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.

项目摘要/摘要肺癌是最致命的癌症形式，超过80％的肺癌和肺癌死亡是由吸烟引起。使用年度低剂量计算机断层扫描的肺癌筛查是建议用于长期和以前的吸烟者，但在760万合格患者中只有2％接受肺癌筛查。这些患者中的大多数是目前的吸烟者，但很少有有效的烟草治疗，非裔美国人人口的护理差距更大。这个问题需要解决方案多个级别，因为肺癌筛查和烟草治疗的摄取均由两种物理订单驱动和患者收到护理。针对医生和患者的新颖，个性化的努力可能会增加吸收肺癌筛查和烟草治疗。我们提出了具有精度风险的多层干预措施旨在通过激励行为改变并支持患者来刺激指导方案护理的工具 - 初级保健医生与有肺风险的医学欠佳患者之间的集中讨论癌症。这项创新是由两个关键发现激发的：1）临床和遗传因素为精确风险提供了肺癌和戒烟，以及2）对个人遗传风险反馈的高度渴望信号信号激活行为改变。在重要的基因组进步的基础上，我们的团队开发了风险折磨，可以纳入遗传风险反馈以促进循证护理的身体和患者的身体和患者的工具和降低癌症风险的行为。这项研究的总体目标是测试风险较高的影响，有或没有遗传信息，并且与通常的护理相比，肺癌筛查的摄取和烟草治疗。我们提出了75位医生和825的3臂群集随机对照试验来自潜水员初级保健环境的符合筛查的患者（每位医生11名）。医师和患者将随机分配到通常的护理与风险封建（基于临床因素）与风险框架 - 基于临床因素（基于临床因素）和遗传因素）评估精度风险干预对肺癌筛查和烟草的影响治疗。在AIM 1和2中，我们将测试风险保护对物理订单的影响和患者完成的影响肺癌筛查和烟草治疗。我们预测，风险填充 - 可能会胜过风险较高的cin，这两个群体都会超越通常的照顾。主要结果将是订购和完成肺筛查符合筛查的患者的癌症筛查。次要结果将是订购和接收烟草符合屏幕符合当前吸烟者的治疗。在AIM 3中，我们将探索风险折磨对行为改变的潜在机制（医师的看法，患者认知或参与因素，以及身体病患者的相互作用）可能会增加肺癌筛查和烟草治疗的摄取。经过针对医生和患者并解决癌症筛查和停止护理，这一精度风险反馈工具有可能降低服务不足人群的肺癌事件和死亡率。