A Personalized Digital Outreach Intervention for Lung Cancer Screening

肺癌筛查的个性化数字外展干预措施

• 批准号: 10062917
• 负责人: David P Miller
• 金额: $ 56.72万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10062917
• 关键词: Address; Advisory Committees; Affect; American; Appointment; Awareness; Behavior; Benefits and Risks; Cancer Etiology; Catchment Area; Cessation of life; Chest; Clinic; Colorectal Cancer; Data; Data Analyses; Decision Aid; Decision Making; Disease; Dose; Education; Electronic Health Record; Electronic Mail; Eligibility Determination; Enrollment; Ensure; Exercise; Future; Goals; Guidelines; Health; Health Personnel; Health Technology; Health system; Individual; Intention; Internet; Intervention; Interview; Knowledge; Lung; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medicare; Methods; Modeling; Morbidity - disease rate; Online Systems; Outpatients; Participant; Patient Care; Patient risk; Patient-Centered Care; Patients; Preventive service; Primary Health Care; Procedures; Provider; Randomized; Randomized Controlled Trials; Risk; Risk Factors; Schedule; Screening Result; Screening for cancer; Structure; Surveys; System; Text Messaging; Time; United States; Visit; X-Ray Computed Tomography; care providers; chest computed tomography; demographics; design; digital; digital intervention; former smoker; high risk; implementation outcomes; innovation; lung basal segment; lung cancer screening; malignant breast neoplasm; mortality; outreach; outreach program; patient portal; patient screening; primary outcome; programs; recruit; routine screening; screening; secondary outcome; shared decision making; social; theories

Using annual chest CTs to screen for lung cancer, the leading cause of cancer death in the United States, can reduce mortality by up to 20%; however, fewer than 4% of eligible Americans are screened. The US Preventive Services Task Force endorses lung cancer screening (LCS) for high risk current and former smokers. At the same time, LCS poses significant risks, such as false positives and invasive procedures. Accordingly, guidelines recommend and Medicare requires that patients engage in a shared decision making visit prior to screening. Unfortunately, primary care providers rarely discuss, and consequently patients rarely receive, LCS. Patient, provider, and system barriers contribute to low LCS rates. Many patients are unaware that LCS exists, that it is effective, or that they qualify for screening. The risks and benefits of LCS vary substantially according to patients’ risk factors making general education about LCS difficult. Healthcare providers have poor understanding of the screening criteria and lack the time and personalized information needed for shared decision making discussions. Decision aids for LCS are a partial solution; they can increase patient awareness, deliver personalized information, and help patients make a screening decision. However, they fail to address many provider and system barriers. Our team has developed an innovative digital outreach strategy called mPATH-Lung (mobile Patient Technology for Health – Lung) based on Social Ecological Theory and the Integrative Model of Behavior. mPATH-Lung has multilevel functionality: it (a) queries the electronic health record to identify potential screening candidates, (b) sends those individuals electronic invitations to visit a web-based LCS decision aid that helps them make a screening decision concordant with their values, and (c) empowers patients to electronically request an LCS clinic appointment for the mandated shared decision making and subsequent screening. Electronic program summaries are sent to patients and providers, ensuring shared decision making visits occur with informed participants. This project will determine the impact of mPATH-Lung on patient decision making and receipt of LCS in a pragmatic randomized controlled trial using a mixed methods design. The Specific Aims of the proposal are to: 1) Determine the effect of mPATH-Lung on receipt of LCS in a pragmatic randomized-controlled trial of 1318 primary care patients in two large health networks with a catchment area extending to 5 states; 2) Elucidate the drivers of patients’ LCS decisions and screening behavior using a values clarification exercise and semi-structured interviews with at least 60 patients selected to represent the spectrum of decision-behavior concordance; and 3) Explore implementation outcomes that will impact the sustainability and dissemination of mPATH-Lung using program data, surveys, and interviews. This project could decrease lung cancer morbidity and mortality by broadening the use of LCS while simultaneously supporting patient-centered care. Importantly, our digital outreach design could have broad applicability to other health conditions, expanding the impact of this proposal beyond LCS.

每年使用胸部 CT 筛查肺癌（美国癌症死亡的主要原因），可以 死亡率降低高达 20%；然而，只有不到 4% 的符合条件的美国人接受了美国预防筛查。 服务工作组支持对当前和曾经吸烟的高危吸烟者进行肺癌筛查 (LCS)。 同时，LCS 带来重大风险，例如误报和侵入性操作。 指南建议和医疗保险要求患者在就诊之前进行共同决策访问 不幸的是，初级保健提供者很少讨论 LCS，因此患者也很少接受 LCS。 患者、提供者和系统障碍导致 LCS 率低，许多患者不知道 LCS 的存在。 LCS 是否有效，或者是否有资格进行筛查 LCS 的风险和益处因情况而异。 患者的危险因素导致 LCS 的普通教育很困难。 了解筛选标准，缺乏共享所需的时间和个性化信息 LCS 的决策辅助是部分解决方案，它们可以增加患者的耐心； 然而，他们失败了。 为了解决许多提供商和系统障碍，我们的团队制定了创新的数字推广策略。 基于社会生态理论和 mPATH-Lung 的综合行为模型具有多级功能：它 (a) 查询电子健康状况。 记录以确定潜在的筛选候选人，(b) 向这些人发送电子邀请，邀请他们参观 基于网络的 LCS 决策辅助，帮助他们做出符合其价值观的筛选决策，以及 (c) 使患者能够以电子方式请求 LCS 诊所预约，以做出强制的共同决定 制作和随后的筛查将发送给患者和提供者，以确保 该项目将由知情的参与者进行共同决策访问。 mPATH-Lung 在一项实用随机对照试验中对患者决策和 LCS 接受的影响 该提案的具体目标是： 1) 确定 mPATH-Lung 对 在一项对两家大型医疗机构的 1318 名初级保健患者进行的实用随机对照试验中接受 LCS 服务范围延伸至 5 个州的网络；2) 阐明患者 LCS 决策的驱动因素； 通过价值观澄清练习和对至少 60 名患者的半结构化访谈来筛查行为 选择代表决策行为一致性的范围；以及 3) 探索实施； 使用计划数据、调查、 该项目可以通过扩大 LCS 的使用来降低肺癌的发病率和死亡率。 同时支持以患者为中心的护理，重要的是，我们的数字化推广设计可以实现这一点。 广泛适用于其他健康状况，从而将该提案的影响扩展到 LCS 之外。