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：
10448983
负责人：
Richard Michael Hoffman
金额：
$ 73.64万
依托单位：
RBHS -CANCER INSTITUTE OF NEW JERSEY
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 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10448983
关键词：
Address Adherence Adult Advisory Committees Age Awareness Cancer Burden Cancer Etiology Caring Cessation of life Characteristics Clinical Cluster randomized trial Conflict (Psychology)Counseling Decision Aid Decision Making Diagnostic Procedure Diagnostic tests Eligibility Determination Goals Guidelines Health Personnel Health Services Accessibility Incidental Findings Individual Intervention Knowledge Longitudinal Studies Lung Malignant neoplasm of lung Medical Methods Minority Minority Women Modeling Nurses Pathway interactions Patient Care Patients Persons Policy Maker Population Heterogeneity Practical Robust Implementation and Sustainability Model Preventive service Primary Health Care Provider Quality of Care Radiation exposure Recording of previous events Reporting Research Resources Smoker Smoking System Telemedicine Testing Time Tobacco Tobacco use Training Trust Uncertainty Underserved Population United States X-Ray Computed Tomography base black men cancer risk care delivery comparison intervention computed tomography screening cost disparity reduction distrust effective intervention effectiveness implementation study effectiveness testing 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 primary care setting primary outcome quitline racial and ethnic 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.

抽象的低剂量 CT (LDCT) 扫描筛查可降低肺癌死亡率，但也存在潜在危害。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、鉴于其复杂性，辐射暴露以及侵入性诊断程序和治疗的并发症。美国预防服务工作组强烈反对肺癌筛查 (LCS) 决定建议患者接受有关戒烟和共同决策 (SDM) 的咨询转介进行 LDCT 之前的医疗保健提供者有关 LCS 的 SDM 讨论应解决以下问题：筛查的好处和危害、坚持每年进行肺癌 LDCT 筛查的重要性以及建议的诊断测试和治疗以及避免吸烟然而，如何做到这一点还存在不确定性。最有效地让患者参与 LCS 的 SDM 患者和初级保健都认为很重要。 LCS 决策和获取医疗服务的障碍在进行筛查讨论时，它们会受到影响。通常无法满足 SDM 的期望，我们建议通过实施工作流程来解决这些缺陷。有意识的远程医疗 SDM 干预，包括决策辅导和患者导航，这可能是一种潜在的该研究的长期目标是采用可扩展且有效的方法来满足国家筛查建议。通过支持高质量的决策来减少重度吸烟者之间的差异和肺癌负担我们的短期目标是找到一种有效的 LCS 和戒烟和戒烟方法。可以在现实世界的初级保健环境中轻松实施的干预措施，以支持高质量的 SDM 我们将针对不同种族和民族的人群进行一项有效性-实施混合型试验。以实用、稳健的实施和可持续性模型 (PRISM) 为指导的整群随机试验。设计包括 40 个初级保健机构、100 名提供者和 400 名患者，将评估远程医疗是否可行与强化常规护理 (EUC) 相比，决策指导和导航干预 (TELESCOPE) 将提高决策质量，提高筛查和诊断测试的依从性，并产生更多戒烟转诊的具体目的是： 1) 测试决策辅导的有效性。护士导航员对 LCS 进行的干预与 EUC 对患者 LCS 决策质量的影响，随后的筛查和诊断测试，以及针对当前吸烟者的戒烟转介；2) 评价濒海战斗舰领航员主导的决策指导的实施潜力；以及 3) 确定资源和为濒海战斗舰实施导航员主导的决策指导干预所需的成本，这非常有影响力。研究有可能极大地推进 SDM 实施领域并通过以下方式提高护理质量：为患者提供有关 LCS 的高质量决策支持，测试忙碌的 PCP 的可行策略支持高风险患者的 SDM，并向政策制定者和付款人展示新的治疗模式为 LCS 有效提供 SDM。