A Patient-Centered Approach to Integration of Life Expectancy into Treatment Decision Making for Patients with Genitourinary Malignancy

以患者为中心的方法，将预期寿命纳入泌尿生殖系统恶性肿瘤患者的治疗决策中

• 批准号: 10198865
• 负责人: TIMOTHY DASKIVICH
• 金额: $ 18.14万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198865
• 关键词: Address; Aftercare; Age; Agreement; Area; Communication; Communities; Complex; Conflict (Psychology); Consensus; Consultations; Counseling; Data; Data Analyses; Decision Analysis; Decision Making; Exercise; Feedback; General Population; Genitourinary system; Goals; Guidelines; Health Services Research; High-Risk Cancer; Incidence; Individual; Indolent; Internet; Intervention; Interview; Kidney; Life Expectancy; Longevity; Malignant Neoplasms; Malignant neoplasm of prostate; Malignant neoplasm of urinary bladder; Medical Oncologist; Methods; Modeling; Morbidity - disease rate; Newly Diagnosed; Patients; Physicians; Positioning Attribute; Prostate; Quality of life; Radiation Oncologist; Renal carcinoma; Research Methodology; Risk; Role; Series; Specialist; Statistical Models; Structure; Testing; Time; Transcript; Treatment Effectiveness; Urogenital Cancer; Urologist; Value of Life; Visit; aggressive therapy; base; cancer risk; cancer therapy; clinical practice; comorbidity; crowdsourcing; design; improved; men; mortality; muscle invasive bladder cancer; overtreatment; patient oriented; preference; randomized trial; shared decision making; side effect; targeted delivery; tool; treatment choice; tumor

PROJECT SUMMARY Life expectancy (LE) is a critical factor in treatment decision making for men with genitourinary (GU) malignancies, since limited LE predicts lower likelihood of sufficient longevity to benefit from treatment, higher morbidity after treatment, and decreased effectiveness of treatment. Despite a prominent role of LE in guidelines, patients with limited LE are often overtreated for indolent cancers and undertreated for high-risk cancers. Data from non-cancer treatment settings suggest that this may be due to physician-level barriers precluding effective communication of LE. Surprisingly little is known about how LE is currently communicated in treatment consultations as well as patient and physician perspectives on how it should be ideally integrated. Furthermore, patient and community opinions on what LE cutoffs are best suited to “non-aggressive treatment” are lacking. In this application, we propose a series of incremental studies with an overarching goal of building a patient-centered approach to integrating LE into treatment decision making for patients with prostate, kidney, and bladder cancer. (1) First, we will delineate how LE is currently communicated to patients with GU cancers through qualitative analysis of treatment consultation transcripts of patients with early-stage prostate, kidney, and muscle-invasive bladder cancer. We believe that the current communication of LE will be highly variable in terms of incidence of discussion, mode of communication, temporal positioning within the visit, emotive context, and time devoted to the topic. (2) Second, we will engage patient and specialist physician stakeholders through structured interviews to identify barriers and opportunities to improve communication information about LE in cancer treatment decision making. (3) Third, we will use online crowdsourcing of conjoint analysis (CA) as a platform to study how patients and the community value LE relative to other tradeoffs typically encountered in prostate, kidney, and bladder cancer treatment decision making. We will analyze crowdsourced conjoint analysis data to identify situations (based on age, comorbidity, and tumor risk) where LE appears to drive “non-aggressive” treatment choices, which will allow for targeting of LE interventions. (4) Fourth, we will test in a randomized trial whether patient-specific LE estimates— communicated in a patient-centered approach as determined in the first and second aims and targeted to specific high-yield situations as identified in the third aim—along with LE-specific conjoint analysis data improve decisional conflict, quality of LE data discussed, and reduce overtreatment of GU malignancies. We anticipate that this patient-centered approach will improve shared decision making and ultimately result in better treatment choices for patients with GU cancers and limited LE.

项目摘要 预期寿命（LE）是治疗决策的关键因素（GU） Malignancys，由于有限的LE预测降低了足够寿命的可能性，从而受益于治疗，更高 治疗后的发病率和治疗有效性提高。尽管LE在 指南，LE有限的患者通常会过度治疗不适的癌症，而对高风险 癌症。来自非癌症治疗环境的数据表明，这可能是由于物理水平的障碍 排除LE的有效交流。令人惊讶的是，关于LE当前如何传达的知之甚少 在治疗咨询以及有关如何理想整合的患者和身体观点中。 此外，关于最适合“非侵略性治疗”的LE临界值的患者和社区意见 缺乏。在此应用程序中，我们提出了一系列增量研究，其总体目标是建立 一种以患者为中心的方法，将LE整合到患有前列腺，肾脏的患者的治疗决策中 和膀胱癌。 （1）首先，我们将描述LE当前如何传达给GU癌症患者 通过定性分析早期前列腺患者的治疗咨询转录本，肾脏， 和肌肉侵入性膀胱癌。我们认为，当前LE的通信将是高度可变的 EOMTICON 上下文以及专门用于主题的时间。 （2）第二，我们将与患者和专业医生联系 利益相关者通过结构化访谈，以确定改善沟通的障碍和机会 有关癌症治疗决策中LE的信息。 （3）第三，我们将使用在线众包 联合分析（CA）是研究患者和社区价值相对于其他的平台 通常在前列腺，肾脏和膀胱癌治疗决策中遇到权衡。我们将 分析众包共同分析数据以识别情况（基于年龄，合并症和肿瘤风险） LE似乎可以推动“非攻击性”治疗选择，这将允许靶向LE 干预措施。 （4）第四，我们将在一项随机试验中测试患者特定的LE估计是否 - 在第一个和第二个目标中确定的以患者为中心的方法进行通信，并针对 第三个目标中确定的特定高收益情况 - 以及LE特异性联合分析数据 改善决策冲突，讨论的LE数据质量以及减少GU恶性肿瘤的过度处理。我们 预计这种以患者为中心的方法将改善共同的决策，并最终导致 GU癌患者和LE LE的更好的治疗选择。