Randomized trial of community health worker-led decision coaching to promote shared decision making for prostate cancer screening among Black male patients and their providers

社区卫生工作者主导的决策辅导随机试验，以促进黑人男性患者及其提供者在前列腺癌筛查方面的共同决策

• 批准号: 9890789
• 负责人: DANIL V. MAKAROV
• 金额: $ 78.81万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-22 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9890789
• 关键词: Adoption; Advisory Committees; Affect; Area; Attitude; Behavior; Clinical; Communication; Community Health Aides; Conflict (Psychology); Control Groups; Cost Measures; Counseling; Decision Aid; Decision Making; Elements; Federally Qualified Health Center; Goals; Healthcare; Intervention; Interview; Judgment; Knowledge; Literature; Malignant Neoplasms; Malignant neoplasm of prostate; Modeling; Outcome; PSA screening; Participant; Patient Care; Patient Preferences; Patients; Perception; Physicians; Population; Population Heterogeneity; Preventive healthcare; Preventive service; Primary Health Care; Procedures; Process; Prostate-Specific Antigen; Provider; Public Health; Randomized; Research; Screening for Prostate Cancer; Self Efficacy; Structure; Structure of base of prostate; Sum; Testing; Time; United States; Vulnerable Populations; base; clinical encounter; community clinic; cost; cost effective; cost effectiveness; cost outcomes; design; efficacy testing; evidence base; experience; group intervention; health care model; high risk; improved; intervention cost; literacy; low socioeconomic status; male; men; patient-clinician communication; preference; primary care setting; program costs; programs; prostate cancer risk; randomized trial; satisfaction; screening; shared decision making

Prostate cancer is the most common non-cutaneous malignancy among men in the United States and affects Black men disproportionately. Experts agree prostate-specific antigen (PSA)–based prostate cancer screening is a preference-sensitive decision and recommend Shared Decision Making (SDM). The US Preventative Services Task Force (USPSTF) recently proposed a revision of their Prostate Cancer Screening Statement, now encouraging that screening decisions happen within a SDM framework based on professional judgment and patient preference. USPSTF has also recognized SDM is underutilized in practice, especially among Black men, and has emphasized the need for research to understand how best to implement and adapt SDM programs within diverse populations. We seek to optimize, evaluate and disseminate a program to help Black men understand their increased risk of prostate cancer and receive guidance sensitive to their values and preferences when deciding about PSA screening. Our group demonstrated the utility of employing a community health worker (CHW) to help Black men decide about PSA screening. Several critical knowledge gaps remain in the literature: 1) will CHW Decision Coaching improve decisions among Black men considering PSA screening? 2) will CHW Decision Coaching improve providers’ experience with PSA counseling? 3) how much will a CHW Decision Coach intervention cost? We propose a CHW-led Decision Coaching program to facilitate SDM for prostate cancer screening among Black men from a primary care Federally Qualified Health Center (FQHC). Patients will be randomized either to 1) receiving a decision aid along with CHW-led Decision Coaching on PSA screening or 2) receiving a decision aid along with CHW-led interaction on an unrelated healthcare topic. Among patients we will assess decision quality and use of PSA screening. Among providers we will assess perceptions of the acceptability and feasibility of the intervention. We will explore communication in both groups. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured in-depth interviews and thematic analysis of clinical encounters. Through a conceptual model that combines elements of the Preventative Health Care Model (PHM) and Informed Decision Making Model, we hypothesize that the decision coaching intervention will positively impact factors that empower preference clarification, decision context, knowledge, and attitudes that will ultimately result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction. Our results will enhance understanding of the efficacy, cost-effectiveness, and sustainability of CHW intervention in a community clinic setting. Findings will inform the subsequent design of a scalable intervention to promote adoption and integration of SDM across contexts and empower high-risk, vulnerable populations.

前列腺癌是美国男性中最常见的非皮肤恶性肿瘤， 黑人不成比例。专家同意前列腺特异性抗原（PSA）为基础的前列腺癌筛查 是一个偏好敏感的决策，并建议共享决策（SDM）。美国代表 服务工作组（USPSTF）最近提出了一项修订他们的前列腺癌筛查声明， 现在鼓励在基于专业判断的SDM框架内进行筛选决策 患者偏好。USPSTF还认识到SDM在实践中未得到充分利用，特别是在黑人中。 并强调有必要进行研究，以了解如何最好地实施和调整可持续发展机制 在不同的人群中。我们寻求优化，评估和传播一个程序，以帮助黑人 男性了解他们患前列腺癌的风险增加，并接受对其价值观敏感的指导， 选择PSA筛查时的偏好。我们的团队展示了使用 社区卫生工作者（CHW）帮助黑人男性决定PSA筛查。几个关键知识 文献中仍然存在差距：1）CHW决策指导是否会改善黑人男性的决策， PSA筛查？2)CHW决策指导是否会改善提供者的PSA咨询体验？3)如何 CHW决策教练的干预费用是多少？我们提出了一个由CHW领导的决策指导计划， 促进SDM在初级保健联邦合格卫生机构的黑人男性中进行前列腺癌筛查 中心（NHC）。患者将随机分配至1）接受决策辅助沿着CHW主导的决策 指导PSA筛查或2）接受决策辅助沿着，并与CHW领导的互动， 健康话题。在患者中，我们将评估决策质量和PSA筛查的使用。提供者之间 我们将评估人们对干预的可接受性和可行性的看法。我们将探讨 两组的沟通。这些结果将通过客观、有效的 量表和定性通过半结构化的深入访谈和主题分析的临床 遭遇通过一个概念模型，该模型结合了替代性医疗保健模式的要素， (PHM)和知情决策模型，我们假设决策辅导干预将 积极影响因素，使偏好澄清，决策背景，知识和态度， 最终将导致偏好一致的决策和决策满意度。我们还假设， 这种干预将提高医生的满意度。我们的研究结果将提高对疗效的理解， 成本效益和社区卫生保健干预在社区诊所环境中的可持续性。调查结果将告知 随后设计一项可扩展的干预措施，以促进在不同背景下采用和整合可持续发展机制， 增强高风险、弱势群体的权能。