Using Community-Engaged Methods to Design a Tool to Promote Informed Breast Cancer Screening Decisions for Low Literacy Women

使用社区参与的方法设计一个工具，以促进低识字率妇女做出知情的乳腺癌筛查决策

• 批准号: 10447785
• 负责人: Christine Marie Gunn
• 金额: $ 12.72万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447785
• 关键词: Address; Adult; Affect; Age; American; Anxiety; Benefits and Risks; Breast Cancer Detection; Breast Cancer Patient; Breast Cancer Risk Factor; Caring; Communication; Communities; Complex; Conflict (Psychology); Consensus; Data; Decision Aid; Decision Making; Diagnosis; Fostering; Goals; Guidelines; Harm Reduction; Healthcare; Healthcare Systems; High Risk Woman; Individual; Information Literacy; Interview; Knowledge; Lead; Low Literacy Population; Malignant Neoplasms; Mammographic screening; Mammography; Mediating; Mentors; Methods; Multimedia; Outcome; Outcome Assessment; Patient Preferences; Patient-Focused Outcomes; Patients; Perception; Physicians; Population; Pre-Post Tests; Preventive service; Probability; Public Health; Quality of life; Research; Research Design; Research Methodology; Risk; Screening for cancer; Societies; Suggestion; Surveys; Testing; Training; Uncertainty; Woman; Work; aged; black women; cancer health disparity; care providers; career; cognitive interview; community engaged research; design; evidence base; experience; health literacy; improved; informant; investigator training; literacy; malignant breast neoplasm; mortality; mortality disparity; novel; patient oriented; precision medicine; preference; primary outcome; programs; screening; screening disparities; screening guidelines; screening services; shared decision making; skills; tool; translational potential; young woman

PROJECT SUMMARY Low health literacy (LHL) is increasingly recognized as an important driver of cancer disparities, and given that one in five Americans lack the necessary literacy skills to function adequately in our health care system, this is a burgeoning public health crisis. Adults with LHL are less likely to use preventive services, less likely to undergo cancer screening, and have higher mortality. Mammography screening decisions, which increasingly call for shared-decision making between patient and physician, is an exemplar of where communication challenges are most likely to affect outcomes for LHL populations. Informed decisions for breast cancer screening that account for individual risk of developing breast cancer and patient preferences are recommended by professional guidelines for women aged 40-54 for whom the harms of screening can exceed the benefits. While mammography screening is estimated to reduce breast cancer mortality by 15% for women in their 40s, screening in younger women has high rates of false positives (40-60% over ten years) and substantial estimates of over-diagnosis (15-48% of those screened). Data consistently show that communication about mammography screening inadequately prepares women for these outcomes and there are widespread misperceptions about mammography and its utility among women making screening decisions. While literacy is a known barrier to receiving mammography, there are currently no decision tools to help women with LHL with their decision-making. Therefore, the goal of this training and research program is to develop the necessary knowledge and skills to create and test a novel decision aid to increase informed breast cancer screening decisions for women ages 40-54 with LHL. Training will cover four essential domains: 1) Community-Engaged Research Methods; 2) Tools to Improve Informed Decision-Making; 3) Low Literacy Populations; and 4) Patient-Centered Outcome Assessment. The knowledge gained through didactic training and one-on-one mentoring will support three proposed Research Aims. First, I will engage multiple stakeholders, including women with LHL (n=25) and their clinicians (n=20), in qualitative interviews to understand and characterize their decisional preferences and identify outcomes that matter most. Second, I will construct a multi-media decision aid appropriate for use with women with LHL ages 40-54. An expert panel (n=10) will assist in evaluating the acceptability of evidence based content for inclusion, and women with LHL will provide input on tool acceptability and pilot outcomes via cognitive interviews and a survey (n=30). Third, I aim to assess the impact of the decision aid on decision-making outcomes (decisional conflict, knowledge, shared decision-making) and screening intentions through a pilot pre-test/post-test study among 50 women and their primary care providers. This work will launch my career as an independent investigator trained to design and disseminate patient-centered decision supports that help to optimize the delivery of cancer screening services for those with LHL.

项目总结

项目成果

Women's Reactions to Breast Density Information Vary by Sociodemographic Characteristics.

女性对乳房密度信息的反应因社会人口特征而异。

• DOI: 10.1016/j.whi.2023.03.002
• 发表时间: 2023
• 期刊: Women's health issues : official publication of the Jacobs Institute of Women's Health
• 作者: Kressin,NancyR;Wormwood,JolieB;Battaglia,TracyA;Slanetz,PriscillaJ;Gunn,ChristineM
• 通讯作者: Gunn,ChristineM

Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study.

• DOI: 10.1002/cncr.33965
• 发表时间: 2022-07-01
• 期刊: Cancer
• 影响因子: 6.2

The Ethics of Delivering Precision Medicine-Pretest Counseling and Somatic Genomic Testing.

• DOI: 10.1001/jamaoncol.2020.0016
• 发表时间: 2020-06-01
• 期刊: JAMA oncology
• 影响因子: 28.4
• 作者: Borno HT;Rider JR;Gunn CM
• 通讯作者: Gunn CM

The FDA-Approved Essure Device Counseling Order Fails to Promote Patient Empowerment.

• DOI: 10.3928/24748307-20190306-01
• 发表时间: 2019-04-01
• 期刊: Health literacy research and practice
• 作者: Gunn, Christine M;Paasche-Orlow, Michael K
• 通讯作者: Paasche-Orlow, Michael K

Disparities in precision medicine-Examining germline genetic counseling and testing patterns among men with prostate cancer.

• DOI: 10.1016/j.urolonc.2020.10.014
• 发表时间: 2021-04
• 期刊: UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS
• 影响因子: 2.7
• 作者: Borno, Hala T.;Odisho, Anobel Y.;Gunn, Christine M.;Pankowska, Magdalena;Rider, Jennifer R.
• 通讯作者: Rider, Jennifer R.