Understanding Older Adults' Perspectives on How to Incorporate Life Expectancy in Cancer Screening

了解老年人对如何将预期寿命纳入癌症筛查的看法

• 批准号: 8958982
• 负责人: Nancy Schoenborn
• 金额: $ 12.15万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8958982
• 关键词: Address; Adult; Advocate; Age; Age-Years; Area; Benefits and Risks; Cause of Death; Characteristics; Clinic; Clinical; Communication; Communities; Comorbidity; Data; Development; Early Diagnosis; Elderly; Fostering; Health; Health Status; Individual; Internal Medicine; Intervention; Interview; Knowledge; Life; Life Expectancy; Malignant Neoplasms; Mentored Patient-Oriented Research Career Development Award; Morbidity - disease rate; Patients; Population; Recommendation; Recruitment Activity; Relative (related person); Research; Research Methodology; Research Personnel; Risk; Role; Sampling; Screening for cancer; Structure; Suggestion; Surveys; Time; United States National Institutes of Health; Variant; Work; base; cancer care; career development; clinical practice; functional status; improved; innovation; mortality; novel; older patient; patient oriented; preference; public health relevance; screening; tool; uptake

 DESCRIPTION (provided by applicant): Cancer is the second leading cause of death among older adults. Cancer screening can lower cancer- related mortality and morbidity but may be associated with significant harms and burdens in older adults. Research has shown that it may take 10 years for people who are screened for cancer to benefit (have lower risk of dying from cancer), compared to those who are not screened. However, harms, including complications and burdens from screening, can occur in the short term. Therefore, cancer screening in older adults with limited life expectancy may inappropriately subject them to harm with they are unlikely to live long enough to benefit. Compared to younger populations, older adults of the same age can be much more heterogeneous in their health status and life expectancies. Older adults with very limited life expectancy are still frequently screened for cancer. Healthy older adults with relatively long life expectancies-who may still benefit from cancer screening-are under-screened. Therefore, it is critically important to communicate and incorporate life expectancy in cancer screening among older adults so that individualized risks and benefits of screening are presented for patients to make informed decisions aligned with their preferences. How to best communicate and incorporate life expectancy in cancer screening of older adults is not well- defined. Multiple tools incorporating individuals' functional status and co-morbidities have been developed to predict life expectancy among older adults. However, it is not clear how frequently or how appropriately these tools are used in clinical practice. One barrier to their uptake is that clinicians have difficulty discussing life expectancy with their older patients. Clinicians lack a clear understanding of older adults' preferences for talking about life expectancy in cancer screening. In this context, it is essential to better understand how older adults perceive the role of life expectancy in cancer screening and what their preferences are for life expectancy communication with their clinicians in the screening context. This proposal fills an important research gap by aiming to better understand older adults' preferences regarding how to communicate and incorporate life expectancy in cancer screening. Because little is known about this area, we will first use a qualitative in-depth study to understand the range of patient perspectives in Aim 1; we will then determine the applicability of these perspectives in a larger, nationally representative population in Aim 2. This innovative work addresses the knowledge gap in understanding older adults' preferences for how to communicate and incorporate life expectancy in cancer screening. The proposed project will provide the much needed empiric data to inform the development of best practices and interventions to improve individualized, patient-centered cancer screening for older adults.

 描述(申请人提供)：癌症是老年人的第二大死因。癌症筛查可以降低与癌症相关的死亡率和发病率，但可能与老年人的重大伤害和负担有关。研究表明，与未接受癌症筛查的人相比，接受癌症筛查的人可能需要10年时间才能受益(死于癌症的风险较低)。然而，危害，包括筛查带来的并发症和负担，可能在短期内发生。因此，对预期寿命有限的老年人进行癌症筛查可能会不适当地使他们受到伤害，因为他们不太可能活得足够长而受益。与年轻人相比，相同年龄的老年人在健康状况和预期寿命方面可能更加不同。预期寿命非常有限的老年人仍然经常接受癌症筛查。预期寿命相对较长的健康老年人--他们仍然可能受益于癌症筛查--没有得到充分的筛查。因此，至关重要的是，在老年人的癌症筛查中沟通并纳入预期寿命，以便为患者提供个性化的筛查风险和好处，以便做出与他们的偏好一致的明智决定。在老年人癌症筛查中，如何最好地沟通和纳入预期寿命并没有明确的定义。已经开发了多种工具来预测老年人的预期寿命，这些工具结合了个人的功能状况和合并症。然而，目前尚不清楚这些工具在临床实践中的使用频率或适当程度。他们被接受的一个障碍是，临床医生很难与他们的老年患者讨论预期寿命。临床医生对老年人在癌症筛查中谈论预期寿命的偏好缺乏明确的理解。在这种情况下，必须更好地了解老年人如何看待预期寿命在癌症筛查中的作用，以及他们在筛查背景下与临床医生沟通预期寿命的偏好是什么。这项建议填补了一个重要的研究空白，旨在更好地了解老年人在如何沟通和将预期寿命纳入癌症筛查的偏好。由于对这一领域知之甚少，我们将首先使用定性的深入研究来了解AIM 1中患者视角的范围；然后我们将确定这些视角在AIM 2中更大的、具有全国代表性的人群中的适用性。这项创新工作解决了在理解老年人在如何沟通和将预期寿命纳入癌症筛查中的偏好方面的知识缺口。拟议的项目将提供急需的经验性数据，为制定最佳实践和干预措施提供信息，以改进针对老年人的个性化、以患者为中心的癌症筛查。