Patient-Centered Decision-Making for Management of Small Renal Tumors - Supplement

项目摘要 目前小肾脏肿瘤（≤ 4 cm）的治疗模式导致总生存期恶化 尽管早期发现和积极的手术切除治疗。这种缺乏改善的结果可能 这可能是由于大多数肾脏肿瘤的无痛性和手术对老年人的伤害。 虽然这些小肾脏肿块大多数是恶性的，但少数肿瘤转移， 大约20%切除的肿瘤是良性的。由于目前的指南建议合并症应 在选择治疗时应权衡，慢性肾脏病患者尤其有 由于手术后生存率下降，决策必须包括平衡的讨论，以减少过度治疗。 作为一名腹部放射科医生和健康结果研究员，我获得了医学博士和医学硕士学位。 科学学位集中在比较有效性研究方法。人口部 纽约大学医学中心的健康和放射学提供指导和资源， 作为一名独立研究者，我成功地在肾脏肿瘤管理方面进行了卫生服务研究。一 医疗决策、决策辅助、放射学、肿瘤学和泌尿学专家团队已经并将 继续指导我的项目和职业发展。在拟议的支持期间，我将完成 测量患者决策偏好的课程和定性分析的教程， 为这个项目和我的职业发展服务我还将完成赠款写作的培训活动， 临床试验设计的目标是直接将拟议的工作转化为R 01应用程序， 所提出的决策辅助对小肾肿瘤患者的有效性。 在目前的提案中，我将为小型肾脏肿瘤建立一个新的基于网络的患者决策工具， 采用比小册子更有效和完整的教育技术和决策支持功能 格式.我们将在基于Web的工具中嵌入我们发布的决策分析模型， 根据患者合并症（如慢性肾病）和肿瘤评估治疗方案 影响每个选项的好处和危害的功能。代表性的管理战略包括 最常见的治疗是肾部分切除术，以及微创经皮消融，监测 成像和活检。这种互动工具将有助于了解早期肾脏肿瘤， 个性化的危害/受益，并引出患者对治疗属性的偏好。循证风险 通信技术和专家委员会的审查将确保它是为共同决定而设计的， 根据国际患者决策辅助标准。然后，我们将完成一项试点研究， 可用性的初步数据、患者知识的改善和共享决策。最终这 及时的工具可能有助于实现以患者为中心的决策，以管理小肾脏肿瘤。

Project Summary The current treatment paradigm for small kidney tumors (≤ 4 cm) has resulted in worsened overall survival despite earlier detection and aggressive treatment with surgical resection. This lack of improved outcomes may be due to the indolence of most kidney tumors and harms of surgery in this generally older population. Although the majority of these small kidney masses are malignant, a small minority of tumors metastasize and approximately 20% resected tumors are benign. Since current guidelines recommend that comorbidities should be weighed when selecting treatment, and that patients with chronic kidney disease are particularly at risk of worsened survival after surgery, decision-making must include balanced discussions to reduce over-treatment. As an abdominal radiologist and health outcomes researcher, I have obtained my MD and a Master of Science degree concentrated in comparative effectiveness research methods. The Departments of Population Health and Radiology within New York University Medical Center offer the mentoring and resources to position me for successful health services research in kidney tumor management as an independent investigator. A team of experts in medical decision-making, decision aids, radiology, oncology and urology have and will continue to guide my project and career development. During the proposed period of support, I will complete coursework in measurement of patient preferences for decision making and tutorials in qualitative analysis, serving both this project and my career development. I will also complete training activities for grant writing and clinical trials design toward the goal of directly translating the proposed work to an R01 application that tests the effectiveness of the proposed decision aid for patients with small kidney tumors. In the current proposal, I will build a new web-based patient decision tool for small kidney tumors that employs more effective and complete educational techniques and decision support features than a pamphlet format. We will embed our published decision-analytic model within the web-based tool, and enable assessment of treatment options according to patient comorbidities (e.g. chronic kidney disease) and tumor features that affect the benefits and harms of each option. Represented management strategies include the most common treatment of partial nephrectomy, as well as less invasive percutaneous ablation, surveillance imaging, and biopsy. This interactive tool will aid understanding of early stage kidney tumors, communicate personalized harms/benefits, and elicit patient preferences for treatment attributes. Evidence-based risk communication techniques and expert committee review will ensure it is designed for shared decisions, pursuant to the International Patient Decision Aids Standards. We will then complete a pilot study for preliminary data on usability, improvement in patient knowledge, and shared decision making. Ultimately, this timely tool may help actualize patient-centered decision-making for management of small kidney tumors.