Automated Colorectal Cancer Educational Support System (ACCESS): Development and Validation of a Novel Online Decision Aid for Improving Colorectal Cancer Screening Uptake

自动化结直肠癌教育支持系统 (ACCESS)：开发和验证新型在线决策辅助工具，以提高结直肠癌筛查的采用率

基本信息

批准号：
10651636
负责人：
Christopher V Almario
金额：
$ 26.13万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-06-30
项目状态：
未结题

项目摘要

PROJECT SUMMARY This proposal aims to improve colorectal cancer (CRC) screening uptake by developing and validating a novel online decision aid called the Automated Colorectal Cancer Educational Support System (ACCESS). While CRC is preventable, it still remains a major public health issue, as it is the third most prevalent and deadly malignancy in the U.S. The U.S. Preventive Services Task Force (USPSTF) recommends that all Americans at average risk for CRC undergo screening starting at age 50, yet one-third of Americans are unscreened. Eliciting patient preferences by engaging in shared decision making via decision aids has been proposed as a potentially effective strategy to improve screening rates. CRC screening is ideally suited for a shared decision making approach, as the USPSTF endorses 7 different testing options (e.g., stool-, imaging-, and endoscopy-based tests), each with distinct advantages and disadvantages. Of the few existing CRC screening decision tools, most were ineffective as they were beset by imprecise assessment of patients’ preferences and ineffective integration in clinical workflows. This proposal will address these gaps by creating an online, efficient, conjoint analysis- based decision aid called ACCESS that generates a personalized report that rank orders the importance of each test attribute (e.g., accuracy, invasiveness, etc.) in patients’ decision making. The report will also be shared with their clinicians via the electronic health record so that they can efficiently recognize their patients’ priorities when selecting a screening test. The hypothesis is that use of ACCESS, through optimizing shared decision making, will lead to selection of a modality that accurately matches each patient’s unique values, and as a result, increase screening uptake. To test this hypothesis, the proposal will achieve the following aims: (1) Gain insights into patients’ knowledge, attitudes, beliefs, and drivers of decision making when selecting among the different screening options through conjoint analysis, a quantitative technique that assesses how individuals make tradeoffs; (2) Build the ACCESS decision aid in partnership with patients, clinicians, implementation and behavioral science experts, and computer scientists; (3) Conduct a pilot randomized controlled trial to determine if ACCESS improves CRC screening uptake vs. usual care. To successfully complete the project, the PI will receive mentorship from experienced clinicians, health services researchers, implementation and behavioral scientists, and digital health experts. The PI will also address his knowledge gaps by taking formal coursework in implementation and behavioral sciences, conjoint choice modeling, qualitative analysis, quality measurement and improvement, and trial design. He will also participate in R grant writing workshops over the award period. Obtaining these competencies combined with successful completion of the study will allow him to work towards his goal of becoming an independent, NIH-funded digital health scientist focused on enhancing cancer prevention and health promotion through the user-centered development and use of innovative, scalable, evidence-based technologies that support patients and clinicians in making shared decisions.

项目概要该提案旨在通过开发和验证一种新型方法来提高结直肠癌 (CRC) 筛查的采用率在线决策援助称为自动结直肠癌教育支持系统 (ACCESS)。虽然是可以预防的，但它仍然是一个重大的公共卫生问题，因为它是第三大流行和致命的恶性肿瘤在美国，美国预防服务工作组 (USPSTF) 建议所有处于平均风险的美国人 CRC 从 50 岁开始接受筛查，但三分之一的美国人没有接受筛查。通过决策辅助工具参与共同决策来进行偏好已被提议作为一种潜在的方法提高筛查率的有效策略非常适合共同决策。方法，因为 USPSTF 认可 7 种不同的测试选项（例如基于粪便、成像和内窥镜检查）测试），在现有的少数 CRC 筛查决策工具中，每种工具都有独特的优点和缺点。由于对患者偏好的评估不精确和整合无效而受到困扰，因此效果不佳该提案将通过创建在线、高效、联合分析来解决这些差距。基于称为 ACCESS 的决策辅助工具，可生成个性化报告，对每个问题的重要性进行排序患者决策中的测试属性（例如准确性、侵入性等）该报告也将与患者共享。他们的追随者通过电子健康记录，以便他们能够有效地识别患者的优先事项选择筛选测试的假设是通过优化共享决策来使用 ACCESS，将导致选择准确匹配每个患者独特价值观的模式，从而增加为了检验这一假设，该提案将实现以下目标：（1）深入了解。患者在不同选择时的知识、态度、信念和决策驱动因素通过联合分析筛选选项，联合分析是一种评估个人如何做出选择的定量技术 (2) 与患者、倡导者、实施者和参与者合作建立 ACCESS 决策援助 (3) 进行随机对照试验以确定如果 ACCESS 与常规护理相比提高了 CRC 筛查率，那么 PI 将成功完成该项目。接受经验丰富的顾客、卫生服务研究人员、实施和行为方面的指导 PI 还将通过参加正式课程来解决他的知识差距。在实施和行为科学中，联合选择建模、定性分析、质量测量他还将在奖励期间参加 R 资助写作研讨会。获得这些能力并成功完成学习将使他能够努力实现他的目标是成为一名独立的、由 NIH 资助的数字健康科学家，专注于增强癌症通过以用户为中心的开发和使用创新的、可扩展的、支持患者和战士做出共同决策的基于证据的技术。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Patient Preferences for Colorectal Cancer Screening Tests in Light of Lowering the Screening Age to 45 Years.

将筛查年龄降低至 45 岁后，患者对结直肠癌筛查测试的偏好。

DOI：
发表时间：
2023-02
期刊：
影响因子：
0
作者：
Makaroff, Katherine E;Shergill, Jaspreet;Lauzon, Marie;Khalil, Carine;Ahluwalia, Sangeeta C;Spiegel, Brennan M R;Almario, Christopher V
通讯作者：
Almario, Christopher V

Measuring and Improving Quality of Colonoscopy for Colorectal Cancer Screening.

测量和提高结肠镜检查的结直肠癌筛查质量。

DOI：
10.1016/j.tige.2021.11.002
发表时间：
2021-11-01
期刊：
Techniques and innovations in gastrointestinal endoscopy
影响因子：
0
作者：
Christopher V. Almario;J. Shergill;Janice Oh
通讯作者：
Janice Oh

Fecal immunochemical test (FIT) versus colonoscopy: Does knowing that a positive FIT requires a follow-up colonoscopy affect initial decision making in the US?

粪便免疫化学测试 (FIT) 与结肠镜检查：知道 FIT 阳性需要进行后续结肠镜检查是否会影响美国的初步决策？

DOI：
发表时间：
2022-06
期刊：
影响因子：
2.8
作者：
Shergill, Jaspreet;Makaroff, Katherine E;Lauzon, Marie;Spiegel, Brennan M R;Almario, Christopher V
通讯作者：
Almario, Christopher V

Filipinos' attitudes, barriers, and enablers on colorectal cancer screening: Insights from a qualitative research study.

菲律宾人对结直肠癌筛查的态度、障碍和推动因素：定性研究的见解。