Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement

优化肺癌筛查的依从性：将理论和实施科学应用于参与者的参与

基本信息

批准号：
10818665
负责人：
Erin Hirsch
金额：
$ 9.3万
依托单位：
HACKENSACK UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10818665
关键词：
Address Adherence Affect Algorithms Benefits and Risks Breast Cancer Detection Cancer Etiology Cervical Cancer Screening Cessation of life Characteristics Clinical Clinical Trials Cognitive Computerized Medical Record Consumption Counseling Data Dedications Development Diagnosis Effectiveness Effectiveness of Interventions Eligibility Determination Exposure to Goals Guideline Adherence Guidelines Health Health Benefit Health behavior Human Resources Hybrids Image Individual Intervention Intervention Studies Interview Malignant Neoplasms Malignant neoplasm of lung Measures Medical Mentors Methods Outcome Outcome Measure Parents Participant Patients Phase Postdoctoral Fellow Process Provider Recommendation Reminder Systems Reporting Research Research Design Research Methodology Research Personnel Research Training Scanning Scientist Screening for cancer Smoker Smoking Specialist Surveys System Testing Time Training Training Programs Visit acceptability and feasibility cancer diagnosis career clinically significant colorectal cancer screening computed tomography screening cost design dissemination science effective intervention effectiveness evaluation effectiveness outcome effectiveness/implementation study effectiveness/implementation trial evidence base experience former smoker health application high risk high risk population implementation outcomes implementation research implementation science improved informant information processing innovation intervention program low dose computed tomography lung cancer screening mortality patient engagement person centered population based population health pragmatic study primary care provider programs protective behavior risk perception routine screening screening screening guidelines screening program shared decision making skills social social health determinants social stigma theories therapy development tool user centered design

Address Adherence Affect Algorithms Benefits and Risks Breast Cancer Detection Cancer Etiology Cervical Cancer Screening Cessation of life Characteristics Clinical Clinical Trials Cognitive Computerized Medical Record Consumption Counseling Data Dedications Development Diagnosis Effectiveness Effectiveness of Interventions Eligibility Determination Exposure to Goals Guideline Adherence Guidelines Health Health Benefit Health behavior Human Resources Hybrids Image Individual Intervention Intervention Studies Interview Malignant Neoplasms Malignant neoplasm of lung Measures Medical Mentors Methods Outcome Outcome Measure Parents Participant Patients Phase Postdoctoral Fellow Process Provider Recommendation Reminder Systems Reporting Research Research Design Research Methodology Research Personnel Research Training Scanning Scientist Screening for cancer Smoker Smoking Specialist Surveys System Testing Time Training Training Programs Visit acceptability and feasibility cancer diagnosis career clinically significant colorectal cancer screening computed tomography screening cost design dissemination science effective intervention effectiveness evaluation effectiveness outcome effectiveness/implementation study effectiveness/implementation trial evidence base experience former smoker health application high risk high risk population implementation outcomes implementation research implementation science improved informant information processing innovation intervention program low dose computed tomography lung cancer screening mortality patient engagement person centered population based population health pragmatic study primary care provider programs protective behavior risk perception routine screening screening screening guidelines screening program shared decision making skills social social health determinants social stigma theories therapy development tool user centered design

展开

项目摘要

PROJECT SUMMARY Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective and feasible interventions to improve LCS adherence and achieve optimal individual and population health benefits. Research during the F99 phase will leverage an innovative, multi-phase, mixed methods design to describe how LCS patients process health information regarding health protective behavior and utilize this information to develop and evaluate reminder messages with individuals eligible for LCS. Using a four-step process, data collected in a survey of LCS program participants (step 1) will inform the development of a pool of candidate reminder messages (step 2). In the final two steps, the reminder messages will be evaluated by LCS experts (step 3) and further evaluated and refined with LCS program participants (step 4) using mixed methods, including surveys and interviews. Differences between health information processing constructs by demographic or clinical characteristics found to be significant from step 1 will be the focus for message targeting (group level) and/or tailoring (individual level). At the conclusion of the F99 phase, I will have a formalized set of clear, engaging, and efficient messages to support LCS annual adherence, ready to be evaluated in a clinical setting. Research proposed in the K00 phase will focus on gaining real-world experience with hybrid effectiveness implementation study designs and pragmatic outcome measures to simultaneously assess effectiveness and implementation outcomes. Specifically, I propose a mentored pre-post type 1 hybrid effectiveness- implementation trial, within a parent trial, that will allow concurrent assessment of effectiveness and implementation outcomes of the F99 reminder strategy in real-world LCS programs. Effectiveness will be tested using a pre-post design, comparing percent screening participants adherent to annual screening guidelines before and after implementation of the reminder strategy. Secondary implementation outcomes (i.e., acceptability and feasibility) will be assessed with surveys and key informant interviews of personnel involved in the reminder system implementation (e.g., LCS program directors, navigators, coordinators). This body of research will prepare me for a career as an independent cancer-focused intervention scientist with expertise in the development and implementation of effective, low-burden interventions aimed at improving LCS adherence, maximizing screening benefit, and reducing lung cancer mortality.

项目摘要肺癌是美国癌症死亡的主要原因，大多数肺癌在晚期诊断阶段。高剂量CT筛查高风险个体是唯一可用于诊断的循证工具在存在可再生治疗方案的早期肺癌。有希望的降低死亡率的好处肺癌筛查（LCS）目前由于次优的基于人口而无法实现遵守年度筛查指南。在研究环境之外，对年度LCS的依从性少于在改变实践的地标临床试验中观察到的一半。迫切需要有效以及可行的干预措施，以提高LCS依从性并实现最佳的个人和人口健康好处。 F99阶段的研究将利用创新的多相，混合方法设计描述LCS患者如何处理有关健康保护行为的健康信息并利用这一点信息以开发和评估与有资格使用LCS的个人的提醒消息。使用四步流程，在LCS计划参与者的调查中收集的数据（步骤1）将告知开发的开发候选提醒消息（步骤2）。在最后两个步骤中，提醒消息将由LCS评估专家（步骤3），并使用LCS计划参与者进行进一步评估和完善（步骤4），使用混合方法，包括调查和访谈。健康信息处理结构之间的差异通过人群或从步骤1中发现很重要的临床特征将是消息定位的重点（小组级别）和/或裁缝（个人级别）。在F99阶段结束时，我将有一套正式的清晰，参与和有效的消息以支持LCS年度依从性，准备在临床环境中进行评估。在K00阶段提出的研究将重点侧重于获得混合有效性的现实经验实施研究设计和务实的结果指标，以同时评估有效性和实施结果。具体而言，我提出了一个受过指导的1型杂种前杂种效率 - 在父母试验中，实施审判将允许同时评估有效性和现实世界LCS计划中F99提醒策略的实现结果。有效性将进行测试使用前设计时，将筛选参与者的百分比与年度筛查指南进行比较实施提醒策略之前和之后。次要实施成果（即可接受性和可行性）将通过对参与人员的调查和主要线人访谈进行评估提醒系统实施（例如，LCS计划董事，导航员，协调员）。这个身体研究将使我成为一名以癌症为中心的独立干预科学家的职业，并具有专业知识旨在改善LCS依从性的有效，低负担干预措施的开发和实施，最大化筛查益处，并降低肺癌死亡率。