• 负责人: Nancy Schoenborn
• 金额: $ 24.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926798
• 关键词: Address; Age; Area; Behavior; Breast Cancer Detection; Clinical Practice Guideline; Clinical Treatment; Clinical Trials; Clinical Trials Design; Colorectal; Colorectal Cancer; Communication; Coupled; Data; Decision Aid; Decision Making; Development; Development Plans; Elderly; Elements; Environment; Feedback; Fostering; Funding; Goals; Grant; Harm Reduction; Health Status; Intervention; Interview; Intuition; Leadership; Learning; Life Expectancy; Malignant Neoplasms; Malignant neoplasm of prostate; Mentors; Morbidity - disease rate; Patients; Pattern; Physicians; Preventive care; Primary Health Care; Process; Publications; Qualitative Methods; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Scholarship; Screening for Prostate Cancer; Screening for cancer; Structure; Surveys; Testing; Time; United States National Institutes of Health; Visit; Work; base; career; career development; experience; follow-up; implementation science; improved; indexing; innovation; leadership development; malignant breast neoplasm; mortality; multi-component intervention; novel; overtreatment; patient oriented; patient screening; point of care; primary outcome; routine screening; screening; screening guidelines; skills; therapy development; tool

PROJECT SUMMARY Background: Cancer screening can lower cancer-related mortality and morbidity but may be associated with significant harms and burdens in older adults. There is often a lag-time of 10 years before patients screened for breast, colorectal, or prostate cancers actually benefit. On the other hand, multiple harms from screening can occur in the short-term. Older adults with limited life expectancy continue to receive cancer screening at high rates even though it exposes them to the harms of screening with little chance of benefit. Clinicians are a major driver of over-screening but why they often continue to recommend cancer screening in older adults with limited life expectancy is unknown. This proposal aims to improve the cancer screening of older adults by 1) identifying the factors that facilitate or hinder clinician recommendations to stop routine screening in older adults with limited life expectancy, and 2) better supporting clinicians to appropriately incorporate life expectancy in their screening recommendations. Research proposal: Aim 1 will use qualitative methods to understand the range of factors that facilitate or hinder clinicians from recommending screening cessation in older adults with limited life expectancy. Aim 2 will test these factors in a national physician survey to determine and quantify their effects on physicians' screening recommendations in older adults with limited life expectancy. Aim 3 will then develop and pilot test a novel multi-modal intervention to target the factors that significantly contribute to over-screening. The intervention will be developed with input from clinicians and older adults and will use multiple, overlapping strategies that may include decision support, communication coaching, and clinician feedback. Career development plan: The candidate is a geriatrician who has already demonstrated national and institutional leadership in research and a strong track record of academic scholarship with numerous high impact publications and early investigator grants. Her long-term career goal is to be a research leader focused on incorporating life expectancy to inform patient-centered, individualized preventive care decisions for older adults. She has laid out a comprehensive, feasible career development plan that will enable her to transition into an independent investigator and research leader. She proposes to learn new skills in decision support, clinical trial design, and implementation science, in addition to continued development of leadership skills. She has assembled an exemplary mentoring team with expertise in the subject area and the relevant research methods and works in a rich research environment with tremendous resources to support her development. Summary: The proposal addresses an important research gap and produces a novel intervention that may have major impact to improve the cancer screening of older adults. The results from this proposal will support a subsequent large-scale clinical trial to test the intervention. This proposal will also further foster the career development of the candidate into a research leader focused on individualized preventive care in older adults.

项目概要 背景：癌症筛查可以降低癌症相关死亡率和发病率，但可能与 对老年人造成重大伤害和负担。患者筛查前通常有 10 年的滞后时间 对于乳腺癌、结直肠癌或前列腺癌实际上有益。另一方面，筛查带来的多重危害 可能会在短期内发生。预期寿命有限的老年人继续接受癌症筛查 高比率，尽管这使他们面临筛查的危害，而几乎没有获益的机会。临床医生是 过度筛查的主要驱动因素，但为什么他们经常继续建议患有癌症的老年人进行癌症筛查 有限的预期寿命未知。该提案旨在通过 1) 改善老年人的癌症筛查 确定促进或阻碍临床医生建议停止对老年人进行常规筛查的因素 预期寿命有限的成年人，2) 更好地支持临床医生适当地融入生活 他们的筛查建议中的期望。 研究建议：目标 1 将使用定性方法来了解促进或促进的因素范围 阻碍临床医生建议预期寿命有限的老年人停止筛查。目标2将 在全国医生调查中测试这些因素，以确定并量化它们对医生的影响 对预期寿命有限的老年人的筛查建议。然后，目标 3 将开发并试点测试 新颖的多模式干预针对显着导致过度筛查的因素。这 干预措施将根据临床医生和老年人的意见制定，并将使用多种、重叠的方法 策略可能包括决策支持、沟通辅导和临床医生反馈。 职业发展计划：候选人是一位老年病学家，已经证明了国家和 研究机构的领导地位和学术奖学金的良好记录，拥有众多高水平的 影响出版物和早期研究者资助。她的长期职业目标是成为专注于研究的领导者 纳入预期寿命，为老年人提供以患者为中心的个性化预防性护理决策 成年人。她制定了全面、可行的职业发展计划，使她能够实现转型 成为一名独立调查员和研究领导者。她建议学习决策支持的新技能， 临床试验设计和实施科学，以及领导技能的持续发展。她 组建了一支具有学科领域和相关研究专业知识的模范指导团队 丰富的研究环境中的方法和工作，以及巨大的资源来支持她的发展。 摘要：该提案解决了一个重要的研究空白，并产生了一种新颖的干预措施，可能会 对改善老年人的癌症筛查具有重大影响。该提案的结果将支持 随后进行大规模临床试验来测试干预措施。该提议也将进一步促进职业发展 将候选人发展成为专注于老年人个性化预防保健的研究领导者。