Preparing to Discuss Genetic Test Results for Colorectal Cancer Risk

准备讨论结直肠癌风险的基因检测结果

• 批准号: 8698784
• 负责人: BRIAN J ZIKMUND-FISHER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-11-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8698784
• 关键词: Address; Affect; Age; Area; Attitude; Behavior; Behavioral; Belief; Blood; Caring; Characteristics; Cheek structure; Cognitive; Colon; Colorectal; Colorectal Cancer; Communication; Communication Barriers; Communication Methods; Comprehension; DNA; Data; Development; Disease; Effectiveness; Elements; Family; Family history of; Family member; Feces; Future; Gene Mutation; Genetic; Genetic Markers; Genetic Materials; Genetic Risk; Genetic screening method; Genomics; Guidelines; Health; Health Services; Healthcare; Individual; Inherited; Investigator-Initiated Research; Judgment; Label; Learning; Mails; Malignant Neoplasms; Medical center; Medicine; Methods; Michigan; Mutation; Odds Ratio; Patients; Polyps; Population; Primary Health Care; Professional counselor; Property; Provider; Randomized; Reaction; Recording of previous events; Regimen; Relative Risks; Reporting; Research; Research Infrastructure; Research Proposals; Resources; Risk; Risk Factors; Sampling; Screening for cancer; Series; Services; Source; Surveys; Swab; Symptoms; Techniques; Test Result; Testing; Training; Trust; Veterans; Visual; Work; abstracting; base; cancer risk; colorectal cancer screening; design; disorder risk; emotional reaction; evidence base; expectation; experience; high risk; improved; innovation; novel; patient expectation; patient population; programs; research study; risk perception; screening; tumor

Proposal Abstract: Project Background: Multiple genetic markers for colorectal cancer (CRC) risk have been identified, and while practical tests for CRC risk are not yet available, such tests are both plausible and representative of the types of applications of genomic medicine currently being contemplated. Such tests could be used in the future by VA primary care clinicians to tailor cancer screening regimens to each individual's personal risk. Unfortunately, current approaches to communicating genetic risks (developed for genetic counselors to use with Mendelian diseases) are impractical and perhaps unnecessary in a VA primary care context. Furthermore, patient acceptance of genetic testing initiatives within VA may depend on the communication techniques used by VA clinicians to discuss test results, on whether the particular attributes and formats of the tests performed match patient's prior expectations about genetic tests, and on whether the reasons used to justify genetic testing make sense to veterans. Project Objectives: This proposal will experimentally evaluate different methods of communicating CRC-predictive genetic test results to VA patients in order to identify those approaches that (a) optimize comprehension and recall of the information, (b) generate consistent levels of risk perceptions and perceived vulnerability across different types of patients, (c) evoke the greatest trust in the validity of the test and (d) result in guideline-adherent CRC screening intentions. It will also seek to identify what properties of a CRC-predictive genetic test and justifications for genetic testing influence VA patient expectations about the test, their acceptance of the use of genetic testing for their care, and/or their reactions to the test results. Lastly, it will assess how well VA clinicians' beliefs about what matters to veterans in this context correspond with VA patient's actual beliefs and attitudes. Project Methods: The project consists of three distinct elements: (1) A series of 4 iterative surveys of veterans and family members (1000 per survey) at 2 VA medical centers will incorporate randomized controlled manipulations of hypothetical scenarios to identify which communication factors and test attributes most influence patient understanding and reactions to genetic test results. Examples of factors include presenting results as a list of mutations vs. an aggregate risk score, whether the DNA sample is derived from stool vs. blood, and whether the patient is being tested due to a family history of CRC or a broader age-based criterion. Results from each survey will be used to identify active factors and thus inform the design of later surveys. (2) A national mailed survey of 2000 veterans age 40 and older will confirm and expand our findings to veteran populations outside of Southeastern Michigan. (3) A national mailed survey of 500 VA primary care clinicians will assess whether clinicians understand what factors affect patients' reactions to genetic test results.

提案摘要： 项目背景：已经确定了结直肠癌（CRC）风险的多种遗传标记， 虽然CRC风险的实际测试还不可用，但这种测试是合理的， 代表了目前正在考虑的基因组医学的应用类型。这样的测试 VA初级保健临床医生将来可以使用它来为每个人定制癌症筛查方案。 个人的个人风险。不幸的是，目前的方法来沟通遗传风险（发达国家） 对于遗传咨询师使用孟德尔疾病）是不切实际的，也许是不必要的， 初级保健背景。此外，患者接受VA内的基因检测计划可能 取决于VA临床医生讨论测试结果时使用的沟通技术， 所进行的测试的特定属性和格式与患者先前关于遗传的期望相匹配， 测试，以及用于证明基因测试的理由是否对退伍军人有意义。 项目目标：本提案将通过实验评估不同的沟通方法 对VA患者进行CRC预测性基因检测结果，以确定（a）优化 对信息的理解和回忆，（B）产生一致的风险感知水平， 不同类型患者的感知脆弱性，（c）唤起对有效性的最大信任 测试和（d）导致遵循指南的CRC筛查意图。它还将设法查明 CRC预测基因检测的性质和基因检测的理由影响VA患者 对测试的期望，他们对使用基因检测进行护理的接受程度，和/或他们的 对测试结果的反应。最后，它将评估VA临床医生对重要因素的信念， 退伍军人在这种情况下符合退伍军人患者的实际信念和态度。 项目方法：该项目包括三个不同的元素：（1）一系列的4个迭代调查， 退伍军人和家庭成员（每次调查1000人）在2个退伍军人医疗中心将纳入随机 对假设场景进行受控操作，以确定哪些沟通因素和测试 最影响患者对基因检测结果的理解和反应的属性。因素的示例 包括将结果呈现为突变列表与总风险评分，DNA样品是否 来源于粪便与血液，以及患者是否因CRC家族史或 更广泛的年龄标准。每次调查的结果将用于确定积极因素， 为以后的调查设计提供信息。(2)一项针对2000名40岁及以上退伍军人的全国性邮寄调查将 确认并将我们的发现扩展到密歇根州东南部以外的退伍军人群体。(3)国家 500名VA初级保健临床医生的邮寄调查将评估临床医生是否了解哪些因素 影响患者对基因检测结果的反应。