Health Care Partners in Cancer Prevention and Care Among Aged - Competing Renewal

描述（由申请人提供）：我们计划实施一项新颖的、基于社区的教育计划，以告知和激励服务不足的老年人与医生建立伙伴关系，将癌症预防作为共同目标。我们将使用随机对照试验（RCT）来评估基于社会学习理论的干预措施的有效性，该干预措施促进患者参与，以加强以患者为中心的医疗护理。这项研究建立在我们正在进行的癌症预防和护理医疗保健合作伙伴关系研究的结果之上。具体来说，我们提出了针对老年人的多模式健康沟通培训计划。这种教育干预（“大声说出来”计划）旨在提高患者与医生沟通的主动性、能力和信心。基于社会学习理论的基础，干预措施预计将导致老年人与其初级保健医生之间关于癌症预防和筛查的讨论增多。干预措施的参与者还有望从医生那里获得更多针对年龄和风险的预防建议，并对他们的医疗保健更加满意。 “大声说出来”促进讨论组（N = 480）的参与者将与“连接”注意力控制组（N = 480）的参与者进行比较。后一个计划解决了加强公民和社会参与的重要目标。干预计划将以小组形式进行，提供用户友好的体验式学习，包括信息、讨论和角色扮演，以帮助老年人发展更好的沟通技巧。这项研究将在随机选择的参与过我们之前研究的社区居住老年人以及参加由老龄化地区机构 (AAA) 赞助的老年人中心营养项目的社区老年人中进行。通过将干预前评估与 2 周、6 个月和 12 个月的电话随访评估进行比较，我们将确定干预措施的短期和长期影响。我们将考虑参与者的个人特征及其医生的背景和支持，因为他们可能会影响干预措施的采用。我们根据进行随机对照试验的干预研究 (CONSORT) 指南设计了该研究，并将仔细评估治疗保真度。除了患者报​​告的结果外，我们还将考虑基于 Medicare 索赔数据和 AAA 计划利用数据的客观指数。我们将在定量数据分析中使用具有固定和随机效应的多级模型。使用混合方法设计，我们还将包括一个定性研究部分，该部分基于对根据项目效益高低选出的 60 名参与者的深入访谈。我们的研究与国家癌症研究所的使命密切相关，即改善癌症控制并减少癌症预防和护理方面的健康差距。我们计划积极进行传播工作，以确保这种便携式且具有成本效益的干预措施可以被社区组织广泛采用，例如为不同老年人提供服务的老龄化地区机构。 公共卫生相关性：拟议的研究与公共卫生直接相关。我们的目标是提高老年患者的宣传技巧以及他们与医生就癌症预防和一般医疗护理进行沟通的能力。我们期望他们因我们的干预而获得的信心和主动性将改善他们所接受的预防性护理。让消息灵通、尊重医生专业知识的患者参与医疗会面，将提高老年人就诊的效率和效果。癌症的预防和早期发现已被认为是减轻慢性和危及生命的疾病对社会和个人负担的重要公共卫生策略。我们对健康素养低下和少数民族老年人的沟通技巧培训的关注也应有助于最大限度地减少健康差距。

DESCRIPTION (provided by applicant): We plan to implement a novel, community based educational program to inform and motivate underserved older adults to forge partnerships with their doctors, targeting cancer prevention as a shared goal. Using a randomized controlled trial (RCT), we will evaluate the efficacy of our social learning theory based intervention that promotes patient participation in order to enhance patient centered medical care. This study builds on findings of our ongoing study of Health Care Partnerships in Cancer Prevention and Care. Specifically we propose a multi-modal health communication training program for older adults. This educational intervention ("Speak Up" program), aims to improve patient initiative, competence, and confidence in communication with physicians. Based on foundations of social learning theory the intervention is expected to result in increased discussion between older adults and their primary care physicians about cancer prevention and screening. Participants in the intervention are also expected to receive more age and risk specific preventive advice from their doctors and report greater satisfaction with their health care. Participants in the "Speak Up" facilitated discussion groups (N=480) will be compared to participants in "Connect" attention control groups (N=480). The latter program addresses important goals of enhancing civic and social engagement. The intervention program will be conducted in small groups and offer user-friendly experiential learning including information, discussion, and role play in order to help older persons develop better communication skills. The study will be conducted among randomly selected community dwelling elders who had participated in our prior research, and among community based older adults who attend Senior Center nutrition programs, sponsored by Area Agencies on Aging (AAA). Based on comparing pre-intervention assessments with 2 week, 6 month, and 12 month telephone follow-up evaluations, we will determine both the short term and long term impact of the intervention. We will consider participants' personal characteristics and their physicians' background and supportiveness as they may influence uptake of the intervention. We designed the study based on intervention research (CONSORT) guidelines for conducting RCTs, and will carefully evaluate treatment fidelity. In addition to patient reported outcomes, we will also consider objective indices based on Medicare claims data and AAA data on program utilization. We will use multilevel models with fixed and random effects in our quantitative data analyses. Using a mixed methods design, we will also include a qualitative study component based on in-depth interviews with 60 participants selected based on high versus low program benefits. Our study is closely aligned with the mission of the National Cancer Institute to improve cancer control and to reduce health disparities in cancer prevention and care. We plan an active dissemination effort to insure that this portable and cost effective intervention may be widely adopted by community organizations such as Area Agencies on Aging that serve diverse older adults. PUBLIC HEALTH RELEVANCE: The proposed study has direct relevance to public health. Our goal is to improve older patients' advocacy skills and their ability to communicate with their physicians regarding cancer prevention and general medical care. We expect that the confidence and initiative they will acquire as a result of our intervention will result in improvements in the preventive care they will receive. Having well informed patients, who also respect physician expertise, participating in medical encounters, will improve both efficiency and effectiveness of office visits for the aged. Prevention and early detection of cancer have been recognized as important public health strategies for reducing the burden of chronic and life threatening illnesses, both on society and on individuals. Our focus on communication skills training among low health literacy and minority elders should also contribute to minimizing health disparities.