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

项目摘要 该提案旨在通过开发和验证一种新的结肠直肠癌（CRC）筛查方法， 自动结直肠癌教育支持系统（Automated Colorectal Cancer Educational Support System，ACCESS）虽然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最致命的恶性肿瘤， 美国预防服务工作组（USPSTF）建议所有处于平均风险的美国人 对于CRC，从50岁开始进行筛查，但三分之一的美国人没有进行筛查。诱导患者 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 提高筛查率的有效战略。CRC筛查非常适合共同决策 方法，因为USPSTF认可7种不同的测试选项（例如，基于粪便、成像和内窥镜检查 测试），每一个都有不同的优点和缺点。在现有的少数CRC筛选决策工具中，大多数 由于对病人的喜好评估不准确， 在临床工作流程中。该提案将通过创建一个在线、高效、联合分析来解决这些差距， 一个名为ACCESS的基于决策的辅助工具，它生成一个个性化的报告， 测试属性（例如，准确性、侵入性等）患者的决策。该报告还将与 他们的临床医生通过电子健康记录，使他们能够有效地认识到他们的病人的优先事项时， 选择筛选测试。假设使用ACCESS，通过优化共享决策， 将导致选择与每个患者的独特值准确匹配的模态， 筛选摄取。为了验证这一假设，该提案将实现以下目标：（1）深入了解 患者的知识，态度，信念和决策的驱动因素，当选择不同的 通过联合分析筛选选项，这是一种定量技术，用于评估个人如何 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 与常规治疗相比，ACCESS是否能提高CRC筛查的接受率。为了成功完成项目，PI将 接受来自经验丰富的临床医生，卫生服务研究人员，实施和行为指导 科学家和数字健康专家。PI还将通过参加正式的课程来解决他的知识差距 在实施和行为科学，联合选择建模，定性分析，质量测量 以及试验设计。他还将在获奖期间参加R赠款写作研讨会。 获得这些能力与成功完成研究相结合，将使他能够努力 他的目标是成为一名独立的，NIH资助的数字健康科学家，专注于提高癌症 通过以用户为中心的开发和使用创新的，可扩展的， 基于证据的技术，支持患者和临床医生共同做出决定。

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.