Developing a Tool to Improve the Quality of Breast Cancer Treatment Decisions

描述(由申请者提供)：很少有医疗保健决定比早期乳腺癌的适当治疗更受到国家的关注。在过去的十年里，人们一直在争论，乳房切除术或保乳手术(BCS)加放射治疗是早期乳腺癌的“最佳”治疗方法。在R21的应用中，我们建议将重点放在乳腺癌手术治疗决策过程上，该过程已被确定为提高护理质量的机制。我们研究的广泛假设是，关于早期乳腺癌的高质量决策将导致高质量的护理。Sepucha和其他人将高质量的决策定义为知情并与决策者的偏好一致的决策。事实上，我们团队的研究表明，目前关于早期乳腺癌治疗的决定不符合“高质量决定”的标准。虽然已经开发和评估了针对早期乳腺癌治疗决策的辅助决策工具，但在使用这些工具的内容和人群方面都存在差距。我们认为，我们之前的研究和其他人的研究产生的新知识促使人们需要专门专注于提高乳腺癌治疗决策质量的新工具。更好的质量决策将带来更高质量的护理。R21项目的总体目标是开发和中试一种决策工具，以提高早期乳腺癌治疗的决策质量。具体目标是：1)与美国外科医师学会(ACOS)附属的乳腺癌外科医生进行小组和个人访谈，讨论该工具的内容以及将该工具整合到临床交付系统中；2)对不同的乳腺癌幸存者进行小组和个人访谈，以获得对其内容和做出治疗决策所需信息类型的反馈；3)与密歇根大学的健康传播研究中心(CHCR)合作，开发用于早期乳腺癌治疗决策的初始、基于网络的决策工具；4)在芝加哥、伊利诺伊地区和密歇根大学乳房中心的三个实践中对决策工具进行试点测试，以评估工具的内容、外观和感觉，以及工具影响知识和偏好的能力。如果不改善治疗决策的质量，就不会看到乳腺癌护理质量的改善。我们团队和其他人之前的研究表明，目前乳腺癌的治疗决定并不“高质量”。该项目将开发和测试一种专门为提高女性乳腺癌治疗决策的质量而设计的决策工具，随后将在R01提案中进行测试。该项目与提高所有妇女的癌症护理质量有直接关系。

DESCRIPTION (provided by applicant): Few healthcare decisions have received more national attention that the appropriate treatment for early stage breast cancer. For the past decade there has been debate around whether mastectomy or breast conserving surgery (BCS) with radiation is the "best" treatment for early stage breast cancer. In this R21 application, we propose to focus on the breast cancer surgical treatment decision making process which has been identified as a mechanism for improving the quality of care. The broad hypothesis of our study is that high quality decisions regarding early stage breast cancer will result in high quality care. Sepucha and others define a high quality decision as one that is informed and is concordant with the preferences of the decision maker. In fact, research from our team suggests that current decisions about treatment for early stage breast cancer do not meet the criteria of a 'high quality decision.' While decision aids directed toward decision making about early stage breast cancer treatment have been developed and evaluated, there are gaps both in the content and the populations in which these tools have been used. We argue that the new knowledge generated by our prior research and that of others motivates the need for new tools specifically focused on improving the quality of breast cancer treatment decisions. Better quality decisions will result in better quality care. The overall goal of this R21 project is to develop and pilot test a decision tool to improve the quality of decision making for early stage breast cancer treatment. The specific aims are: 1) Conduct group and individuals interviews with breast cancer surgeons affiliated with the American College of Surgeons (ACoS) regarding the content of the tool and integration of the tool into clinical delivery systems; 2) Conduct group and individual interviews with diverse breast cancer survivors to obtain feedback on the content and on the type of information desired in making treatment decisions; 3) Work with the Center for Health Communication Research (CHCR) at the University of Michigan to develop an initial interactive, web-based decision tool for use in early stage breast cancer treatment decision making; and 4) Pilot test the decision tool in three practices in the Chicago, IL area and at the University of Michigan Breast Center to evaluate the content, look and feel of the tool, and the ability of the tool to influence knowledge and preferences. Improvements in quality of care for breast cancer will not be seen without improvements in the quality of treatment decisions. Prior research from our team, and others, demonstrates that current treatment decisions for breast cancer are not "high quality." This project will develop and test a decision tool designed specifically to improve the quality of breast cancer treatment decisions by women, which will be subsequently tested in an R01 proposal. This project has direct relevance for improving the quality of cancer care for all women.