An Interactive Video Doctor to Encourage Cancer Screening

描述（由申请人提供）：癌症筛查可以挽救生命，建议50岁及以上的男性和女性进行几种癌症的常规筛查。妇女的癌症筛查包括乳腺癌筛查、结肠直肠癌筛查和定期宫颈癌筛查（通常比妇女接受的频率低）。男性癌症筛查包括结直肠癌筛查，由于前列腺癌筛查的争议，建议采用共同决策的方法。虽然建议进行筛查，但许多人没有接受筛查，需要采取新的方法来提高筛查率。 在初级保健诊所环境中进行干预具有挑战性。病人来与其他医疗问题，并有时间和系统的限制。我们建议开发一种新的工具，该工具将在系统中运行在一个忙碌的诊所设置，并将整合从一个特定的病人与供应商线索的信息，将是有效的，将减轻时间限制的负担，并将量身定制的个别病人。 为响应“癌症决策;单一事件决策”计划，并与R 21资助机制保持一致，我们计划开发一种创新工具，旨在提高癌症筛查率和有关癌症筛查的讨论。这一工具将是一个多媒体互动视频医生，将评估个人在癌症筛查方面的变化阶段，并以可行和有效的方式针对个人变化阶段提供信息。该工具的创新之处在于：1）它将专注于针对特定个体的所有推荐癌症筛查，2）它将针对个体的变化阶段和个体筛查障碍进行定制，3）它以前没有在初级保健诊所环境中进行过测试以促进癌症筛查，因此是一种提高癌症筛查率和关于癌症筛查的讨论的新方法。拟议研究的具体目标如下： 1.开发多组件交互式视频医生干预，包括：a）评估癌症筛查行为和变化阶段，B）交互式视频医生，以及c）生成个性化提供者提示表（提供者警报）。 2.在初级保健环境中，对80名患者进行多组分交互式视频医生干预的可行性和可接受性的试点测试。 3.在这项试点研究的80名患者，以评估意向进行筛选，筛选的兴趣和阶段的变化之前和之后的视频医生干预。 在未来的研究中，我们计划进行一项随机对照试验，以确定多组分交互式视频医生干预的有效性，其中包括评估变化阶段和癌症筛查，交互式视频医生，以及生成个性化的提供者提示表（提供者警报）三个结果：1）提高乳腺癌和结直肠癌筛查率，2）提高参与者接受乳腺癌和结直肠癌筛查的准备程度，以及3）增加关于子宫颈癌和前列腺癌筛查的医患讨论。 50至70岁妇女的适当癌症检查包括乳房X光检查乳腺癌、结肠直肠癌检查和定期宫颈癌检查。男性癌症筛查包括结直肠癌筛查，由于前列腺癌筛查存在争议，建议采用共同决策的方法。非常需要有效的干预措施来提高癌症筛查率，我们建议开发一种多组件交互式视频医生，用于提高年龄适当的癌症筛查率。然后，我们将在一个初级保健诊所进行试点测试，有80人参加，以评估在干预前后向提供者询问筛查和筛查兴趣的意图。在未来的研究中，我们将在随机临床试验中测试干预措施，以确定其在提高癌症筛查率和增加有关癌症筛查的讨论方面的有效性。如果干预成功，它可以用于许多其他环境，以提高癌症筛查率。

DESCRIPTION (provided by applicant): Cancer screening saves lives and routine screening for several cancers is recommended for men and women aged 50 and over. Cancer screening for women includes breast cancer screening, colorectal cancer screening and periodic cervical cancer screening (often less frequently than the woman has been receiving it). Cancer screening for men includes colorectal cancer screening and because of the controversy about prostate cancer screening, a shared decision making approach is recommended. Although screening is recommended, many individuals are not being screened and novel approaches to increasing rates of screening are needed. Conducting interventions in a primary care clinic setting is challenging. Patients come in with other medical problems, and there are time and system limitations. We propose developing a novel tool that will function within the system in a busy clinic setting, and will integrate information obtained from a particular patient with provider cues and will be efficient, will relieve the burden of time constraints and will be tailored to the individual patient. In response to the program announcement Decision Making in Cancer; Single Event Decisions and consistent with the R 21 funding mechanism, we plan to develop an innovative tool which will be designed to increase rates of cancer screening and discussions about cancer screening. This tool will be a multimedia interactive Video Doctor that will assess an individual's stage of change with respect to cancer screening and will give messages targeted to individual stage of change in a feasible and efficient manner. This tool is innovative in that 1) it will focus on all recommended cancer screening for a particular individual and 2) it will be tailored to an individual's stage of change and individual barriers to screening and 3) it has not been previously been tested in a primary care clinic setting to facilitate cancer screening and is thus a novel approach to increasing rates of cancer screening and discussions about cancer screening. The specific aims of the proposed study are as follows: 1. To develop a multi-component interactive Video Doctor intervention that includes: a) assessment of cancer screening behavior and stage of change, b) an interactive Video Doctor, and c) the generation of individualized provider cue sheets (Provider Alerts). 2. To pilot test the multi-component interactive Video Doctor intervention with 80 patients for feasibility and acceptability in a primary care setting. 3. In this pilot study of 80 patients, to assess intention to be screened, interest in screening and stage of change before and after the Video Doctor intervention. In a future study, we plan to conduct a randomized controlled trial to determine the effectiveness of a multi- component interactive Video Doctor intervention which includes assessment of stage of change and cancer screening, an interactive Video Doctor, and generation of individualized provider cue sheets (Provider Alerts) on three outcomes: 1) increasing rates of breast and colorectal cancer screening, 2) increasing participants' readiness to be screened for breast and colorectal cancer, and 3) increasing physician-patient discussions about screening for cervical cancer and prostate cancer. Appropriate cancer screening for women aged 50 to 70 includes breast cancer screening with mammography, colorectal cancer screening and periodic cervical cancer screening. Cancer screening for men includes colorectal cancer screening and because prostate cancer screening is controversial, a shared decision making approach is recommended. There is a great need for effective interventions to improve rates of cancer screening and we propose developing a multi-component interactive Video Doctor that will be used to increase rates of age appropriate cancer screening. We will then pilot test it in a primary care clinic setting with 80 individuals to assess intention to ask providers about screening and interest in screening before and after the intervention. In a future study, we will test the intervention in a randomized clinical trial to determine its effectiveness in increasing rates of cancer screening and in increasing discussions about cancer screening. Should the intervention be successful, it can be used in many other settings in order to increase rates of cancer screening.