Improving shared decision-making around the use of disease modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer

改善类风湿关节炎和癌症患者使用疾病缓解抗风湿药物的共同决策

基本信息

批准号：
10650753
负责人：
Namrata Singh
金额：
$ 16.49万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10650753
关键词：
American Cancer Etiology Caring Cause of Death Cessation of life Characteristics Collaborations Data Databases Decision Aid Decision Making Development Diagnosis Disease-Modifying Second-Line Drugs Ensure Family Family member Foundations Funding Future General Population Goals Guidelines Immune response Immunosuppressive Agents Impairment Incidence Individual Interview Knowledge Lung Lymphoma Lymphoma Malignant Neoplasms Malignant neoplasm of lung Mentors Mentorship Methodology Methods Newly Diagnosed Nurse Practitioners Oncologist Outcome Outcomes Research Patient Care Patient-Focused Outcomes Patients Perception Persons Pharmaceutical Preparations Pharmacoepidemiology Pharmacotherapy Population Process Property Qualitative Research Recording of previous events Recurrence Research Research Design Research Methodology Research Personnel Retrospective cohort study Rheumatism Rheumatoid Arthritis Risk Safety Sample Size Shapes Signal Transduction Smoking Specialist Stage at Diagnosis Testing Training Treatment Protocols Tumor stage United States Department of Veterans Affairs Universities Veterans Washington cancer diagnosis cancer risk career development clinical decision-making clinical practice comorbidity comparative effectiveness comparative safety evidence base experience follow-up improved individual patient member mortality patient oriented patient population preference primary care provider rheumatologist shared decision making skills standard care treatment and outcome treatment guidelines treatment planning tumor willingness

项目摘要

PROJECT SUMMARY Over 1.8 million Americans have rheumatoid arthritis (RA). Compared to the general population these patients are at an increased risk of developing cancer, especially lymphoma and lung cancer. There has been a theoretical concern that use of immunosuppressive agents may impair immune responses to tumors placing patients at risk for developing new cancers and for recurrence of previously treated cancers. These concerns have made clinicians reluctant to use standard therapies for RA in patients with an active or recently diagnosed cancer. Although only a limited number of studies have evaluated their safety, they have in fact not shown any signal of harm from disease modifying anti-rheumatic drugs (DMARDs) in patients with RA and cancer. However, these studies have numerous limitations including focus on mostly patients with remote (> 5 years) history of cancer, small sample sizes, focus on only certain DMARDs, and/or limited information on cancer- specific mortality and other outcomes that might matter to patients. Also, nothing is known about the perspectives and experiences of patients with RA who are being treated for a cancer and how this experience might shape their willingness to use DMARDs. Treatment guidelines for the management of RA support a shared decision-making (SDM) approach that attempts to leverage the professional expertise of the rheumatologist to uphold what is most important to each patient. We herein propose a mixed methods approach to identify the optimal ways to enhance delivery of care for these patients and to provide a foundation for shared decision making to ensure alignment between treatment decisions and the values, goals, and preferences of individual patients. The studies proposed here will build an evidence base to identify the safest DMARD options for patients with RA who develop cancer (Aim 1); elicit the experiences, perceptions, and most valued outcomes of patients with RA and an active or recently diagnosed (<5 years) cancer, their family members and clinicians who care for these patients (Aim 2). The overall goal of this K23 mentored career development proposal is to support Dr. Namrata Singh’s development as an independent, patient-oriented researcher whose long-term goal is to develop a research agenda focused on the identification of factors that contribute to suboptimal treatment and outcomes for patients with rheumatic diseases, especially those with cancer. The training and research plans proposed here will allow her to develop critical skills in advanced pharmacoepidemiology and in qualitative research methods. Combined with an outstanding mentorship team, the University of Washington’s world-class facilities, and a rigorous training plan, this project will prepare Dr. Singh to successfully obtain future funding to adapt and test a decision aid for SDM implementation among patients with RA and an active or recent cancer.

项目概要与普通人群相比，超过 180 万美国人患有类风湿性关节炎 (RA)。患者患癌症的风险增加，尤其是淋巴瘤和肺癌。理论上担心使用免疫抑制剂可能会损害对放置肿瘤的免疫反应有患新癌症和先前治疗的癌症复发风险的患者这些问题。使得大象不愿意对患有活动性或最近诊断出的类风湿性关节炎患者使用标准疗法尽管只有有限数量的研究评估了它们的安全性，但实际上并没有显示出任何安全性。 RA 和癌症患者疾病缓解抗风湿药物 (DMARD) 的危害信号。然而，这些研究有许多局限性，包括主要关注远程（> 5 年）的患者癌症病史、样本量小、仅关注某些 DMARD 和/或有关癌症的信息有限 - 此外，对于患者可能重要的具体死亡率和其他结果也一无所知。正在接受癌症治疗的 RA 患者的观点和经历以及这种经历如何可能会影响他们使用 DMARD 治疗 RA 治疗指南的意愿。共享决策（SDM）方法试图利用各方的专业知识风湿病学家坚持对每个患者最重要的事情，我们在此提出了一种混合方法。确定加强为这些患者提供护理的最佳方法并提供基础共同决策，以确保治疗决策与价值观、目标和目标之间的一致性个别患者的偏好。这里提出的研究将为患者建立一个证据基础，以确定最安全的 DMARD 选择与罹患癌症的 RA 进行交流（目标 1）；患有 RA 并患有活动性或最近诊断出（<5 年）癌症的患者及其家人和谁照顾这些患者（目标 2）。这项 K23 指导职业发展提案的总体目标是支持 Namrata Singh 博士的发展成为一名独立的、以患者为中心的研究人员，其长期目标是开展研究议程重点是确定导致治疗和结果不理想的因素风湿病患者，特别是癌症患者，这里提出了培训和研究计划。将使她能够发展高级药物流行病学和定性研究方法方面的关键技能。结合了优秀的导师团队、华盛顿大学世界一流的设施和严格的培训计划，该项目将为辛格博士成功获得未来的适应和测试资金做好准备在患有 RA 和患有活动性或近期癌症的患者中实施 SDM 的决策辅助工具。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Racial/ethnic disparities in the risk of preterm birth among women with systemic lupus erythematosus or rheumatoid arthritis.

患有系统性红斑狼疮或类风湿性关节炎的妇女早产风险的种族/民族差异。

DOI：
发表时间：
2023-09
期刊：
影响因子：
3.4
作者：
Strouse, Jennifer;Sabih, Lena;Bandoli, Gretchen;Baer, Rebecca;Jelliffe;Chambers, Christina;Ryckman, Kelli;Singh, Namrata
通讯作者：
Singh, Namrata

2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases.

2022 年美国风湿病学会风湿病和肌肉骨骼疾病患者疫苗接种指南。

DOI：
发表时间：
2023-03
期刊：
影响因子：
0
作者：
Bass, Anne R;Chakravarty, Eliza;Akl, Elie A;Bingham, Clifton O;Calabrese, Leonard;Cappelli, Laura C;Johnson, Sindhu R;Imundo, Lisa F;Winthrop, Kevin L;Arasaratnam, Reuben J;Baden, Lindsey R;Berard, Roberta;Bridges Jr, S Louis;Cheah, Jonathan
通讯作者：
Cheah, Jonathan

Supporting International Medical Graduates in Rheumatology: A Call to Action.

支持风湿病学国际医学毕业生：行动呼吁。

DOI：
发表时间：
2023-02
期刊：
影响因子：
0
作者：
Fernandez;Duarte;Rolle, Noelle A;Sattui, Sebastian E;Saygin, Didem;Dowell, Sharon;Alexander, Swetha A;Kumar, Bharat;Danila, Maria I;Singh, Namrata
通讯作者：
Singh, Namrata

Racial disparities in pregnancy outcomes among women with rheumatic diseases: A systematic literature review.

风湿病女性妊娠结局的种族差异：系统文献综述。

DOI：
发表时间：
2023-06
期刊：
影响因子：
5
作者：
Shen, Gloria;Swaminathan, Maya;Huang, Irvin;Louden, Diana;Feterman, Dominique;Tahir, Muhammad Waqas;Singh, Namrata
通讯作者：
Singh, Namrata

Use of Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis: Supporting Shared Decision-Making Between Patients With Cancer and Clinicians.

使用缓解疾病的抗风湿药物治疗类风湿关节炎：支持癌症患者和临床医生之间的共同决策。