Diagnostic Labeling: Effect on White Coat Hypertension

描述（由申请人提供）：拟议的职业发展奖项将使Tanya Goyal博士成为一名独立的科学家，在高血压和心血管疾病的行为和心理干预方面具有专长。申请人是有心血管研究经验的持牌临床心理学家。然而，她在高血压患者临床试验方面的经验有限，缺乏独立研究职业所需的一些基本技能；这些技能是她短期目标的重点。哥伦比亚大学医学中心（Columbia University Medical Center）有一个由多学科导师组成的团队。Gerin, Pickering， Sloan和Schwartz将提供以下方面的培训：(1)随机对照试验设计和分析；(2)心血管心理生理学；(3)流行病学;(4)医学研究传播。职业发展计划还包括在哥伦比亚大学梅尔曼公共卫生学院完成生物统计学硕士学位。申请人将进行一项研究计划，研究诊断标签对临床血压及白大褂高血压的影响。先前的研究表明，高血压的诊断（即标签）与随后的静息血压升高有关，申请人的初步工作已证明高血压标签与白大褂效应之间存在横断关联。在高血压前期患者中，白大褂效应可能尤其有问题，因为临床血压的小幅升高可能导致高血压的诊断临界值，从而可能导致误诊和不必要的治疗。提出的研究将检查高血压前期标签对临床和动态血压的影响，并将检查这些关联的潜在心理介质。参与者将是100名从未被标记的新发现的高血压前期患者。他们将被随机分配到两组，这两组对他们最初的血压检查结果给予不同类型的反馈，并将被跟踪三个月。本研究将为针对医生向患者提供诊断信息方式的干预措施的发展提供基础。本研究的长期目标是制定策略，以减少标签的负面心理和生理后果，从而提高诊断的准确性。（摘要结束）

DESCRIPTION (provided by applicant): The proposed career development award will enable Dr. Tanya Goyal to become an independent scientist with expertise in behavioral and psychological interventions for hypertension and cardiovascular disease. The applicant is a licensed clinical psychologist with experience in cardiovascular research. However, she has limited experience in the conduct of clinical trials with hypertensive patients and lacks some fundamental skills that are necessary for an independent research career; these skills are the focus of her short-term goals. A multidisciplinary team of mentors at Columbia University Medical Center, including Drs. Gerin, Pickering, Sloan, and Schwartz will provide training in: (1) randomized controlled trial design and analysis; (2) cardiovascular psychophysiology; (3) epidemiology; and (4) medical research dissemination. The career development plan also includes completion of a Master's degree in Biostatistics at the Columbia University Mailman School of Public Health. The applicant will conduct a research project to study the effects of diagnostic labeling on clinic blood pressure and white coat hypertension. Previous research has shown that a diagnosis (i.e., label) of hypertension is associated with subsequent increases in resting blood pressure, and preliminary work by the applicant has demonstrated a cross-sectional association between hypertension labeling and the white coat effect. The white coat effect may be particularly problematic in prehypertensives, because a small elevation in clinic blood pressure could result in crossing the diagnostic cutoff for hypertension, potentially leading to misdiagnosis and unnecessary treatment. The proposed study will examine effects of prehypertension labeling on clinic and ambulatory blood pressure, and will examine potential psychological mediators of these associations. Participants will be 100 newly identified prehypertensives who have never been labeled. They will be randomly assigned to two groups which are given different types of feedback about their initial blood pressure screening results, and will be followed for three months. This study will provide a foundation for the development of interventions targeting the manner of delivery of diagnostic information by physicians to patients. The long-term goal of this research is to develop strategies to reduce negative psychological and physiological consequences of labeling, and thus to improve the accuracy of diagnosis. (End of Abstract)