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（由申请人提供）：McGrady 博士是一名儿科心理学家，其总体职业目标是通过以药物不依从性为目标来改善患有癌症的青少年和年轻人（AYA，15-24 岁）的健康结果。近一半的 AYA 患有癌症，并增加了治疗失败和死亡的风险。对于患有癌症的 AYA，没有任何干预措施可以提高依从性并预防这些破坏性后果。针对依从性对生存至关重要的人群，提出一种新颖的依从性促进干预措施。 候选人：McGrady 博士是辛辛那提儿童医院医疗中心行为医学和临床心理学 (BMCP) 部门的儿科助理教授。 McGrady 博士在辛辛那提大学和 CCHMC 完成了博士培训，在那里她为患有慢性疾病的 AYA 提供临床护理，这些患者在经历发育转变时难以坚持严格的药物治疗方案。 AYA 时期（即社会压力、自主权的增加）目睹这些 AYA 的健康状况因不依从而恶化，迫使 McGrady 博士将她的研究重点放在理解和提高依从性上，并完成了儿科依从性科学方面的 T32 奖学金。 2014 年，McGrady 博士被招募加入 CCHMC，担任 BMCP 和癌症与血液疾病研究所 (CBDI) 健康中心的研究员。麦格雷迪教授职位的设立是为了支持一项专注于改善患有癌症的 AYA 的生活质量和健康结果的研究项目。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来了解依从性并开发一种新颖的依从性促进干预措施。这项创新研究计划有可能降低 44-48% 不依​​从的癌症 AYA 所面临的复发和死亡风险，因此与 NCI 的呼吁直接一致。癌症控制“行为科学研究……降低癌症风险、发病率、发病率和死亡率。” 培训目标：成功地从事这一重要的研究领域，并实现成为一名独立资助的癌症控制研究人员的职业目标。 ，麦格雷迪博士必须填补她的内容和程序知识方面的空白。拟议的 K07 将为麦格雷迪博士提供填补这些空白的机会，并使她能够：1）获得行为经济学方法应用到依从性的专业知识；发展知识AYA 癌症的治疗和健康结果；3) 加强她在随机临床试验设计方面的培训：McGrady 博士的主要导师 Ahna Pai 博士是一位 NCI R01 资助的研究员，在癌症的依从性和 AYA 方面拥有专业知识。在 Pai 博士的指导下，McGrady 博士组建了一支由行为经济学、依从性、AYA 癌症、行为干预和伦理学领域国际公认的领导者组成的专家团队，他们补充了 Pai 博士的专业知识和环境：CCHMC 和辛辛那提大学 (UC) 拥有独特的条件，可以通过 UC 的临床和转化科学奖（由 McGrady 博士的顾问 Dr. McGrady 共同指导）来促进像 McGrady 博士这样的初级研究人员的职业发展。 Joel Tsevat）、BMCP（即心理学评论小组、数据核心）和 CBDI（即沉浸式学习、研讨会），McGrady 博士拥有当地的 .当当地无法提供最佳培训时，CBDI 将通过国际认可的课程来补充这些经验，因为 CBDI 是拟议研究的理想临床环境，因为其当前的优先事项包括调查。 “CBDI 还将利用她目前与 CBDI 教师（即联合导师 Fouladi 博士）的关系，为大量患者提供服务。” Perentesis 博士（顾问）；Nagarajan 博士（顾问）实施拟议的研究：动机是成年乳腺癌患者不依从的主要原因，但尚未在 AYA 中进行研究。现有的措施不能评估患有癌症的 AYA 的依从性相关动机，研究 1 包括行为经济学方法的创新应用来确定患者偏好，患者偏好的表现是进一步研究的理想目标。随行为而改变干预并考虑到可能由于治疗方案、诊断等的差异而导致的患者动机的广泛变化。研究 1 的结果将量化患者偏好和依从性之间的关系，并确定循证干预的目标在研究 2 中，将以患者为中心的定性方法将用于开发一种针对癌症 AYA 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，以检查该干预措施的有效性。的有效性有限现有针对患有癌症的 AYA 的依从性促进干预措施，这些努力有可能显着改善数万名因不依从性而苦苦挣扎的 AYA 的健康结果。