Understanding the Adoption and Impact of New Risk Assessment Technologies in Prostate Cancer Care

项目摘要/摘要 新的、昂贵的风险评估技术正在迅速整合到对患有 前列腺癌。先进的成像(前列腺核磁共振)和基因组测试已经开发出来，现在正在进行 部署是为了克服疾病管理中的一个核心挑战：非常高的流行率， 但杀伤力相对较低。几十年来，关于患者前列腺真实性质的不确定性 癌症导致数百万男性对惰性(低风险)疾病进行不必要的治疗，从而导致 对许多人来说都有持久的副作用。通过提高区分低风险癌症和侵袭性癌症的能力，它是 相信更准确的工具将让许多患者安全地仔细观察低风险癌症 监控(主动监控)。尽管这两种占优势的技术已经在受控领域进行了评估 研究表明，没有现实世界的证据来理解它们的影响。具体地说，还不知道是哪种 患者正在接受检测，这些技术的使用是否减少了不必要的治疗，或者如何 患者和医生都意识到了他们的好处。为了解决这些知识差距，我们的目标是全面 了解前列腺核磁共振和基因组检测如何影响前列腺癌的治疗。我们会 通过两个相辅相成的阶段实现这一目标，旨在：(1)确定如何采用前列腺核磁共振 和/或基因组检测已影响临床管理，以及(2)了解患者和医生如何 在决策过程中要注意这些工具。我们假设无论是前列腺核磁共振和/或 基因组测试的执行取决于他们看的医生，但这种测试与 较低的治疗率。我们将使用前列腺癌男性的大型国家数据集，并检查 采用前列腺核磁共振和/或基因组检测，以及这些技术的使用是否与 更多地使用观察而不是治疗。要了解这些工具如何用于低成本的决策- 前列腺癌的风险，我们将对前列腺癌患者和 诊断和治疗疾病。这项研究的结果将决定改进这些工具的方式的努力 用于前列腺癌患者的治疗。候选人：这项提案支持专业人士 将候选人培养为独立的、以患者为导向的外科医生-调查员，专注于改进 前列腺癌护理。此应用程序以严格的培训计划为中心，包括 利用候选人作为前列腺癌外科医生和临床结果研究人员的背景， 之前的工作主要集中在风险评估技术和低风险前列腺癌的主动监测上。 申请者将在其专业知识的基础上获得耶鲁大学的健康科学硕士学位，以及 培养定性研究和实施科学方面的技能。本次辅导培训的完成 奖项将使候选人能够开发和测试一个框架，以完善新技术的使用 前列腺癌患者，潜在地减少过度治疗和成本。

PROJECT SUMMARY/ABSTRACT New, expensive risk assessment technologies are rapidly being integrated into the care of patients with prostate cancer. Advanced imaging (prostate MRI) and genomic tests have been developed and are now deployed to overcome a central challenge in the management of the disease: a remarkably high prevalence, yet comparatively low lethality. For decades, uncertainty regarding the true nature of a patient's prostate cancer has led to the unnecessary treatment of indolent (`low-risk') disease in millions of men resulting in lasting side-effects for many. By improving the ability to distinguish low-risk from aggressive cancers, it is believed that more accurate tools will allow many patients to safely observe low-risk cancers with careful monitoring (active surveillance). Although these two ascendant technologies have been evaluated in controlled studies, no real-world evidence is available to understand their impact. Specifically, it is not known which patients are receiving testing, whether use of these technologies reduces unnecessary treatment, or how patients and doctors perceive of their benefit. To address these knowledge gaps, we aim to comprehensively understand how prostate MRI and genomic testing impact the management of prostate cancer. We will accomplish this goal through two complementary phases aimed at: (1) defining how adoption of prostate MRI and/or genomic testing has affected clinical management, and (2) understanding how patients and physicians perceive of these tools during decision-making. We hypothesize that whether or not prostate MRI and/or genomic testing are performed is dependent on the doctor that they see, but that testing is associated with lower rates of treatment. We will use large national datasets of men with prostate cancer and examine the adoption of prostate MRI and/or genomic testing, and whether the use of these technologies is associated with increased use of observation versus treatment. To learn how these tools are used in decision-making for low- risk prostate cancer, we will conduct in-depth interviews of both patients with prostate cancer and doctors who diagnose and treat the disease. The results from this research will shape efforts to improve how these tools are used in the management of men with prostate cancer. Candidate: this proposal supports the professional development of the candidate as an independent, patient-oriented surgeon-investigator focusing on improving prostate cancer care. This application is centered around a rigorous training program including coursework that leverages the candidate's background as a prostate cancer surgeon and clinical outcomes researcher whose prior work has focused on risk assessment technologies and active surveillance of low-risk prostate cancer. The applicant will build upon his expertise by earning a Masters in Health Science from Yale University, and develop a skill set in qualitative research and implementation science. The completion of this mentored training award will position the candidate to develop and test a framework for refining the use of new technologies for patients with prostate cancer, potentially reducing over-treatment and cost.