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

老年人癌症预防和护理方面的医疗保健合作伙伴 - 竞争更新

基本信息

批准号：
8598855
负责人：
EVA KAHANA
金额：
$ 26.01万
依托单位：
CASE WESTERN RESERVE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-30 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8598855
关键词：
Active Learning Address Adopted Advocacy Age Aging Appointment Area Attention Cancer Control Caring Characteristics Chronic Clinical Communication Communities Competence Complement Control Groups Data Data Analyses Decision Aid Decision Making Disadvantaged Education Educational Intervention Effectiveness Elderly Evaluation Foundations Funding Future Goals Guidelines Health Health Communication Health Promotion Healthcare Individual Intervention Intervention Studies Interview Judgment Lead Learning Life Low income Medical Medicare claim Methods Minority Mission Modality Modeling National Cancer Institute Office Visits Outcome Participant Patient Education Patient Outcomes Assessments Patient Participation Patient advocacy Patients Perception Physicians Play Population Study Prevention Preventive Primary Care Physician Process Public Health Randomized Randomized Controlled Trials Readiness Recommendation Relative (related person)Reporting Research Research Design Resources Risk Role Screening for cancer Societies Telephone Testing Time Training Training Programs Visit aged base cancer care cancer prevention community organizations cost effective design diaries empowerment ethnic minority population follow-up forging group intervention health disparity health literacy improved indexing insight intervention effect intervention program multilevel analysis novel nutrition older patient patient oriented post intervention programs public health relevance rehearsal satisfaction screening skills skills training social social cognitive theory uptake user-friendly

项目摘要

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.

描述(由申请者提供)：我们计划实施一项新颖的、以社区为基础的教育计划，以告知和激励服务不足的老年人与他们的医生建立伙伴关系，将癌症预防作为共同目标。使用随机对照试验(RCT)，我们将评估我们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中的卫生保健伙伴关系研究结果的基础上。具体地说，我们建议为老年人提供多模式的健康沟通培训计划。这项教育干预(“直言不讳”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，这项干预预计将导致老年人和他们的初级保健医生之间关于癌症预防和筛查的讨论增加。预计参与干预的参与者还将从他们的医生那里收到更多针对年龄和风险的预防建议，并报告对他们的医疗保健更满意。“发声”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。后一方案涉及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，并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能。这项研究将在随机选择的参加过我们先前研究的社区居住的老年人中进行，并在参加由地区老龄机构(AAA)赞助的老年中心营养计划的社区老年人中进行。根据干预前评估与2周、6个月和12个月电话随访评估的比较，我们将确定干预的短期和长期影响。我们将考虑参与者的个人特征以及他们的医生的背景和支持，因为他们可能会影响对干预的接受。我们根据进行随机对照试验的干预研究(COSORT)指南设计了这项研究，并将仔细评估治疗的保真度。除了患者报告的结果外，我们还将考虑基于联邦医疗保险索赔数据和AAA计划利用数据的客观指数。在我们的定量数据分析中，我们将使用具有固定和随机影响的多水平模型。使用混合方法设计，我们还将包括一个定性研究部分，基于对60名参与者的深入采访，这些参与者是根据计划的高效益和低效益挑选出来的。我们的研究与国家癌症研究所改善癌症控制和减少癌症预防和护理方面的健康差距的使命密切相关。我们计划进行积极的传播努力，以确保这种便携和成本效益高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地区老龄机构。