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

项目摘要/摘要 改善乳腺癌患者中心的沟通：共享决策参与系统的RCT (阴影) 乳腺癌的诊断触发了一连串的决定，因为患者考虑进行多种治疗 由不同的专家导航的模式。精确的评估治疗算法有更好的个体化 治疗建议，[还在筛选复杂的测试信息和治疗选项 可能经常对患者构成挑战，并经常引起焦虑]。因此，精准医学的进步 如果没有以患者为中心的沟通(PCC)的并行发展，就无法实现这一目标。这一快速发展的 决策环境推动了对更多以患者为中心的沟通的迫切需求，以解决 患者在进行乳腺癌治疗时面临的认知和情感问题的广度 决定。迫切需要一种工具，能够让患者在情感和认知上都参与进来，并成为 整合到乳房肿瘤护理临床工作流程中。这个项目是一个多层次的因素研究， 对25个乳腺外科肿瘤科的700名新诊断的乳腺癌患者进行了患者水平的随机对照试验 评估共享决策参与系统(Shades)以支持PCC的实践。系统会将一个 情感支持-研究小组先前开发的面向患者的iCanDecide的增强版本 带有临床医生仪表板临床级别试验的决策工具，以帮助临床医生解决剩余的认知和 他们的病人的情感需求。与联盟NCORP研究基地及其统计数据合作 和Data Core，试验将：1)评估iCanDecide的情感支持增强对以下方面的影响 一次和二次结果衡量患者对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的潜在中介， 4)对两个干预组件进行过程评估，以告知修订和未来 色调的广泛应用。[结果将为广泛实施 共享决策参与系统，以改善乳腺癌患者中心的沟通。]

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.]