Shared decision-making and colorectal cancer screening behaviors among older adults with low health literacy

项目摘要/摘要 结直肠癌(CRC)筛查的悖论是，健康的老年人往往筛查不足， 那些健康状况不佳的人被过度筛查。一项研究发现，51%的75岁以上的美国成年人 对预期寿命进行了筛查，而62%的10岁以下患者没有。指南建议成人&>75 岁月根据对利益、伤害、价值和偏好的预期做出个性化的决定。那里 现有的决策辅助工具(DAS)是否存在缺口，专为具有低健康素养(LHL)的成年人而设计&>75岁以帮助 作出结直肠癌筛查决定。这是令人担忧的，因为风险因素(&>75岁，低社会经济地位， 低教育水平、种族/少数民族身份)与低儿童疾病知识水平有关。 筛查选项，低自我效能感，明显缺乏参与SDM的意愿，以及 最佳筛选。此K23应用程序的主要目标是优化CRC筛选决策和 改善76-85岁LHL成年人的护理质量，注意性别差异。具体的 目的是：1.了解老年人对结直肠癌筛查的信息需求和认知； 编写和修改简短的纸质小册子《儿童权利公约》，供老年人使用；以及3.开展 CRC DA的可行性试点随机对照试验。混合定性(结构化访谈、焦点小组) 并将使用定量的方法来评估和测试关于结肠癌的决策 筛选“DA”创建一种简单、有效的DA工具，供认知功能正常的老年LHL患者使用 四个以社区为基础的机构和三个社区卫生中心。候选人的长期目标是 成为一名独立的健康服务研究员，开发健康促进干预措施并 改善对服务不足和代表不足、健康素养较低的老年人的决策支持。 并通过美国国立卫生研究院R01的S和相关奖项获得独立研究资金 在不同的成人人群中进行循证筛查(PAR-18-932)“和”减少过度筛查 老年人的乳腺癌、子宫颈癌和结直肠癌；PA-17-109。为了达到研究目标 和职业目标，三个培训目标是接受高级培训：1.发展健康技能 使用混合方法进行扫盲/健康沟通；2.学习如何制定和评估决策 支持LHL老年人；3.设计和进行随机对照试验。该研究和 职业发展将在西蒙斯大学社会工作学院与 贝丝以色列女执事医疗中心的普通医学和初级保健部门 候选人的主要导师已找到。这两个机构的资源组合提供了非常丰富的 具有相关专业知识的智力环境对成功的可能性做出重大贡献 建议的研究。

Project Summary/Abstract The paradox of colorectal cancer (CRC) screening is that healthy older adults are often under-screened and those in poor health are over-screened. One study found that 51% of US adults >75 years with < 10 years of life expectancy were screened while 62% with >10 year LE were not. Guidelines recommend that adults >75 years make individualized decisions based on expectations of benefits, harms, values, and preferences. There is a gap in existing decision aids (DAs) designed for low health literate (LHL) adults >75 years to assist in making CRC screening decisions. This is concerning since risk factors (>75 years, low socioeconomic status, low educational levels, racial/ethnic minority status) for LHL are associated with low CRC knowledge of screening options, low self-efficacy, an apparent lack of desire to participate in SDM, and with less than optimal screening. The primary objective for this K23 application is to optimize CRC screening decisions and improve the quality of care among LHL adults 76-85 years with attention to differences by sex. The specific aims are to: 1. Identify the information needs and perceptions of LHL older adults about CRC screening; 2. Develop and modify short, paper-based pamphlet CRC DA for use with LHL older adults; and 3. Conduct a feasibility pilot randomized control trial of the CRC DA. Mixed qualitative (structured interviews, focus groups) and quantitative methods will be used to evaluate and test the “Making a decision about colon cancer screening” DA to create a simple, effective DA tool for use among cognitively intact older adults with LHL in four community based settings and three community health centers. The candidate's long-term goals are to become an independent health services researcher who develops health promotion interventions and improved decision support for underserved and underrepresented older adults with low health literacy. and secure independent research funding through NIH R01's and related awards such as “Increasing Uptake of Evidence-Based Screening in Diverse Adult Populations (PAR-18-932)” and “Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults; PA-17-109.” To the meet the research objective and career goal, the three training goals are to receive advanced training in:1. Developing skills in health literacy/health communication using mixed methodology; 2. Learning how to develop and evaluate decision support for LHL older adults; and 3. Designing and conducting randomized control trials. The research and career development will take place at Simmons University School of Social Work in collaboration with the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, where the candidate's primary mentor is located. The combination of resources at both institutions provide a very rich intellectual environment with relevant expertise to contribute substantially to the probability of success of the proposed study.