Individualizing surveillance mammography for older breast cancer survivors

项目总结/摘要 这项工作的长期目标是优化老年乳腺癌的监测乳房X线摄影 幸存者和减少过度筛查的一组急需以证据为基础的，统一的方法， 后续护理。拟议的研究将通过专家共识解决重大知识差距， 前瞻性数据收集。这项研究将为讨论如何/何时停止提供框架 在预期寿命有限的老年乳腺癌幸存者中进行乳房X光检查（他们通常具有低风险， 乳腺癌复发率与筛查人群相似）以及如何最佳地讨论生活 与患者的期望，目标是加强患者与临床医生之间的沟通，以及 初级保健临床医生（PC）和专家之间的关系。在这个独特的，多层次的建议，我们将建立在我们的 之前的工作是就≥75岁乳腺癌幸存者的乳房X线检查和随访护理达成共识， (a)完善专家小组的建议，（B）检查临床医生和患者对这些建议的态度， 建议和讨论预期寿命，以及（c）测试一种通信工具，以促进决策- 通过临床医生和患者的直接参与。 在目标1中，我们将召集专家和患者，完善乳房X光检查的建议， 为年龄≥75岁的乳腺癌幸存者提供随访护理，并进一步发展和认知测试沟通 一个工具，总结了临床医生和患者的建议，重点是如何舒适地包括 舒适地谈论预期寿命。然后，我们将进行30次基于电话的患者访谈， 4-6与肿瘤学家和PC的焦点小组，以获得他们对通信工具的意见，如何 沟通乳房X光检查的益处/风险，以及讨论预期寿命的最佳策略， 停止乳房X光检查和协调护理。在目标2中，我们将使用45 年龄≥75岁的老年乳腺癌幸存者及其肿瘤学家使用干预前后研究。在这里，我们将 研究该工具的可行性和可接受性，以及使用该工具对妇女的意图的影响， 乳房X光检查我们还将探讨跨医学专业的沟通策略。我们假设 我们的沟通工具将是可行的，为患者和提供者所接受，并导致更少的妇女 打算明年接受乳房X光检查。这项研究将为更大规模的试点提供初步数据 最终，前瞻性，随机研究，总体目标是进一步评估影响，改善 协调护理，并传播我们的新的和迫切需要的干预。 这项研究的目标无疑符合NIH和NCI提出的任务， 填补老年患者的研究空白。此外，每年约有7万名年龄≥75岁的女性 在美国被诊断出患有乳腺癌的人和越来越多的老年乳腺癌患者， 努力提高我们提供的后续护理的质量并使其平等，将变得越来越重要。

PROJECT SUMMARY/ABSTRACT The long-term goals of this work are to optimize surveillance mammography use for older breast cancer survivors and decrease overscreening for a group in critical need of evidence-based, unified approaches for follow-up care. The proposed study will address significant knowledge gaps through expert consensus and prospective data collection. This study will provide a framework for discussions on how/when to stop mammography in older breast cancer survivors with limited life expectancy (who typically have a low risk for in- breast recurrences with rates similar to that of screening populations) and how to optimally discuss life expectancy with patients, with the goal to enhance communication between patients and clinicians as well as between primary care clinicians (PCs) and specialists. In this unique, multilevel proposal, we will build on our prior work to develop consensus on mammography and follow-up care for breast cancer survivors aged ≥75 by (a) refining expert-panel recommendations, (b) examining clinician and patient attitudes towards these recommendations and discussing life expectancy, and (c) testing a communication tool to facilitate decision- making, all through direct engagement of clinicians and patients. In Aim 1, we will convene experts and patients to refine recommendations for mammography and follow-up care for breast cancer survivors age ≥75 and further develop and cognitively test a communication tool that summarizes recommendations for clinicians and patients with a focus on how to comfortably include conversations on life expectancy comfortably. We will then conduct 30 telephone-based patient interviews and 4-6 focus groups with oncologists and PCs to obtain their opinions about the communication tool, how to communicate the benefits/risks of mammography, and optimal strategies for discussing life expectancy and cessation of mammography and coordination of care. In Aim 2, we will test the communication tool with 45 older breast cancer survivors age ≥75 and their oncologists using a pre-post intervention study. Here, we will examine the feasibility and acceptability of the tool and the effect of using the tool on women's intentions for mammography. We will also explore communication strategies across medical specialties. We hypothesize that our communication tool will be feasible, acceptable for patients and providers, and lead to fewer women intending to receive mammography in the next year. This study will provide preliminary data for a larger pilot and eventual, prospective, randomized study, with the overarching goal to further assess impact, improve coordination of care, and disseminate our novel and urgently needed intervention. The goals of this study are undoubtedly in line with the missions set forth by the NIH and NCI to address the research gaps in older patients. Further, with approximately 70,000 women age ≥75 per year diagnosed with breast cancer in the United States and a growing population of older breast cancer patients, efforts to improve and equalize the quality of follow-up care we deliver will become increasingly important.