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

项目总结/摘要 新的、昂贵的风险评估技术正在迅速融入对患有糖尿病的患者的护理中。 前列腺癌先进的成像（前列腺MRI）和基因组测试已经开发出来，现在正在 部署这些系统是为了克服疾病管理中的一个核心挑战：非常高的患病率， 但杀伤力相对较低。几十年来，关于患者前列腺的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， 对很多人来说都有副作用。通过提高区分低风险癌症和侵袭性癌症的能力， 相信更准确的工具将使许多患者能够安全地观察低风险癌症， 主动监测（active surveillance）。虽然这两项方兴未艾的技术已经在受控的 研究中，没有真实世界的证据可以了解其影响。具体来说，不知道是哪一个。 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它们的好处。为了解决这些知识差距，我们的目标是全面 了解前列腺MRI和基因组检测如何影响前列腺癌的治疗。我们将 通过两个互补的阶段来实现这一目标：（1）定义如何采用前列腺MRI 和/或基因组测试影响了临床管理，（2）了解患者和医生如何 在决策过程中使用这些工具。我们假设前列腺MRI和/或 基因组检测的进行取决于他们看到的医生，但该测试与 治疗率较低。我们将使用大型国家前列腺癌患者数据集， 采用前列腺MRI和/或基因组检测，以及这些技术的使用是否与 观察与治疗的使用增加。为了了解这些工具是如何用于决策低- 前列腺癌的风险，我们将进行深入的采访，前列腺癌患者和医生， 诊断和治疗疾病。这项研究的结果将有助于改善这些工具的使用方式。 用于治疗男性前列腺癌。候选人：该提案支持专业人士 发展候选人作为一个独立的，以病人为导向的外科医生，调查重点是改善 前列腺癌护理。此应用程序是围绕一个严格的培训计划，包括课程， 利用候选人作为前列腺癌外科医生和临床结果研究员的背景， 先前的工作集中于风险评估技术和对低风险前列腺癌的积极监测。 申请人将通过获得耶鲁大学健康科学硕士学位来建立自己的专业知识， 发展定性研究和实施科学的技能。完成这一指导培训 该奖项将定位候选人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.