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，以癌症预防为共同目标。使用随机对照试验（RCT），我们将评估我们的社会学习理论为基础的干预措施，促进患者参与，以加强以患者为中心的医疗保健的有效性。这项研究建立在我们正在进行的癌症预防和护理卫生保健伙伴关系研究的基础上。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（“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上，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。参与干预的人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感到更满意。将“大声说出来”促进讨论组的参与者（N=480）与“连接”注意力控制组的参与者（N=480）进行比较。后一个方案涉及加强公民和社会参与的重要目标。干预方案将以小组形式进行，并提供方便用户的体验式学习，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社区居住的老年人中进行，这些老年人参加了我们以前的研究，并参加了由地区老龄化机构（AAA）赞助的老年中心营养计划。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和他们的医生的背景和谨慎性，因为他们可能会影响干预的吸收。我们根据干预研究（CONSORT）进行RCT的指导原则设计了这项研究，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计划利用率数据的客观指数。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，该部分基于对60名参与者的深入访谈，这些参与者是根据高与低的计划收益选择的。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中的健康差异。我们计划积极宣传，以确保这种便携式和成本效益的干预措施可能会被社区组织广泛采用，如地区老龄化机构，为不同的老年人服务。

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.