Doctor-Patient Communication about Colorectal Cancer Screening and Health Dispari

描述(申请人提供)：这项职业发展申请的长期目标是启动一项独立的癌症预防和控制研究计划，在改善服务不足人群中的临床医生与患者沟通方面具有特定的专业知识。最近，沟通在临床接触中的重要作用及其对患者预后的影响受到了关注。总体而言，这项研究没有在服务不足的人群中进行，尽管服务不足人群中的患者对临床医生的不信任程度更高，报告的满意度较低，依从性较差。鉴于临床医生与患者沟通的重要性，以及关于改善临床医生与患者沟通的干预措施有效性的新证据，需要对医生与未得到充分服务的患者之间的沟通及其对患者预后的影响有更深入的了解。这个职业奖项的学习目标包括：1)增加对健康差距影响因素的了解，以便更好地规划研究和解释结果；2)获得癌症流行病学的工作知识，为我选择结果措施提供参考；3)学习制定社区干预措施以改变健康行为的核心原则；4)通过出席会议和建立网络，与健康差距问题的研究人员发展工作关系；5)探索提供者与低收入少数族裔患者之间的沟通，重点是坚持结直肠癌筛查；以及6)使用以社区为基础的参与式方法，征求利益攸关方对以医生为中心的沟通培训干预措施的可行性和可接受性的意见。结直肠癌筛查将为这一应用提供研究范例，因为不同种族、收入和教育程度的筛查和癌症发病率存在差异。深入研究医生和患者关于癌症筛查的讨论的影响，将提供机会来探索在服务不足的人群中临床医生和患者沟通所面临的独特挑战。最终，这项工作将导致制定干预措施，以改善这些环境中的沟通。通过在资源充足的机构环境中与导师和多学科同事的密集互动，正式的课程和教育活动，以及拟议的研究，这个奖项将为我作为一名医患沟通和健康差距的独立研究员的职业生涯做好准备。

DESCRIPTION (provided by applicant): The long-term goal of this career development application is to launch an independent research program in cancer prevention and control with specific expertise in improving clinician-patient communication in underserved populations. Recent attention has been paid to the vital role of communication in clinical encounters and its effect on patient outcomes. In general, this research has not taken place with underserved populations, although patients in underserved populations have higher levels of mistrust of their clinicians, report lower levels of satisfaction with the encounter, and have poorer adherence. Given the import of clinician-patient communication and the emerging evidence about the effectiveness of interventions to improve clinician-patient communication, a more sophisticated understanding of communication between doctors and underserved patients and its impact on patient outcomes is required. Learning objectives for this career award include: 1) gain an increased understanding of the factors influencing health disparities in order to better plan studies and interpret results; 2) obtain a working knowledge of cancer epidemiology to inform my selection of outcome measures; 3) learn core principles for developing community interventions to change health behavior; 4) develop working relationships with researchers in health disparities through conference attendance and networking; 5) explore the communication between providers and low-income, minority patients with a focus on adherence to CRC screening; and 6) use a community-based participatory approach to obtain stakeholders' opinions about feasibility and acceptability of doctor-focused communication training interventions. Colorectal cancer screening will provide the paradigm for study in this application because of the disparities in both screening and cancer incidence by race, income, and education. The in-depth study of the effect of doctor-patient discussions about cancer screening will provide the opportunity to explore unique challenges faced in clinician-patient communication in underserved populations. Ultimately, this work will lead to the development of interventions to improve communication in these settings. Through intensive interaction with mentors and multi- disciplinary colleagues within a well-resourced institutional environment, formal coursework and educational activities, and the proposed research, this award will prepare me for a career as an independent researcher in doctor-patient communication and health disparities.