Shared Decision-Making for Colorectal Cancer Screening

产品说明：结直肠癌（CRC）是美国癌症相关死亡的主要原因。筛查是降低CRC发病率和死亡率的一种具有成本效益的策略，但尚未对疾病负担产生重大影响，部分原因是患者依从性差。 共同决策是提高CRC筛查率的一种潜在有效但未经证实的策略。 该提案的总体目标是开发一种互动的、基于网络的决策辅助工具，并评估其对共享决策和患者依从CRC筛查建议的影响。 在第1阶段（第1年），将开发一个互动的、基于网络的决策辅助工具，该工具采用最先进的技术来教育患者有关五种推荐的CRC筛查策略，提高风险认知，并使患者能够参与决策过程。 内容将使用相关文献和现有的决策辅助工具，专家意见和决策理论的批判性审查。 将纳入个性化风险评估工具以及评估人口统计学、知识、信念、愿望、障碍和患者偏好的前/后测试模块。 还将提供有针对性的反馈。 一旦开发完成，援助将接受外部咨询委员会的外部审查，以确定内容的有效性，并对可用性进行预先测试。 在第2阶段（第1年），将确定在两个门诊护理环境中实施决策辅助的最佳策略。 研究小组将与医生和办公室工作人员互动，以确定潜在的后勤障碍，并共同制定一个量身定制的战略，在有针对性的门诊护理网站的实施。 要解决的问题包括资源需求，空间分配，病人识别和调度，以及跟踪。 在实施前，将举办医生和工作人员教育研讨会。 在第3阶段（第2 - 5年），将进行一项随机对照临床试验，以评估决策辅助对共同决策和遵守CRC筛查建议的影响。 合格的患者将被随机分组，以审查决策辅助工具、单独的个性化风险评估工具或对照条件。 主要结局将是使用计算机化跟踪系统的患者对CRC筛查建议的依从性;次要结局将包括使用决策辅助或经验证工具的评价组件的患者知识和患者满意度。

DESCRIPTION: Colorectal cancer (CRC) is a leading cause of cancer-related death in the U.S. Screening is a cost-effective strategy for reducing both CRC incidence and mortality but has yet to have a major impact on disease burden partly because of poor patient adherence. Shared decision-making is a potentially effective yet unproven strategy for increasing CRC screening rates. The overall objective of this proposal is to develop an interactive, web-based decision aid and evaluate its impact on shared decision-making and patient adherence to CRC screening recommendations. During Phase 1 (Year 1), an interactive, web-based decision aid will be developed that employs state-of-the-art technology to educate patients about the five recommended CRC screening strategies, heighten risk perception, and empower patients to participate in the decision-making process. Content will be developed using a critical review of relevant literature and existing decision aids, expert opinion, and decision-making theory. A personalized risk assessment tool plus pre-/post-test modules to assess demographics, knowledge, beliefs, desire, barriers, and patient preferences will be incorporated. Tailored feedback will also be provided. Once developed, the aid will be subjected to external review by an outside advisory committee for content validity and pre-tested for usability. During Phase 2 (Year 1), an optimal strategy will be defined for implementation of the decision aid in two ambulatory care settings. The research team will interact with physicians and office staff to identify potential logistical barriers and to conjointly develop a tailored strategy for implementation at the targeted ambulatory care sites. Issues to be addressed include resource needs, space allocation, patient identification and scheduling, and tracking. Physician and staff educational seminars will be conducted before implementation. During Phase 3 (Years 2 to 5), a randomized controlled clinical trial will be conducted to evaluate the impact of the decision aid on shared decision-making and adherence to CRC screening recommendations. Eligible patients will be randomized to review the decision aid, the personalized risk assessment tool alone or a control condition. The primary outcome will be patient adherence to CRC screening recommendations using computerized tracking systems; secondary outcomes will include patient knowledge and patient satisfaction using evaluation components of the decision aid or validated instruments.