The Impact of Provider Social Networks on Breast Cancer Screening

 描述（由申请人提供）：在美国，寻求减少某些患者癌症筛查的指南通常不会影响临床实践。医生的社会网络-个人之间的关系网-已被证明是一个重要的因素，在创新的扩散，也可能是至关重要的，在设置中的指导方针可能会冲突，有些指导方针可能会寻求回滚，或取消实施，临床实践。这项探索性R21补助金的目的是描述来自医生的社交网络（定义为他们的同事、朋友和家庭成员沿着他们自己的临床实践经验）的信息如何改变关于乳腺癌筛查的看法和建议，以及这些信息如何影响人群筛查率。在目标1中，我们将对医生进行一项全国性调查，以确定他们的乳腺癌筛查建议在多大程度上受到他们与医学同事的经验，被诊断患有乳腺癌的朋友和家人的知识以及与患者的接触的影响。在目标2中，我们将使用调查结果将医生纳入我们现有的基于代理的患者乳腺癌筛查决策模型。由此产生的模型将允许研究医生和患者之间的相互作用，捕获由此产生的反馈回路。使用这个模型，我们将通过改变社交网络如何影响患者和提供者的决策来模拟不同的干预措施。随着网络干预措施的部署越来越多，癌症筛查的证据基础不断发展，拟议的项目将有助于优先考虑可能在改变临床实践方面取得成功的干预措施。

 DESCRIPTION (provided by applicant): In the US, guidelines that seek to reduce cancer screening among certain patients often fail to impact clinical practice. Physician's social networks-the web of relationships among individuals-have been shown to be an important factor in the diffusion of innovation and may also be critical in settings where guidelines may conflict and where some guidelines may seek to roll-back, or de-implement, clinical practice. The objective of this exploratory R21 grant is to characterize how information from physicians' social networks defined as their colleagues, friends, and family members along with experiences from their own clinical practice may alter perceptions and recommendations regarding breast cancer screening and how this information affects population rates of screening. In Aim 1, we will conduct a national survey of physicians to characterize the extent to which their breast cancer screening recommendations are influenced by their experiences with medical colleagues, knowledge of friends and family who have been diagnosed with breast cancer, and encounters with their patients. In Aim 2, we will use the results of the survey to incorporate physicians into our existing agent-based model of patients' breast cancer screening decisions. The resulting model will allow study of interactions between physicians and patients, capturing the resulting feedback loops. Using this model, we will simulate different interventions by altering how social networks influence patient and provider decision making. With network interventions being increasingly deployed and the evidence base for cancer screening continuing to evolve, the proposed project will help prioritize aspects of interventions that may have the greatest likelihood of success in changing clinical practice.