Patient Preferences and Adherence in Adolescents and Young Adults with Cancer

患有癌症的青少年和年轻人的患者偏好和依从性

• 批准号: 9011142
• 负责人: Meghan Eileen McGrady
• 金额: $ 14.49万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9011142
• 关键词: 15 year old; Academic Medical Centers; Accounting; Acute; Adherence; Adolescent and Young Adult; Adult; Age; Asthma; Award; Behavior Therapy; Behavioral Medicine; Behavioral Sciences; Biological; Breast; Cancer Control; Cancer Control Research; Cardiovascular Diseases; Caring; Cessation of life; Child; Childhood; Chronic; Clinical; Clinical Psychology; Clinical Sciences; Clinical Trials Design; Complement; Data; Decision Making; Development; Diabetes Mellitus; Diagnosis; Disease; Doctor of Philosophy; Effectiveness; Effectiveness of Interventions; Environment; Ethics; Evidence based intervention; Factor-42; Faculty; Feedback; Fellowship; Focus Groups; Funding; Goals; Health; Healthcare; Hematological Disease; Incidence; Individual; Institutes; Intervention; Investigation; Knowledge; Learning; Malignant Neoplasms; Measures; Medical; Medical center; Mentors; Mentorship; Methodology; Methods; Modification; Morbidity - disease rate; Motivation; National Cancer Institute; Neurologic; Observational Study; Outcome; Patient Preferences; Patients; Pediatric Hospitals; Pediatric Oncology Group; Pediatrics; Pharmaceutical Preparations; Population; Positioning Attribute; Problem Solving; Process; Psychologist; Psychology; Qualitative Methods; Quality of life; Randomized Clinical Trials; Recruitment Activity; Regimen; Relapse; Research; Research Personnel; Resources; Rewards; Risk; Role; Science; Series; Survival Rate; Time; Training; Translational Research; Treatment Failure; Treatment Protocols; Universities; Wellness Center; base; behavioral economics; cancer clinical trial; cancer risk; cancer therapy; career; career development; clinical care; compliance behavior; design; experience; family support; health care service utilization; improved; innovation; interest; malignant breast neoplasm; medication compliance; meetings; mortality; neglect; novel; novel therapeutics; patient oriented; patient population; preference; pressure; prevent; professor; programs; public health relevance; relapse risk; research study; response; skills; social; therapy development

 DESCRIPTION (provided by applicant): Dr. McGrady is a pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents and young adults (AYAs, ages 15-24 years) with cancer by targeting adherence. Medication non- adherence is demonstrated by nearly half of all AYAs with cancer and increases the risk of treatment failure and mortality. There are no interventions for AYAs with cancer that improve adherence and prevent these devastating consequences. Dr. McGrady's program of research has the potential to result in a novel adherence-promotion intervention for a population in which adherence is critical for survival. Candidate: Dr. McGrady is an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). Dr. McGrady completed her doctoral training at the University of Cincinnati and CCHMC where she provided clinical care to AYAs with chronic medical conditions who struggled to adhere to demanding medication regimens while undergoing the developmental transitions (i.e., social pressures, increasing autonomy) of the AYA period. Witnessing the health of these AYAs deteriorate as a result of non-adherence compelled Dr. McGrady to focus her research on understanding and improving adherence and complete a T32 fellowship in pediatric adherence science at CCHMC. In 2014, Dr. McGrady was recruited to join CCHMC as a researcher in BMCP and the Wellness Center of the Cancer and Blood Diseases Institute (CBDI). Dr. McGrady's faculty position was created to support a research program focused on improving quality of life and health outcomes of AYAs with cancer. In this position, Dr. McGrady is applying her unique interest in behavioral economics to understand adherence and develop a novel adherence-promotion intervention for AYAs with cancer. This innovative research program has the potential to reduce the increased risk of relapse and mortality faced by the 44-48% of AYAs with cancer who are non-adherent and thus directly aligns with NCI's call for cancer control "research in the behavioral sciences that...reduces cancer risk, incidence, morbidity, and mortality." Training Objectives: To successfully pursue this important line of research and meet her career goal of becoming an independently-funded cancer control researcher, Dr. McGrady must fill gaps in her content and procedural knowledge. The proposed K07 will provide Dr. McGrady with the opportunity to fill these gaps and enable her to: 1) gain expertise in the application of behavioral economics methods to adherence; 2) develop knowledge of the treatment and health outcomes of AYA cancers; and 3) enhance her training in randomized clinical trial design. Mentors: Dr. McGrady's primary mentor, Ahna Pai, PhD, is an NCI R01-funded researcher with expertise in adherence and AYAs with cancer. Under Dr. Pai's mentorship, Dr. McGrady has assembled an expert team of internationally recognized leaders in behavioral economics, adherence, AYA cancer, behavioral interventions, and ethics who complement Dr. Pai's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers like Dr. McGrady. Through UC's Clinical and Translational Science Award (co-directed by Dr. McGrady's consultant, Dr. Joel Tsevat), BMCP (i.e., Psychology Review Group, Data Core), and the CBDI (i.e., immersive learning, seminars), Dr. McGrady has the local resources to achieve her training objectives and complete the proposed research. When optimal training is not available locally, Dr. McGrady will supplement these experiences with internationally-recognized courses. The CBDI is the ideal clinical setting for the proposed research as its current priorities include investigating "innovatve approaches to care for adolescents and young adults." The CBDI also provides access to a large patient population. Dr. McGrady will capitalize on her current relationships with CBDI faculty (i.e., Dr. Fouladi, Co-Mentor; Dr. Perentesis, Consultant; Dr. Nagarajan, Consultant) to implement the proposed research. Research: Motivation is the primary driver of non-adherence among adults with breast cancer but has not been examined among AYAs. A primary reason for this gap may be that available measures do not assess adherence-related motivation among AYAs with cancer. Study 1 includes an innovative application of behavioral economic methods to identify patient preferences, a manifestation of adherence-related motivation. Patient preferences are an ideal target for further investigation as they can be modified with behavioral intervention and account for the wide range of patient-level variability in motivation that may be due to differences in treatment regimens, diagnoses, etc. Results of Study 1 will quantify the relationship between patient preferences and adherence and determine targets for an evidence-based intervention. In Study 2, patient-centered qualitative methods will be used to develop a novel adherence-promotion intervention for AYAs with cancer. In Year 4, Dr. McGrady will submit an R-series proposal to NCI to examine the effectiveness of this intervention. Given the limited effectiveness of available adherence-promotion interventions for AYAs with cancer, these efforts have the potential to significantly improve health outcomes for the tens of thousands of AYAs who struggle with non-adherence.

 描述（由适用提供）：McGrady博士是一位儿科心理学家，其总体职业目标是通过针对依从性来改善青少年和年轻人（AYAS，15-24岁的AYA，15-24岁）的健康成果。几乎所有AYA患有癌症的AYA中的一半都证明了药物不遵守，并增加了治疗衰竭和死亡率的风险。 AYA的癌症没有干预措施可以改善依从性并防止这些毁灭性后果。 McGrady博士的研究计划有可能为人群进行新的依从性促进干预措施，其中依从性对于生存至关重要。候选人：McGrady博士是辛辛那提儿童医院医疗中心（CCHMC）的行为医学与临床心理学（BMCP）的儿科助理教授。 McGrady博士在辛辛那提大学和CCHMC大学完成了博士培训，在那里她为AYA提供了临床护理，他们的慢性医疗状况为AYA努力遵守苛刻的药物治疗方案，同时经历了AYA时期的发展过渡（即社会压力，增加了自治）。由于不遵守的结果，目睹了这些AYA的健康，迫使麦格雷迪博士将研究重点放在CCHMC的儿科依从性科学领域的T32奖学金上。 2014年，McGrady博士被招募加入CCHMC，担任BMCP的研究员和癌症和血液疾病研究所（CBDI）的健康中心。 McGrady博士的教师职位旨在支持一项研究计划，旨在改善AYAS癌症的生活质量和健康成果。在这个职位上，麦格雷迪博士正在运用她对行为经济学的独特兴趣，以了解依从性并为AYAS患有癌症的依从性促进干预。这项创新的研究计划有可能减少44-48％的AYA患有癌症的救济风险和死亡的风险增加，这些AYA具有非依从性，因此直接与NCI呼吁进行癌症控制的呼吁“在行为科学中的研究……降低癌症，事件，发病率和死亡率”。培训目标：为了成功地追求这一重要的研究线，并实现了她成为独立资助的癌症控制研究员的职业目标，McGrady博士必须填补其内容和程序知识的空白。拟议的K07将为McGrady博士提供填补这些空白的机会，并使她能够：1）在应用行为经济学方法的应用方面获得专业知识； 2）发展AYA癌症治疗和健康结果的知识； 3）增强她在随机临床试验设计中的培训。导师：McGrady博士的主要导师Ahna Pai博士是NCI R01资助的研究人员，在依从性方面具有专业知识，而AYAS患有癌症。在PAI博士的心态下，麦格雷迪博士召集了一支由行为经济学，依从性，AYA癌症，行为干预措施以及填写Pai博士专业知识的国际认可领导者的专家团队，并将提供宝贵的心态。环境：CCHMC和辛辛那提大学（UC）独特地等同于支持McGrady博士等初级研究人员的职业发展。通过UC的临床和转化科学奖（由McGrady博士的顾问Joel Tsevat博士共同导演），BMCP（即心理学审查小组，数据核心）和CBDI（即身临其境的学习，半数，半人物），McGrady拥有本地资源来实现她的培训目标，并完成了拟议的研究。如果在当地没有最佳培训时，McGrady博士将通过国际认可的课程来补充这些经验。 CBDI是拟议研究的理想临床环境，因为其当前的优先级包括研究“为青少年和年轻人照顾的创新方法”。 CBDI还提供了对大型患者人群的访问权限。 McGrady博士将利用她与CBDI教职员工的当前关系（即，Co-Incermor; Fouladi博士；顾问Perentesis；顾问Nagarajan博士）实施了拟议的研究。研究：动机是乳腺癌成年人不遵守的主要驱动力，但尚未在AYA中进行检查。造成此差距的主要原因可能是可用的措施不能评估AYA与癌症的依从性动机。研究1包括行为经济方法的创新应用，以识别患者偏好，这是与依从性相关动机的表现。患者的偏好是进一步研究的理想目标，因为可以通过行为干预进行修改，并说明了患者级别的动机差异范围，这可能是由于治疗方案，诊断等方面的差异。研究结果1将量化患者偏好与依从性之间的关系并确定基于证据的干预目标。在研究2中，以患者为中心的定性方法将用于开发针对AYA患有癌症的新型依从性促进干预措施。在第4年，McGrady博士将向NCI提交R系列提案，以研究此干预的有效性。鉴于对AYA患有癌症的可用依从性促进干预措施的有效性有限，因此这些努力有可能显着改善成千上万因不遵守的AYA的健康状况。