Facilitating Web-based Patient Decision Support for Hereditary Breast Cancer Risk

促进基于网络的遗传性乳腺癌风险患者决策支持

基本信息

批准号：
7575262
负责人：
MARY Beryl DALY
金额：
$ 21.77万
依托单位：
FOX CHASE CANCER CENTER
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-03-01 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7575262
关键词：
Address Affective Area Basic Behavioral Science Benign Breast Diseases Cancer Information Service Caring Chemoprevention Classification Clinical Cognitive Complement Complex Conflict (Psychology)Cues Data Decision Making Decision Support Systems Development Diagnosis Distress Effectiveness Emotional Environment Evaluation Experimental Designs Face Family Family history of Foxes Future Genetic Genetic Programming Genetic screening method Goals Health Health Personnel Health Professional Health Services Healthcare Hereditary Breast Carcinoma High Risk Woman Histologic Hyperplasia Impact evaluation Individual Informal Social Control Inherited Intervention Intervention Studies Intraductal Hyperplasia Knowledge Life Literature Lobular Malignant Neoplasms Mastectomy Measures Mediating Mediator of activation protein Medical center Menopausal Status Methods Modeling Monitor Morbidity - disease rate Movement NCI Center for Cancer Research National Cancer Institute Online Systems Operative Surgical Procedures Outcome Ovariectomy Participant Patient Participation Patients Persons Phase Pilot Projects Pre-Post Tests Process Psychological Factors Public Health Quality Control Raloxifene Randomized Randomized Clinical Trials Regrets Research Resources Risk Risk Assessment Risk Behaviors Risk Management Risk Reduction Risk Reduction Behavior Sampling Side Staging Surgical Oncology Tamoxifen Target Populations Testing Trust Uncertainty Upper arm Visit Woman Work base cancer chemoprevention cancer genetics cancer risk clinical care design efficacy testing evidence base experience high risk improved information processing innovation instrument lobular breast carcinoma in situ malignant breast neoplasm meetings member mortality mutation carrier prevent primary outcome programs prophylactic prototype risk perception social theories therapy development usability web site

项目摘要

DESCRIPTION (provided by applicant): For women at high risk of breast cancer, it is important to help them realistically assess their decision making needs and access quality decision support resources so they can make informed, value-sensitive decisions about chemoprevention. This presents a timely clinical and public health opportunity to inform women about their breast cancer risk decisions and support their decision-making needs through an innovative web-based decision support intervention to complement clinical care, that is available whenever, wherever, and as often as needed during the decision-making period. The proposed project will be guided by the Cognitive-Social Health Information Processing model overall, and incorporate the Ottawa Decision Support Framework in one consistent decision support process. Specific aims are to: (1) Aim 1: Develop and refine a web-based patient decision support module for high-risk women making a decision about breast cancer chemoprevention, to be used as a prototype for designing a more comprehensive Trusted Advisor for Cancer Health Decisions (TACHD) decision support system, and (2) Aim 2: Conduct a formative evaluation of the impact of the chemoprevention module, which will include a pilot study and a process evaluation. For Aim 1, TACHD development will follow three phases that will result in: (1) functional HTML screens; (2) a fully functional intervention web site; and (3) an administrative functionality. They will be user- tested and usability tested with the target population. For Aim 2, pilot testing of the chemoprevention decision support module will be conducted in a two-group pre- post-test experimental design with 64 at-risk women identified through Fox Chase Risk Assessment Programs and the NCI Clinical Cancer Genetics Program at National Naval Medical Center. A process evaluation analysis will assess participants' experiences using TACHD. For aim 2 analyses, (1) two-sided two-sample paired t-tests will evaluate the impact of TACHD on changes in the primary outcome of decisional conflict, as well as decision stage, attentional style, cancer worry, cancer distress, and cancer risk perception; (2) two-sample, paired t-tests will identify discrete versions of psychological factors associated with differential changes in decisional conflict; and (3) potential moderator (attentional style) and mediator variables (cancer worry, cancer distress, cancer risk perception) will be explored. Decision support interventions such as TACHD can promote quality decisions -- defined as informed and consistent with personal values -- among individuals concerned about breast cancer risk and result in better public health outcomes such as improved risk reduction behaviors and lower cancer-related morbidity and mortality.

描述（由申请人提供）：对于乳腺癌高危女性来说，帮助她们现实地评估自己的决策需求并获得高质量的决策支持资源非常重要，这样她们就可以就化学预防做出明智的、价值敏感的决策。这提供了一个及时的临床和公共卫生机会，让妇女了解她们的乳腺癌风险决定，并通过创新的基于网络的决策支持干预来支持她们的决策需求，以补充临床护理，无论何时、何地、多久都可以使用决策期间需要的。拟议的项目将总体以认知社会健康信息处理模型为指导，并将渥太华决策支持框架纳入一个一致的决策支持流程。具体目标是： (1) 目标 1：开发和完善基于网络的患者决策支持模块，供高危女性做出有关乳腺癌化学预防的决定，作为设计更全面的可信癌症顾问的原型健康决策 (TACHD) 决策支持系统，以及 (2) 目标 2：对化学预防模块的影响进行形成性评估，其中包括试点研究和过程评估。对于目标 1，TACHD 开发将遵循三个阶段，这将导致： (1) 功能性 HTML 屏幕； (2) 功能齐全的干预网站； (3) 管理功能。它们将接受目标人群的用户测试和可用性测试。对于目标 2，化学预防决策支持模块的试点测试将以两组测试前实验设计进行，其中包括通过 Fox Chase 风险评估计划和国家海军 NCI 临床癌症遗传学计划确定的 64 名高危女性。医疗中心。过程评估分析将评估参与者使用 TACHD 的体验。对于目标 2 分析，(1) 两侧双样本配对 t 检验将评估 TACHD 对决策冲突主要结果变化的影响，以及决策阶段、注意力风格、癌症担忧、癌症困扰和癌症风险认知； (2) 双样本配对 t 检验将识别与决策冲突差异变化相关的心理因素的离散版本； (3) 将探讨潜在调节变量（注意方式）和中介变量（癌症担忧、癌症困扰、癌症风险认知）。 TACHD 等决策支持干预措施可以促进关注乳腺癌风险的个人做出高质量决策（定义为知情且符合个人价值观），并带来更好的公共卫生结果，例如改善降低风险的行为并降低癌症相关发病率和死亡率。