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

项目总结/摘要 结直肠癌（CRC）筛查的矛盾之处在于，健康的老年人往往筛查不足， 那些身体不好的人被过度筛选。一项研究发现，51%的美国成年人> 75岁， 而62%的> 10年LE患者未接受筛查。指南建议成年人> 75 根据对利益、危害、价值观和偏好的预期，做出个性化的决定。那里 是为> 75岁的低健康素养（LHL）成年人设计的现有决策辅助工具（DA）中的一个缺口， 做出CRC筛选决定。这是令人担忧的，因为风险因素（> 75岁，社会经济地位低， 低教育水平，种族/少数民族地位）与CRC对以下方面的知识水平低有关： 筛选选项，自我效能低，明显缺乏参与SDM的愿望， 最佳筛选K23应用的主要目标是优化CRC筛选决策， 提高76 - 85岁LHL成人的护理质量，注意性别差异。具体 目标是：1.确定LHL老年人对CRC筛查的信息需求和看法; 2. 开发和修改简短的纸质小册子CRC DA，用于LHL老年人;以及3.进行 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） 定量的方法将被用来评估和测试“关于结肠癌的决策” 筛选"DA，以创建一个简单，有效的DA工具，用于认知完整的老年LHL患者， 四个社区设置和三个社区卫生中心。候选人的长期目标是 成为一名独立的卫生服务研究人员，开发健康促进干预措施， 改善对服务不足和代表性不足、健康知识水平低的老年人的决策支持。 并通过NIH R01和相关奖项，如"增加摄取"， 在不同成人人群中进行循证筛查（PAR-18 - 932）"和"减少对 乳腺癌、宫颈癌和结直肠癌在老年人中; PA-17 - 109。达到研究目的 和职业目标，这三个培训目标是接受高级培训：1。发展保健技能 采用混合方法进行扫盲/保健宣传; 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。研究与 职业发展将在西蒙斯大学社会工作学院与 贝斯以色列女执事医疗中心的普通医学和初级保健部， 候选人的主要导师所在地。两个机构的资源组合提供了非常丰富的 具有相关专门知识的知识环境，以极大地促进 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.