Predicting Surgical Decisions of High-Risk UC Patients

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DESCRIPTION (provided by applicant): This 5-year K07 award application describes a program of training and research that will provide the applicant, a social/health psychologist with a background in psychosocial research on maternal-fetal health, with mentoring and "protected time" to build skills and knowledge relevant to a research career in cancer prevention and control. Emphasis is on building knowledge of cancer (e.g., biology, psychosocial issues), methods for the study of close relationship processes, and advanced statistical skills for analysis of longitudinal data. At the conclusion of training, the applicant will have developed sufficient expertise to be a fully-established, independent investigator at the forefront of research exploring how medical and psychosocial factors together influence cancer prevention and control. The proposed training includes formal and informal didactics and a complementary program of innovative research. This research applies knowledge and skills gained during the training period to a theoretically-based, clinically-relevant study of how ulcerative colitis (UC) patients at high risk for colorectal cancer (CRC) make the difficult decision to accept a physician's recommendation for surgical removal of their colon and rectum after detection of pre-cancerous cell change, indicating high short-term risk for CRC. To address the lack of research on this high-risk population, the proposed research progresses logically from a qualitative study, to a retrospective, cross-sectional study, to a prospective, longitudinal study using "daily diary" methods. Three key influences on the surgical decision are investigated: 1) medical factors, 2) health beliefs, and 3) romantic partners. UC patients* dispositional tendency to take risks will also be explored as a potential influence on their decision. Findings will assist clinical efforts to ensure that UC patients referred for surgery are able to make an informed decision, with the overarching goals of helping to reduce CRC morbidity and mortality in this population. Theoretical advances include extension of decision-making models to include irreversible, life-altering decisions as well as interpersonal/family influences. The study will be conducted at Mount Sinai, a primary referral site for UC, and supported by an experienced mentor who is a distinguished gastroenterologist and a team of psychological and health researchers who will serve as co-mentors. The award will be instrumental to the applicant in achieving her short-term goal of becoming an independent investigator of medical and psychosocial influences on cancer prevention and control outcomes, as well as her longer-term objective of conducting innovative research capable of helping to reduce cancer mortality and morbidity.