Improving cancer screening in older adults with limited life expectancy

项目摘要 背景：癌症筛查可以降低癌症相关的死亡率和发病率，但可能与 对老年人造成重大伤害和负担。在病人接受筛查之前，通常有10年的滞后时间 乳腺癌、结肠直肠癌或前列腺癌的患者实际上是受益的。另一方面，筛查的多重危害 可以在短期内发生。预期寿命有限的老年人继续接受癌症筛查， 高比率，即使它使他们暴露于筛查的危害，几乎没有机会受益。医生是一个 过度筛查的主要驱动因素，但为什么他们经常继续建议老年人进行癌症筛查， 有限的预期寿命是未知的。该提案旨在通过以下措施改善老年人的癌症筛查：1） 确定促进或阻碍临床医生建议停止老年人常规筛查的因素 预期寿命有限的成年人，2）更好地支持临床医生适当地将生命 在他们的筛选建议的期望。 研究建议：目标1将使用定性方法来了解促进或 阻碍临床医生建议寿命有限的老年人停止筛查。目标2将 在全国医生调查中测试这些因素，以确定和量化它们对医生健康的影响。 对预期寿命有限的老年人的筛查建议。Aim 3将开发并试点测试一种 新的多模式干预，以针对那些大大有助于过度筛选的因素。的 干预措施将根据临床医生和老年人的意见制定， 这些策略可能包括决策支持、沟通指导和临床医生反馈。 职业发展计划：候选人是一名老年病学家，已经证明了国家和 学院在研究方面具有领导地位，并在学术研究方面有着良好的记录， 影响出版物和早期研究者赠款。她的长期职业目标是成为一名专注于 纳入预期寿命，为老年人提供以患者为中心的个性化预防性护理决策 成年人了她已经制定了一个全面、可行的职业发展计划， 独立调查员和研究领导者她建议学习决策支持方面的新技能， 临床试验设计和实施科学，以及领导技能的持续发展。她 已经组建了一个具有学科领域和相关研究专业知识的模范指导团队 方法和作品在丰富的研究环境与巨大的资源，以支持她的发展。 该提案解决了一个重要的研究空白，并产生了一种新的干预措施， 对改善老年人的癌症筛查有重大影响。该提案的结果将支持一项 随后的大规模临床试验来测试干预措施。这一建议也将进一步促进职业生涯 将候选人发展成为专注于老年人个性化预防护理的研究领导者。

PROJECT SUMMARY Background: Cancer screening can lower cancer-related mortality and morbidity but may be associated with significant harms and burdens in older adults. There is often a lag-time of 10 years before patients screened for breast, colorectal, or prostate cancers actually benefit. On the other hand, multiple harms from screening can occur in the short-term. Older adults with limited life expectancy continue to receive cancer screening at high rates even though it exposes them to the harms of screening with little chance of benefit. Clinicians are a major driver of over-screening but why they often continue to recommend cancer screening in older adults with limited life expectancy is unknown. This proposal aims to improve the cancer screening of older adults by 1) identifying the factors that facilitate or hinder clinician recommendations to stop routine screening in older adults with limited life expectancy, and 2) better supporting clinicians to appropriately incorporate life expectancy in their screening recommendations. Research proposal: Aim 1 will use qualitative methods to understand the range of factors that facilitate or hinder clinicians from recommending screening cessation in older adults with limited life expectancy. Aim 2 will test these factors in a national physician survey to determine and quantify their effects on physicians' screening recommendations in older adults with limited life expectancy. Aim 3 will then develop and pilot test a novel multi-modal intervention to target the factors that significantly contribute to over-screening. The intervention will be developed with input from clinicians and older adults and will use multiple, overlapping strategies that may include decision support, communication coaching, and clinician feedback. Career development plan: The candidate is a geriatrician who has already demonstrated national and institutional leadership in research and a strong track record of academic scholarship with numerous high impact publications and early investigator grants. Her long-term career goal is to be a research leader focused on incorporating life expectancy to inform patient-centered, individualized preventive care decisions for older adults. She has laid out a comprehensive, feasible career development plan that will enable her to transition into an independent investigator and research leader. She proposes to learn new skills in decision support, clinical trial design, and implementation science, in addition to continued development of leadership skills. She has assembled an exemplary mentoring team with expertise in the subject area and the relevant research methods and works in a rich research environment with tremendous resources to support her development. Summary: The proposal addresses an important research gap and produces a novel intervention that may have major impact to improve the cancer screening of older adults. The results from this proposal will support a subsequent large-scale clinical trial to test the intervention. This proposal will also further foster the career development of the candidate into a research leader focused on individualized preventive care in older adults.