Improving shared decision-making around the use of disease modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer

改善类风湿关节炎和癌症患者使用疾病缓解抗风湿药物的共同决策

• 批准号: 10449904
• 负责人: Namrata Singh
• 金额: $ 16.68万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10449904
• 关键词: American; Antirheumatic Agents; Cancer Etiology; Caring; Cause of Death; Cessation of life; Characteristics; Data; Databases; Decision Aid; Decision Making; Development; Diagnosis; Disease; Ensure; Family; Family member; Foundations; Funding; Future; General Population; Goals; Guidelines; Immune response; Immunosuppressive Agents; Impairment; Incidence; Individual; Interview; Knowledge; Lung Lymphoma; Lymphoma; Malignant Neoplasms; Malignant neoplasm of lung; Mentors; Mentorship; Methodology; Methods; Nurse Practitioners; Oncologist; Outcome; Outcomes Research; Patient Care; Patient-Focused Outcomes; Patients; Perception; Persons; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacotherapy; Population; Process; Property; Qualitative Research; Recording of previous events; Research; Research Design; Research Methodology; Research Personnel; Retrospective cohort study; Rheumatism; Rheumatoid Arthritis; Risk; Safety; Sample Size; Shapes; Signal Transduction; Smoking; Specialist; Stage at Diagnosis; Testing; Training; Treatment Protocols; Treatment outcome; Tumor stage; United States Department of Veterans Affairs; Universities; Veterans; Washington; base; cancer diagnosis; cancer recurrence; cancer risk; care providers; career development; clinical decision-making; clinical practice; comorbidity; comparative effectiveness; comparative safety; evidence base; experience; follow-up; improved; individual patient; member; mortality; patient oriented; patient population; preference; rheumatologist; shared decision making; skills; standard care; treatment guidelines; treatment planning; tumor; willingness

PROJECT SUMMARY Over 1.8 million Americans have rheumatoid arthritis (RA). Compared to the general population these patients are at an increased risk of developing cancer, especially lymphoma and lung cancer. There has been a theoretical concern that use of immunosuppressive agents may impair immune responses to tumors placing patients at risk for developing new cancers and for recurrence of previously treated cancers. These concerns have made clinicians reluctant to use standard therapies for RA in patients with an active or recently diagnosed cancer. Although only a limited number of studies have evaluated their safety, they have in fact not shown any signal of harm from disease modifying anti-rheumatic drugs (DMARDs) in patients with RA and cancer. However, these studies have numerous limitations including focus on mostly patients with remote (> 5 years) history of cancer, small sample sizes, focus on only certain DMARDs, and/or limited information on cancer- specific mortality and other outcomes that might matter to patients. Also, nothing is known about the perspectives and experiences of patients with RA who are being treated for a cancer and how this experience might shape their willingness to use DMARDs. Treatment guidelines for the management of RA support a shared decision-making (SDM) approach that attempts to leverage the professional expertise of the rheumatologist to uphold what is most important to each patient. We herein propose a mixed methods approach to identify the optimal ways to enhance delivery of care for these patients and to provide a foundation for shared decision making to ensure alignment between treatment decisions and the values, goals, and preferences of individual patients. The studies proposed here will build an evidence base to identify the safest DMARD options for patients with RA who develop cancer (Aim 1); elicit the experiences, perceptions, and most valued outcomes of patients with RA and an active or recently diagnosed (<5 years) cancer, their family members and clinicians who care for these patients (Aim 2). The overall goal of this K23 mentored career development proposal is to support Dr. Namrata Singh’s development as an independent, patient-oriented researcher whose long-term goal is to develop a research agenda focused on the identification of factors that contribute to suboptimal treatment and outcomes for patients with rheumatic diseases, especially those with cancer. The training and research plans proposed here will allow her to develop critical skills in advanced pharmacoepidemiology and in qualitative research methods. Combined with an outstanding mentorship team, the University of Washington’s world-class facilities, and a rigorous training plan, this project will prepare Dr. Singh to successfully obtain future funding to adapt and test a decision aid for SDM implementation among patients with RA and an active or recent cancer.

项目摘要 超过180万美国人患有类风湿性关节炎（RA）。与一般人群相比， 患者患癌症，特别是淋巴瘤和肺癌的风险增加。出现 理论上担心使用免疫抑制剂可能会损害对肿瘤的免疫反应， 有患新癌症和既往治疗癌症复发风险的患者。这些关切 使得临床医生不愿意在活动性或最近诊断为RA的患者中使用标准疗法 癌虽然只有有限数量的研究评估了它们的安全性，但事实上它们没有显示出任何安全性。 RA和癌症患者中疾病缓解抗风湿药物（DMARD）的危害信号。 然而，这些研究有许多局限性，包括主要集中在远程患者（> 5年） 癌症史、小样本量、仅关注某些DMARD和/或癌症信息有限- 具体的死亡率和其他可能对患者有影响的结果。此外，关于 正在接受癌症治疗的RA患者的观点和经验，以及这种经验如何影响他们的健康。 可能会影响他们使用DMARD的意愿。RA管理的治疗指南支持a 共享决策（SDM）的方法，试图利用专业知识的专业知识， 风湿病学家坚持什么是最重要的每一个病人。本文提出了一种混合方法 方法，以确定最佳方式，以加强对这些患者的护理，并提供一个基础 共同决策，以确保治疗决策与价值观、目标和 患者个人的偏好。 这里提出的研究将建立一个证据基础，以确定患者最安全的DMARD选择 患有癌症的RA患者（目标1）;引出以下方面的经验、看法和最有价值的结果： 患有活动性或近期诊断（<5年）癌症的RA患者及其家人和临床医生 照顾这些病人（目标2）。 这份K23指导式职业发展提案的总体目标是支持Namrata Singh博士的 发展为一个独立的，以病人为导向的研究人员，其长期目标是发展一个研究 议程的重点是确定有助于次优治疗和结果的因素， 风湿病患者，尤其是癌症患者。这里提出的培训和研究计划 将使她在先进的药物流行病学和定性研究方法的发展关键技能。 结合优秀的导师团队，华盛顿大学世界一流的设施， 严格的培训计划，这个项目将准备辛格博士成功地获得未来的资金，以适应和测试 在患有RA和活动性或近期癌症的患者中实施SDM的决策辅助。