Automated Colorectal Cancer Educational Support System (ACCESS): Development and Validation of a Novel Online Decision Aid for Improving Colorectal Cancer Screening Uptake

项目总结 这项建议旨在通过开发和验证一种新的方法来提高结直肠癌(CRC)的筛查接受率 在线决策辅助工具名为自动结直肠癌教育支持系统(Access)。而CRC 虽然它是可以预防的，但它仍然是一个主要的公共卫生问题，因为它是第三大最流行和致命的恶性肿瘤 在美国，美国预防服务工作组(USPSTF)建议，所有处于中等风险的美国人 由于结直肠癌从50岁开始接受筛查，但三分之一的美国人没有进行筛查。诱人的病人 通过决策辅助参与共享决策的偏好已被提议作为一种潜在的 提高筛查率的有效策略。CRC筛查非常适合共同决策 方法，因为USPSTF认可7种不同的检测选项(例如，基于粪便、成像和内窥镜的检测 测试)，每个测试都有明显的优势和劣势。在现有的少数CRC筛查决策工具中，大多数 是无效的，因为他们被不准确的患者偏好评估和无效的整合所困扰 在临床工作流程中。该提案将通过创建在线、高效、联合分析来解决这些差距- 基于称为Access的决策辅助工具，可生成个性化报告，对每个报告的重要性进行排序 测试属性(例如，准确性、侵入性等)在病人的决策过程中。该报告还将与 他们的临床医生通过电子健康记录，以便他们可以在以下情况下有效地识别患者的优先事项 选择筛查测试。假设是，通过优化共享决策，使用访问权限， 将导致选择与每个患者的独特价值精确匹配的医疗方式，并因此增加 筛查摄取。为了检验这一假设，该提议将实现以下目标：(1)深入了解 在不同的选择中，患者的知识、态度、信念和决策驱动因素 通过联合分析筛选选项，这是一种评估个人如何 权衡；(2)与患者、临床医生、实施和 行为科学专家和计算机科学家；(3)进行试点随机对照试验，以确定 如果与通常的护理相比，获得更多的CRC筛查摄取率。为了成功完成项目，PI将 接受经验丰富的临床医生、卫生服务研究人员、实施和行为方面的指导 科学家和数字健康专家。PI还将通过参加正式课程来解决他的知识差距 在实施和行为科学中，联合选择建模、定性分析、质量测量 和改进，以及试验设计。他还将参加颁奖期间的R赠款写作研讨会。 获得这些能力，再加上成功完成学习，将使他能够努力实现 他的目标是成为一名独立的、由NIH资助的数字健康科学家，专注于增强癌症 通过以用户为中心开发和使用创新、可扩展、 基于证据的技术，支持患者和临床医生做出共同的决定。

PROJECT SUMMARY This proposal aims to improve colorectal cancer (CRC) screening uptake by developing and validating a novel online decision aid called the Automated Colorectal Cancer Educational Support System (ACCESS). While CRC is preventable, it still remains a major public health issue, as it is the third most prevalent and deadly malignancy in the U.S. The U.S. Preventive Services Task Force (USPSTF) recommends that all Americans at average risk for CRC undergo screening starting at age 50, yet one-third of Americans are unscreened. Eliciting patient preferences by engaging in shared decision making via decision aids has been proposed as a potentially effective strategy to improve screening rates. CRC screening is ideally suited for a shared decision making approach, as the USPSTF endorses 7 different testing options (e.g., stool-, imaging-, and endoscopy-based tests), each with distinct advantages and disadvantages. Of the few existing CRC screening decision tools, most were ineffective as they were beset by imprecise assessment of patients’ preferences and ineffective integration in clinical workflows. This proposal will address these gaps by creating an online, efficient, conjoint analysis- based decision aid called ACCESS that generates a personalized report that rank orders the importance of each test attribute (e.g., accuracy, invasiveness, etc.) in patients’ decision making. The report will also be shared with their clinicians via the electronic health record so that they can efficiently recognize their patients’ priorities when selecting a screening test. The hypothesis is that use of ACCESS, through optimizing shared decision making, will lead to selection of a modality that accurately matches each patient’s unique values, and as a result, increase screening uptake. To test this hypothesis, the proposal will achieve the following aims: (1) Gain insights into patients’ knowledge, attitudes, beliefs, and drivers of decision making when selecting among the different screening options through conjoint analysis, a quantitative technique that assesses how individuals make tradeoffs; (2) Build the ACCESS decision aid in partnership with patients, clinicians, implementation and behavioral science experts, and computer scientists; (3) Conduct a pilot randomized controlled trial to determine if ACCESS improves CRC screening uptake vs. usual care. To successfully complete the project, the PI will receive mentorship from experienced clinicians, health services researchers, implementation and behavioral scientists, and digital health experts. The PI will also address his knowledge gaps by taking formal coursework in implementation and behavioral sciences, conjoint choice modeling, qualitative analysis, quality measurement and improvement, and trial design. He will also participate in R grant writing workshops over the award period. Obtaining these competencies combined with successful completion of the study will allow him to work towards his goal of becoming an independent, NIH-funded digital health scientist focused on enhancing cancer prevention and health promotion through the user-centered development and use of innovative, scalable, evidence-based technologies that support patients and clinicians in making shared decisions.