TELEhealth Shared decision-making COaching for lung cancer screening in Primary care (TELESCOPE)

TELEhealth 初级保健中肺癌筛查的共享决策辅导 (TELESCOPE)

基本信息

批准号：
10597180
负责人：
Richard Michael Hoffman
金额：
$ 70.05万
依托单位：
RUTGERS BIOMEDICAL AND HEALTH SCIENCES
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：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597180
关键词：
Address Adherence Adult Age Awareness Cancer Burden Cancer Etiology Caring Cessation of life Characteristics Clinical Cluster randomized trial Conflict (Psychology)Counseling Decision Aid Decision Making Diagnosis Diagnostic Procedure Diagnostic tests Disparity Eligibility Determination Ethnic Origin Exclusion Goals Guidelines Health Personnel Health Services Accessibility Incidental Findings Individual Intervention Knowledge Longitudinal Studies Lung Malignant neoplasm of lung Medical Methods Minority Modeling Nurses Pathway interactions Patient Care Patients Persons Policy Maker Population Heterogeneity Practical Robust Implementation and Sustainability Model Primary Care Provider Quality of Care Race Radiation exposure Recommendation Recording of previous events Reporting Research Resources Smoker Smoking System Telemedicine Testing Time Tobacco Tobacco use Training Trust Uncertainty Underserved Population United States Preventative Services Task Force Woman X-Ray Computed Tomography black men cancer risk care delivery comparison intervention computed tomography screening cost disparity reduction distrust effective intervention effectiveness testing effectiveness/implementation hybrid ethnic diversity expectation experience feasibility testing follow-up high risk hybrid type 1 trial implementation evaluation improved interest low dose computed tomography lung cancer screening meetings mortality novel strategies patient engagement patient navigation primary care clinician primary care practice primary care setting primary outcome quitline racial diversity randomized trial screening screening guidelines screening services shared decision making smoking abstinence smoking cessation social stigma socioeconomics telehealth tobacco control treatment as usual trial design uptake

项目摘要

ABSTRACT Screening with low-dose CT (LDCT) scans reduces lung cancer mortality. However, the potential harms associated with screening include false-negative and false-positive results, incidental findings, overdiagnosis, radiation exposure, and complications from invasive diagnostic procedures and treatments. Given the complexity of lung cancer screening (LCS) decisions, the United States Preventive Services Task Force strongly recommends that patients receive counseling about smoking cessation and shared decision-making (SDM) with a health care provider before being referred for LDCT. The SDM discussion about LCS should address the benefits and harms of screening, the importance of adhering to annual lung cancer LDCT screening and recommended diagnostic testing and treatment, and tobacco avoidance. Yet, there is uncertainty about how to most effectively engage patients in SDM for LCS. Both patients and primary care clinicians perceive important barriers to LCS decision making and accessing health service. When screening discussions are conducted, they often fail to meet expectations for SDM. We propose to address these deficiencies by implementing a workflow aware telemedicine SDM intervention that includes decision coaching and patient navigation that is a potentially scalable and efficient approach to meeting national screening recommendations. The study’s long-term goal is to reduce disparities and the burden of lung cancer among heavy smokers by supporting high-quality decision making about LCS and smoking cessation and abstinence. Our short-term goal is to identify an effective intervention that can readily be implemented in real-world primary care settings to support high-quality SDM in racially and ethnically diverse populations. We will conduct an effectiveness-implementation hybrid type I trial guided by the Practical, Robust Implementation and Sustainability Model (PRISM). A cluster randomized trial design including 40 primary care practices, 100 providers and 400 patients will evaluate whether a telemedicine decision coaching and navigation intervention (TELESCOPE) compared to enhanced usual care (EUC) will improve the quality of decision making, increase adherence with screening and diagnostic testing, and generate more referrals for smoking cessation. The specific aims are to: 1) Test the effectiveness of a decision coaching intervention for LCS delivered by nurse navigators vs. EUC on the quality of patient decision making about LCS, subsequent screening and diagnostic testing, and smoking cessation referrals for current smokers; 2) Evaluate the implementation potential of navigator-led decision coaching for LCS; and 3) Determine the resources and costs required to implement the navigator-led decision coaching intervention for LCS. This highly impactful research has the potential to greatly advance the field of SDM implementation and improve quality of care by providing patients with high-quality decision support about LCS, testing feasible strategies for busy PCPs to support SDM for their high-risk patients, and demonstrating for policy makers and payors new models for effective delivery of SDM for LCS.

抽象的用低剂量CT（LDCT）扫描筛查可降低肺癌的死亡率。但是，潜在危害与筛查相关的包括假阴性和假阳性结果，偶然发现，过度诊断，辐射暴露以及侵入性诊断程序和治疗的并发症。考虑到复杂性肺癌筛查（LCS）的决定，美国预防服务工作组强烈建议患者接受有关戒烟和共享决策（SDM）的咨询在转介LDCT之前，医疗保健提供者。有关LCS的SDM讨论应解决筛查的益处和危害，遵守年度肺癌LDCT筛查的重要性建议进行诊断测试和治疗以及避免烟草。然而，关于如何的不确定性最有效地使患者参与SDM的LCS。患者和初级保健临床医生都认为重要 LCS决策和访问卫生服务的障碍。进行筛选讨论时，他们通常无法满足SDM的期望。我们建议通过实施工作流来解决这些缺陷意识到远程医疗SDM干预措施，包括决策教练和患者导航，这是一个潜在的可扩展有效的方法来满足国家筛查建议。该研究的长期目标是通过支持高质量的决定，减少烟民中肺癌的分布和肺癌的燃烧关于LCS，戒烟和禁欲。我们的短期目标是确定有效的可以在现实世界中很容易实施的干预措施，以支持高质量的SDM 种族和种族多样化的人群。我们将进行有效性实施混合I型试验在实践，强大的实施和可持续性模型（PRISM）的指导下。群集随机试验设计包括40种初级保健实践，100名提供者和400名患者将评估远程医疗是否是否与增强的常规护理（EUC）相比，决策教练和导航干预（望远镜）将提高决策质量，通过筛查和诊断测试提高依从性，然后产生戒烟的更多推荐。具体目的是：1）测试决策教练的有效性护士导航员与EUC提供的LCS干预有关LCS的患者决策质量，随后的筛查和诊断测试以及对当前吸烟者的戒烟转介； 2）评价 LCS领导的Navigator领导的决策教练的实施潜力； 3）确定资源和实施由Navigator主导的决策教练干预所需的成本。这很有影响力研究有可能大力推进SDM实施领域，并通过为患者提供有关LCS的高质量决策支持，测试繁忙PCP的可行策略为其高风险患者提供支持SDM，并为政策制定者和付款人展示新的模型有效地用于LCS的SDM。