Improving Patient-Centered Communication in Breast Cancer: A RCT of a Shared Decision Engagement System (ShaDES)

项目概要/摘要 改善乳腺癌患者以患者为中心的沟通：共享决策参与系统的随机对照试验 （沙德） 当患者考虑多种治疗时，乳腺癌的诊断引发了一系列决策 由不同专家指导的模式。精准的评估治疗算法，更好的个体化 治疗建议，[但要筛选测试信息和治疗方案的复杂性 通常对患者来说是具有挑战性的，并且常常会引起焦虑]。由此可见，精准医疗的进步 如果没有以患者为中心的沟通（PCC）的并行进步，这一目标就无法实现。这种快速发展的 决策背景迫切需要更多以患者为中心的沟通，以解决全面的问题 患者在进行乳腺癌治疗时面临的一系列认知和情感问题 决定。迫切需要能够在情感和认知上吸引患者的工具，并使其能够参与其中。 融入乳腺肿瘤护理临床工作流程。该项目是一项多层次的析因研究 跨越 25 个乳腺外科肿瘤学领域内 700 名新诊断乳腺癌患者的患者级随机对照试验 评估支持 PCC 的共享决策参与系统 (ShaDES) 的实践。该系统链接一个 该研究小组之前开发的面向患者的 iCanDecide 的情感支持增强版 决策工具与临床医生仪表板的临床水平试验，以帮助临床医生解决剩余的认知和 患者的情感需求。与联盟NCORP研究基地及其统计合作 和 Data Core，该试验将： 1) 评估情感支持增强对 iCanDecide 的影响 主要和次要结果衡量患者对 PCC 的评价，2) 评估临床医生的影响 PCC 患者评估仪表板，3) 检查患者和临床干预措施的潜在调节因素， 4) 对两个干预组成部分进行过程评估，为修订和未来提供信息 ShaDES 的广泛实施。 [结果将为广泛实施 共享决策参与系统，以改善乳腺癌中以患者为中心的沟通。]

Project Summary/Abstract Improving Patient-Centered Communication in Breast Cancer: A RCT of a Shared Decision Engagement System (ShaDES) The diagnosis of breast cancer triggers a cascade of decisions as patients consider multiple treatment modalities navigated by different specialists. Precise evaluative treatment algorithms have better individualized treatment recommendations, [yet sifting through the complexity of the test information and treatment options can be often challenging to patients and can often cause anxiety]. Thus, the advances of precision medicine cannot be realized without parallel advances in patient-centered communication (PCC). This rapidly evolving decision context has fueled a pressing need for more patient-centered communication to address the full breadth of issues—both cognitive and emotional—faced by patients in making breast cancer treatment decisions. There is a critical need for tools that can engage the patient both emotionally and cognitively and be integrated into the breast oncology care clinical workflow. This project is a multi-level, factorial study that crosses a patient-level RCT of 700 newly-diagnosed breast cancer patients within 25 breast surgical oncology practices to evaluate a shared decision engagement system (ShaDES) to support PCC. The system links an emotional support-enhanced version of the research group’s previously developed iCanDecide patient-facing decision tool with a clinic level trial of a Clinician Dashboard to help clinicians address remaining cognitive and emotional needs in their patients. In collaboration with the Alliance NCORP Research Base and its Statistics and Data Core, the trial will: 1) evaluate the impact of the emotional support enhancements to iCanDecide on primary and secondary outcomes measuring patient appraisal of PCC, 2) evaluate the impact of the Clinician Dashboard on patient appraisal of PCC, 3) examine potential mediators of the patient and clinic interventions, and 4) conduct a process evaluation of the two intervention components to inform revision and future widespread implementation of ShaDES. [The results will lay the groundwork for broad implementation of a shared decision engagement system to improve patient-centered communication in breast cancer.]