Decisions about Cancer Screening in Alzheimer's Disease

项目概要/摘要： 阿尔茨海默病和相关痴呆（AD）以及乳腺癌的发病率随着年龄的增长而增加。 因此，许多患有AD的老年妇女面临着乳腺癌筛查的问题。患有AD 影响妇女的预期寿命和她们参与乳房医疗决策的能力 癌症筛查因此，AD家庭照顾者经常参与决策， 乳房X光检查每年有超过800，000名患有AD的老年妇女接受筛查性乳房X光检查。照顾者 认为与乳房X光检查有关的决策和程序特别紧张，没有数据表明， 乳房X光检查有助于AD女性活得更长或更好。 没有随机试验评估乳房X光筛查的益处和危害，包括AD女性 目前的指南建议不要筛查预期寿命<10年的女性。其基本原理是 这些妇女活不到足够长的时间来体验乳房X光检查延长寿命的好处 筛选相反，筛查这些女性可能会使她们面临身体和心理伤害的风险， 过度诊断、过度治疗、假阳性导致的额外检查以及临床上 不重要的癌症相反，虽然乳房X光检查筛查可能无法帮助老年女性AD患者生存， 更长的时间，它可能有助于更早发现乳腺癌，因为它们更容易治疗。因此， AD患者及其护理人员可以获得信息，以便就筛查做出明智的决定。 决策辅助工具有望提高AD患者的医疗决策质量， 家庭护理人员了解在这一人群中进行乳房X光检查的风险、益处和选择。我们 一个研究小组创建并评估了一种乳腺X光检查决策辅助工具，用于老年AD妇女的护理人员。 该决策辅助工具包括有关预期寿命与AD之间关系的具体信息， 受益于乳房X光检查，乳房X光检查对老年AD女性生活质量的影响， 在做出关于乳腺X射线摄影的决定时， 相对于AD。 我们正在提出关于阿尔茨海默病癌症筛查的决定（DECAD）研究，作为第一个 一项旨在测试AD护理人员的循证决策辅助工具是否可以支持以下决策的研究 乳腺X线摄影和提高有关乳腺癌筛查的医疗决策质量。这个大 一项随机对照试验将招募426名老年AD女性患者和一名来自24岁以下的家庭照顾者， 印第安纳州中部的初级保健实践来测试这种决策辅助。

Project Summary/Abstract: The incidence of both Alzheimer’s disease and related dementias (AD) and of breast cancer increases with age; thus, many older women with AD are faced with questions about breast cancer screening. Having AD impacts a woman’s life expectancy and their ability to participate in her medical decision-making about breast cancer screening. As a result, AD family caregivers are frequently involved in making decisions about mammography. Each year over 800,000 older women with AD receive screening mammography. Caregivers cite decision-making and procedures related to mammograms as particularly stressful and there is no data that mammography screening helps women with AD live longer or better. No randomized trials evaluating the benefits and harms of mammography screening include women with AD and current guidelines recommend not screening women with a life expectancy of <10 years. The rationale is that these women will not live long enough to experience the life prolonging benefits of mammography screening. Instead, screening these women can put them at risk for physical and psychological harm as a result of overdiagnosis, overtreatment, additional tests due to false positives, and the identification of clinically unimportant cancer. Conversely, while mammography screening may not help older women with AD live longer, it may help find breast cancers earlier when they are easier to treat. Therefore, it is important that women with AD and their caregivers have information to make an informed decision about screening. Decision aids have promise to improve the quality of medical decision-making for patients with AD and inform family caregivers about the risks, benefits, and choices about screening mammography in this population. Our team has created and evaluated a mammogram decision aid for use with caregivers of older women with AD. This decision aid includes specific information about the relationship between life expectancy with AD and benefit from mammograms, the impact of mammography on quality of life for older women with AD, and a recognition of the emotions and experience of caregivers when making decisions about mammography for a relative with AD. We are proposing the Decisions about Cancer screening in Alzheimer's Disease (DECAD) study, as the first study to test if an evidence-based decision aid for AD caregivers can support decision-making about mammography and improve the quality of medical decision-making about breast cancer screening. This large randomized controlled trial will recruit 426 dyads of older women with AD and a family caregiver from 24 primary care practices in central Indiana to test this decision aid.