Precision prevention strategy to increase uptake and engagement in lung cancer screening and smoking cessation treatment

精准预防策略，提高肺癌筛查和戒烟治疗的接受度和参与度

基本信息

批准号：
10369388
负责人：
Li-Shiun Chen
金额：
$ 65.3万
依托单位：
WASHINGTON UNIVERSITY
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：
2022-03-21 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10369388
关键词：
Accounting Address Adult African American African American population Behavior Behavioral Mechanisms Cancer Control Caring Cause of Death Clinical Cognitive Communication Tools Consensus Continuity of Patient Care Data Environment Feedback Genetic Genetic Risk Genomics Goals Guidelines Incidence Intervention Lead Malignant Neoplasms Malignant neoplasm of lung Medical Genetics Meta-Analysis Nature Outcome Patients Perception Pharmacotherapy Physicians Population Prevention strategy Primary Care Physician Primary Health Care Randomized Randomized Controlled Trials Research Risk Screening for cancer Signal Transduction Smoke Smoker Smoking Smoking Cessation Intervention Smoking History Source Testing Tobacco Underserved Population Work aged arm base behavior change cancer care cancer prevention cancer risk cigarette smoking design efficacious treatment evidence base former smoker genetic information genome-wide health disparity populations improved individualized prevention innovation low dose computed tomography lung basal segment lung cancer screening medically underserved mortality motivated behavior multidisciplinary novel patient oriented preventable death primary care setting primary outcome screening secondary outcome smoking cessation social success support tools theories therapy development tool treatment as usual uptake

项目摘要

PROJECT SUMMARY/ABSTRACT Lung cancer is the deadliest form of cancer, and more than 80% of lung cancers and lung cancer deaths are caused by cigarette smoking. Lung cancer screening with annual low‐dose computed tomography is recommended for long‐term current and former smokers, yet as few as 2% of 7.6 million eligible patients receive lung cancer screening. Most of these patients are current smokers, yet few receive effective tobacco treatment, with even larger care gaps among African American populations. This problem requires solutions at multiple levels, as uptake of lung cancer screening and tobacco treatment are driven by both physician orders and patient receipt of care. Novel, personalized efforts that target physicians and patients may boost uptake in lung cancer screening and tobacco treatment. We propose a multi-level intervention featuring a precision risk tool designed to stimulate guideline-concordant care by motivating behavior change and facilitating patient- centered discussions between primary care physicians and medically underserved patients at risk for lung cancer. This innovation is motivated by two key findings: 1) clinical and genetic factors inform precision risk for lung cancer and smoking cessation, and 2) high desire for personal genetic risk feedback signals its potential to activate behavior change. Building on important genomic advances, our team developed RiskProfile, a physician- and patient-facing tool that can incorporate genetic risk feedback to promote evidence-based care and cancer risk-reducing behaviors. The overarching goal of this study is to test the impact of RiskProfile, either with or without genetic information and in comparison to usual care, on uptake of lung cancer screening and tobacco treatment. We propose a 3-arm cluster randomized controlled trial of 75 physicians and 825 screen-eligible patients (11 per physician) from a diverse primary care setting. Physicians and patients will be randomized to usual care vs. RiskProfile-Clin (based on clinical factors) vs. RiskProfile-Gen (based on clinical and genetic factors) to evaluate the effect of precision risk interventions on lung cancer screening and tobacco treatment. In Aims 1 and 2, we will test the effect of RiskProfile on physician orders and patient completion of lung cancer screening and tobacco treatment. We predict that RiskProfile-Gen will outperform RiskProfile-Clin, and that both groups will outperform usual care. Primary outcomes will be ordering and completion of lung cancer screening among screen-eligible patients. Secondary outcomes will be ordering and receiving tobacco treatment among screen-eligible current smokers. In Aim 3, we will explore the impact of RiskProfile on potential mechanisms of behavior change (physician perceptions, patient cognitive or engagement factors, and physician-patient interactions) that may increase uptake of lung cancer screening and tobacco treatment. By targeting both physicians and patients and addressing both cancer screening and cessation care, this precision risk feedback tool has potential to drive down lung cancer incidence and mortality in underserved populations.

项目概要/摘要肺癌是最致命的癌症，超过80%的肺癌和肺癌死亡是由肺癌引起的。每年进行低剂量计算机断层扫描进行肺癌筛查。建议长期吸烟者和既往吸烟者使用，但 760 万符合条件的患者中只有 2% 这些患者中的大多数目前都是吸烟者，但很少有人接受有效的烟草治疗。治疗，非洲裔美国人群体中的护理差距更大，这个问题需要解决。多个层面，因为肺癌筛查和烟草治疗的采用是由医生命令推动的针对医生和患者的新颖、个性化的努力可能会促进对治疗的接受。我们提出以精准风险为特色的多层次干预措施。该工具旨在通过激励行为改变和促进患者的行为来促进符合指南的护理讨论集中在初级保健医生和医疗服务不足的有肺病风险的患者之间这项创新是由两个关键发现推动的：1）临床和遗传因素可准确告知癌症的风险。肺癌和戒烟，2) 对个人遗传风险反馈的强烈渴望表明了其潜力为了激活行为改变，我们的团队在重要的基因组进展的基础上开发了 RiskProfile，面向医生和患者的工具，可以纳入遗传风险反馈以促进循证护理这项研究的总体目标是测试 RiskProfile 的影响，无论是否有遗传信息，以及与常规护理相比，肺癌筛查的接受情况我们提出了一项由 75 名医生和 825 名医生参与的 3 组随机对照试验。来自不同初级保健机构的符合筛选资格的患者（每位医生 11 名）将来自不同的初级保健机构。随机分配至常规护理 vs. RiskProfile-Clin（基于临床因素）与 RiskProfile-Gen（基于临床因素）和遗传因素）评估精准风险干预对肺癌筛查和烟草的影响在目标 1 和 2 中，我们将测试 RiskProfile 对医生医嘱和患者完成治疗的影响。我们预测 RiskProfile-Gen 将优于 RiskProfile-Clin，两组的主要结果将是肺部手术的订购和完成。对符合筛查资格的患者进行癌症筛查的次要结果是订购和接受烟草。在目标 3 中，我们将探讨 RiskProfile 对符合筛查条件的当前吸烟者的治疗。行为改变的潜在机制（医生的看法、患者的认知或参与因素，以及医患互动）可能会增加肺癌筛查和烟草治疗的采用率。针对医生和患者并解决癌症筛查和戒烟护理问题，这种精确性风险反馈工具有可能降低服务不足人群的肺癌发病率和死亡率。