Behavioral Economics and Improving Chemotherapy Decisions for Advanced Cancer

行为经济学和改善晚期癌症的化疗决策

• 批准号: 8765356
• 负责人: Nancy L Keating
• 金额: $ 17.64万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-09 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8765356
• 关键词: Achievement; Address; Advanced Malignant Neoplasm; Age; American; American Cancer Society; American Society of Clinical Oncology; Award; Back; Behavioral; Benefits and Risks; Biomedical Research; Cancer Care Outcomes Research and Surveillance Consortium; Cancer Patient; Caring; Clinical; Clinical Trials; Cognitive; Colorectal Cancer; Communities; Consent Forms; Data; Decision Making; Development Plans; Diagnosis; Disease; Disseminated Malignant Neoplasm; Economics; Environment; Evidence based intervention; Faculty; Focus Groups; Foundations; Funding; Future; Goals; Guidelines; Health; Healthcare; Home environment; Individual; Internal Medicine; Intervention Studies; Journals; Lead; Life; Life Extension; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medicine; Mentors; Mentorship; Mid-Career Clinical Scientist Award (K24); Midcareer Investigator Award in Patient-Oriented Research; Mutation; National Cancer Institute; Outcome; Palliative Care; Patient Care; Patients; Peer Review; Performance Status; Physicians; Postdoctoral Fellow; Provider; Publications; Quality of Care; Reading; Refractory; Regrets; Reporting; Research; Research Personnel; Research Project Grants; Rewards; Science; Scientist; Societies; Students; Symptoms; Testing; Time; Update; Work; Writing; advanced disease; anticancer research; base; cancer care; cancer therapy; career; career development; chemotherapy; end of life; improved; oncology; outcome forecast; palliative; patient oriented; patient oriented research; preference; prognostic; programs; skills; success; theories

DESCRIPTION (provided by applicant): In 2012, more than 1.6 million Americans were diagnosed with cancer and about 577,000 died of cancer. Evidence, including work that I have conducted, suggests that many patients with cancer do not receive the care that is recommended by guidelines, and such deficiencies are associated with worse outcomes. Evidence also suggests that many patients do not receive care that is concordant with their preferences, particularly for patients with advanced cancers. This application for a NCI K24 Midcareer Investigator Award in Patient Oriented Research seeks support to provide Dr. Keating with necessary protected time to further develop her capabilities and expertise in cancer-related patient oriented research and to expand her ability to mentoring promising junior investigators in patient-oriented research. Dr. Keating's prior research has focused on: (1) understanding patient, provider, and organizational factors influencing the care delivered to patients with cancer and (2) understanding outcomes for cancer patients in non-trial settings. Much of this work has identified challenges in the receipt of high-quality care. Her research has resulted in more than 120 peer-reviewed original research articles in top general medicine and oncology journals. She has a strong and successful record of independent research funding from the National Cancer Institute and foundations, including the American Cancer Society, the Prostate Cancer Foundation, and the Komen for the Cure Foundation. The high quality of her research has been recognized by her induction into the American Society for Clinical Investigation, an honor society recognizing individuals with an outstanding record of scholarly achievement in biomedical research before the age of 45. Dr. Keating's immediate career goals and objectives are to acquire skills in behavioral economics, decision science, and intervention research to identify and test promising opportunities to improve care for patients with cancer, to further her work in understanding the reasons for sub-optimal care delivered to cancer patients, and to continue to provide outstanding mentorship and attract new investigators to mentor in the conduct of rigorous patient-oriented research focused on improving cancer care and outcomes. The K24 award will be instrumental in achieving these objectives. Dr. Keating's career development plan involves formal coursework, seminars, targeted readings, and mentored research. She will study behavioral economics and decision science theory and their applications to health care, and particularly patients' decisions about treatment for cancer. She will also develop skills in intervention research. She will work closely throughout the duration of the award with a group of highly skilled clinician researchers and scientists, including Drs. Michael Norton, Kevin Volpp, Peter Ubel, Eric Winer, and Anthony Back. Dr. Keating works in a rich environment with ready access to talented collaborators and trainees and support staff. She has demonstrated a commitment to mentoring young investigators in patient-oriented research, with 26 senior author publications since 2012, and increasing successes among her prior mentees. She has access to trainees from across the Harvard community, including students, residents, post-doctoral fellows, and junior faculty, and she has a variety of ongoing projects that provide excellent opportunities for mentoring junior investigators in patient-oriented research in oncology. Dr. Keating's research project seeks to apply behavioral economic and decision science principles to improve patients' understanding of the goals of chemotherapy for advanced cancer by updating and broadening the default information that patients receive in the chemotherapy consent form. Evidence from the fields of behavioral economics and decision science suggests that individuals do not always make rational decisions that might bring the best outcomes for them. Individuals are typically overly optimistic, are biased towards rewards in the present vs. the future, are susceptible to the way that information is framed, have a tendency to select default options, and are regret averse. Other research has shown that most patients with metastatic cancer do not understand the goals of chemotherapy. A revised consent form can serve as a "nudge" to physicians to provide patients with information about the goals of chemotherapy. It also gives patients written information about goals of chemotherapy to take home with them. Better information should make patients better informed about the goals of chemotherapy and may ultimately decrease the use of later lines of chemotherapy, where benefits are likely to be smaller. Dr. Keating's project has two aims. First, she and her mentees will revise the chemotherapy consent form based on focus groups with patients and physicians. The revised consent form will include information about the purpose of chemotherapy and information about the likely duration of life extension when life extension is a goal. Second, they will assess whether the use of this consent form can increase patients' understanding of the goals of chemotherapy and prognostic understanding and decrease use of late-line chemotherapy for advanced cancer.

描述（申请人提供）：2012年，超过160万美国人被诊断患有癌症，约577，000人死于癌症。证据，包括我所做的工作，表明许多癌症患者没有得到指南推荐的护理，这些缺陷与更糟糕的结果有关。有证据还表明，许多患者，特别是晚期癌症患者，得不到符合其偏好的护理。这项NCI K24中期职业研究者奖的申请旨在为Keating博士提供必要的保护时间，以进一步发展她在癌症相关的患者导向研究方面的能力和专业知识，并扩大她在患者导向研究中指导有前途的初级研究人员的能力。Keating博士之前的研究集中在：（1）了解影响癌症患者护理的患者，提供者和组织因素;（2）了解非试验环境中癌症患者的结局。这项工作的大部分查明了在接受高质量护理方面的挑战。她的研究在顶级普通医学和肿瘤学期刊上发表了120多篇同行评审的原创研究文章。她有一个强大的和成功的记录，从国家癌症研究所和基金会，包括美国癌症协会，前列腺癌基金会和科门的治疗基金会的独立研究资金。她的高质量的研究已被她的感应到美国临床研究学会，一个荣誉社会承认个人在45岁之前在生物医学研究的学术成就的杰出记录的认可。基廷博士的近期职业目标和目标是获得行为经济学，决策科学和干预研究的技能，以确定和测试有希望的机会，以改善癌症患者的护理，进一步了解她的工作为癌症患者提供次优护理的原因，并继续提供优秀的指导，吸引新的研究人员指导开展严格的以患者为导向的研究，重点是改善癌症护理和结果。K24奖将有助于实现这些目标。基廷的职业发展计划包括正式的课程，研讨会，有针对性的阅读和指导研究。她将研究行为经济学和决策科学理论及其在医疗保健中的应用，特别是患者对癌症治疗的决定。她还将发展干预研究的技能。她将在整个任期内密切合作， 该奖项与一组高技能的临床研究人员和科学家，包括博士迈克尔诺顿，凯文沃尔普，彼得乌贝尔，埃里克维纳和安东尼回来。Keating博士在一个丰富的环境中工作，随时可以接触到有才华的合作者、学员和支持人员。她已经证明了在以患者为导向的研究中指导年轻研究人员的承诺，自2012年以来有26篇资深作者出版物，并且在她以前的学员中取得了越来越多的成功。她可以接触到来自整个哈佛社区的学员，包括学生、住院医生、博士后研究员和初级教师，她还有各种正在进行的项目，为指导初级研究人员进行以患者为导向的肿瘤学研究提供了极好的机会。Keating博士的研究项目旨在应用行为经济学和决策科学原理，通过更新和扩大患者在化疗同意书中收到的默认信息，提高患者对晚期癌症化疗目标的理解。行为经济学和决策科学领域的证据表明，个人并不总是做出可能为他们带来最佳结果的理性决策。个人通常过于乐观，偏向于现在与未来的奖励，容易受到信息框架的影响，倾向于选择默认选项，并且后悔。其他研究表明，大多数转移性癌症患者不了解化疗的目标。修订后的同意书可以“推动”医生向患者提供有关化疗目标的信息。它还为患者提供有关化疗目标的书面信息，以便带回家。更好的信息应该使患者更好地了解化疗的目标，并可能最终减少后期化疗的使用，后者的益处可能较小。基廷博士的项目有两个目标。首先，她和她的学员将根据患者和医生的焦点小组修改化疗同意书。修订后的知情同意书将包括有关化疗目的的信息，以及有关延长生命的可能持续时间的信息。其次，他们将评估使用该同意书是否可以增加患者对化疗目标和预后的理解，并减少晚期癌症晚期化疗的使用。