Engaging PCPs to optimize active surveillance of low-risk prostate cancer

项目摘要 老年和医学上复杂的癌症患者人数呈指数级增长，呼吁 初级保健提供者（PCP）参与基于团队的模式，为癌症提供高质量的护理 患者的连续性。鉴于诊断的快速增长，特别需要基于团队的护理 低风险癌症（如前列腺癌、甲状腺癌和乳腺癌）。这些患者不仅年龄较大， 更多的合并症，但治疗策略越来越多地从手术和放射治疗转向积极治疗。 监视因为低风险前列腺癌指南现在建议积极监测， 作为初级疾病管理策略，它代表了研究如何更好地吸引PCP的理想案例。一 五氯苯酚的参与可以帮助解决的一个关键差距是改善对主动监测的坚持;尽管越来越多的 虽然有许多男子选择这一战略，但一旦选择，坚持积极监测仍然不是最佳选择。 因此，了解如何支持低风险前列腺癌患者以最大限度地坚持 积极监测，重要的是，如何有效地使PCP参与低风险癌症管理。 博士Radhakrishnan的长期职业目标是成为一名独立的临床调查员，专注于 优化PCP在整个癌症连续体中基于团队的护理提供中的作用。她专注于低- 风险癌症管理，因为及时和迫切需要满足越来越多的低， 癌症患者的风险。利用密歇根泌尿外科改进协作（音乐），这 项目旨在：1）描述提供者和患者对主动监测依从性的看法; 2）设计一个 以患者为中心的干预，使提供者能够支持男性进行积极的监测， 依从性; 3）对初级保健和泌尿科的关键结果进行干预的试点评估 实践这项工作的成功完成，以及随后的R 01研究，将改善低风险癌症 通过制定以患者为中心的干预措施，将其纳入初级保健提供系统，从而实现管理。 博士Radhakrishnan寻求建立在她的临床背景作为一个PCP和她的研究奖学金培训 获得更多的技能和经验，以实现她的长期职业目标。在她的指导团队中，她 已经制定了一个全面的职业发展计划，将支持她：1）完成培训 目标和发展在干预设计，评估和质量方法和专业知识的强大技能， 2）参与职业发展活动，使她能够过渡到独立， 临床调查员她将得到由敬业的导师和顾问组成的多学科团队的支持， 谁将监督广泛的课程和体验式学习，并致力于确保她 成功此外，密歇根大学为Radhakrishnan博士提供了理想的环境， 建议，其特殊的资源和优秀的指导团队，在开发方面取得了成功 初级临床科学家

PROJECT SUMMARY The population of older and medically complex cancer patients is growing exponentially, calling for the involvement of primary care providers (PCPs) in team-based models to deliver high-quality care to cancer patients across the continuum. Team-based care is especially needed in light of the rapid growth in diagnoses of low-risk cancers (such as prostate, thyroid, and breast). Not only are these patients typically older and with more comorbidities, but treatment strategies are increasingly moving away from surgery and radiation to active surveillance. Because guidelines for low-risk prostate cancer now recommend active surveillance as the primary disease management strategy, it represents the ideal case for studying how to better engage PCPs. A key gap where PCP involvement can help is in improving adherence to active surveillance; though a growing number of men are choosing this strategy, adherence to active surveillance once chosen remains suboptimal. Thus, it is critical to understand how to support men with low-risk prostate cancer to maximize adherence to active surveillance and importantly, how to effectively engage PCPs in low-risk cancer management. Dr. Radhakrishnan’s long-term career goal is to become an independent clinician-investigator focused on optimizing the role of PCPs in team-based care delivery across the cancer continuum. She is focusing on low- risk cancer management given the timely and critical need to meet the demands of the growing number of low- risk cancer patients. Leveraging the Michigan Urological Surgery Improvement Collaborative (MUSIC), this project aims to: 1) characterize provider and patient perspectives on active surveillance adherence; 2) design a patient-centered intervention that enables providers to support men on active surveillance to maximize adherence; and 3) perform a pilot evaluation of the intervention on key outcomes at primary care and urology practices. Successful completion of this work, and subsequent R01 studies, will improve low-risk cancer management by developing a patient-centered intervention integrated into primary care delivery systems. Dr. Radhakrishnan seeks to build upon her clinical background as a PCP and her research fellowship training to acquire additional skills and experiences to achieve her long-term career goal. With her mentoring team, she has developed a comprehensive career development plan that will support her to: 1) accomplish her training aims and develop a strong skillset in qualitative methods and expertise in intervention design, evaluation, and implementation; and 2) engage in career development activities to enable her to transition to independence as a clinician-investigator. She will be supported by a multidisciplinary team of dedicated mentors and advisors, who will oversee a broad range of coursework and experiential learning, and are committed to ensuring her success. Additionally, the University of Michigan offers Dr. Radhakrishnan the ideal environment for this proposal, with its exceptional resources and an outstanding mentoring team with proven success in developing junior clinician-scientists.