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

描述（由申请人提供）：我们计划实施一个新颖的，基于社区的教育项目，告知和激励缺乏服务的老年人与他们的医生建立伙伴关系，以预防癌症为共同目标。采用随机对照试验（RCT），我们将评估我们的社会学习理论为基础的干预，促进病人参与，以加强以病人为中心的医疗服务的效果。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。具体而言，我们提出了一个针对老年人的多模式健康沟通培训计划。这种教育干预（“畅所欲言”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，干预有望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。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，并报告对自己的保健服务更满意。“畅所欲言”促进讨论组的参与者（N=480）将与“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巧。该研究将随机选择参与我们之前研究的社区居住的老年人，以及参加由地区老龄化机构（AAA）赞助的老年中心营养计划的社区老年人。通过比较干预前评估与2周、6个月和12个月的电话随访评估，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支持，因为他们可能会影响干预的吸收。我们根据进行随机对照试验的干预研究（CONSORT）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，我们还将考虑基于医疗保险索赔数据和AAA项目利用率数据的客观指标。我们将在定量数据分析中使用具有固定效应和随机效应的多层模型。采用混合方法设计，我们还将包括一个定性研究组成部分，该研究基于对60名参与者的深度访谈，这些参与者是根据项目效益的高低选择的。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，减少癌症预防和护理方面的健康差距。我们计划进行积极的宣传工作，以确保这种可携带且具有成本效益的干预措施可以被社区组织广泛采用，例如为不同老年人服务的地区老龄机构。

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.