A Patient-Centered Approach to Integration of Life Expectancy into Treatment Decision Making for Patients with Genitourinary Malignancy

以患者为中心的方法，将预期寿命纳入泌尿生殖系统恶性肿瘤患者的治疗决策中

• 批准号: 10198865
• 负责人: TIMOTHY DASKIVICH
• 金额: $ 18.14万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198865
• 关键词: Address; Aftercare; Age; Agreement; Area; Communication; Communities; Complex; Conflict (Psychology); Consensus; Consultations; Counseling; Data; Data Analyses; Decision Analysis; Decision Making; Exercise; Feedback; General Population; Genitourinary system; Goals; Guidelines; Health Services Research; High-Risk Cancer; Incidence; Individual; Indolent; Internet; Intervention; Interview; Kidney; Life Expectancy; Longevity; Malignant Neoplasms; Malignant neoplasm of prostate; Malignant neoplasm of urinary bladder; Medical Oncologist; Methods; Modeling; Morbidity - disease rate; Newly Diagnosed; Patients; Physicians; Positioning Attribute; Prostate; Quality of life; Radiation Oncologist; Renal carcinoma; Research Methodology; Risk; Role; Series; Specialist; Statistical Models; Structure; Testing; Time; Transcript; Treatment Effectiveness; Urogenital Cancer; Urologist; Value of Life; Visit; aggressive therapy; base; cancer risk; cancer therapy; clinical practice; comorbidity; crowdsourcing; design; improved; men; mortality; muscle invasive bladder cancer; overtreatment; patient oriented; preference; randomized trial; shared decision making; side effect; targeted delivery; tool; treatment choice; tumor

PROJECT SUMMARY Life expectancy (LE) is a critical factor in treatment decision making for men with genitourinary (GU) malignancies, since limited LE predicts lower likelihood of sufficient longevity to benefit from treatment, higher morbidity after treatment, and decreased effectiveness of treatment. Despite a prominent role of LE in guidelines, patients with limited LE are often overtreated for indolent cancers and undertreated for high-risk cancers. Data from non-cancer treatment settings suggest that this may be due to physician-level barriers precluding effective communication of LE. Surprisingly little is known about how LE is currently communicated in treatment consultations as well as patient and physician perspectives on how it should be ideally integrated. Furthermore, patient and community opinions on what LE cutoffs are best suited to “non-aggressive treatment” are lacking. In this application, we propose a series of incremental studies with an overarching goal of building a patient-centered approach to integrating LE into treatment decision making for patients with prostate, kidney, and bladder cancer. (1) First, we will delineate how LE is currently communicated to patients with GU cancers through qualitative analysis of treatment consultation transcripts of patients with early-stage prostate, kidney, and muscle-invasive bladder cancer. We believe that the current communication of LE will be highly variable in terms of incidence of discussion, mode of communication, temporal positioning within the visit, emotive context, and time devoted to the topic. (2) Second, we will engage patient and specialist physician stakeholders through structured interviews to identify barriers and opportunities to improve communication information about LE in cancer treatment decision making. (3) Third, we will use online crowdsourcing of conjoint analysis (CA) as a platform to study how patients and the community value LE relative to other tradeoffs typically encountered in prostate, kidney, and bladder cancer treatment decision making. We will analyze crowdsourced conjoint analysis data to identify situations (based on age, comorbidity, and tumor risk) where LE appears to drive “non-aggressive” treatment choices, which will allow for targeting of LE interventions. (4) Fourth, we will test in a randomized trial whether patient-specific LE estimates— communicated in a patient-centered approach as determined in the first and second aims and targeted to specific high-yield situations as identified in the third aim—along with LE-specific conjoint analysis data improve decisional conflict, quality of LE data discussed, and reduce overtreatment of GU malignancies. We anticipate that this patient-centered approach will improve shared decision making and ultimately result in better treatment choices for patients with GU cancers and limited LE.

项目概要 预期寿命 (LE) 是男性泌尿生殖系统 (GU) 患者治疗决策的关键因素 恶性肿瘤，因为有限的 LE 预测足够长的寿命以从治疗中受益的可能性较低，因此 治疗后发病率和治疗效果下降。尽管 LE 在 根据指南，有限 LE 患者常常因惰性癌症而过度治疗，而因高危癌症而治疗不足 癌症。来自非癌症治疗环境的数据表明，这可能是由于医生层面的障碍造成的 妨碍 LE 的有效沟通。令人惊讶的是，目前人们对于 LE 的传播方式知之甚少 治疗咨询以及患者和医生对如何理想整合的看法。 此外，患者和社区对于 LE 截止值最适合“非积极治疗”的意见 缺乏。在此应用中，我们提出了一系列增量研究，其总体目标是构建 一种以患者为中心的方法，将 LE 纳入前列腺、肾脏、 和膀胱癌。 (1) 首先，我们将描述目前如何向 GU 癌症患者传达 LE 通过对早期前列腺、肾脏、 和肌肉浸润性膀胱癌。我们相信，当前 LE 的通信将在以下方面发生很大变化： 讨论的发生率、沟通方式、访问中的时间定位、情感 上下文以及专门用于该主题的时间。 (2) 其次，我们将聘请患者和专科医生 通过结构化访谈与利益相关者沟通，找出改善沟通的障碍和机会 有关 LE 在癌症治疗决策中的信息。 （三）第三，我们将利用网络众包的方式 联合分析 (CA) 作为一个平台来研究患者和社区相对于其他人如何评价 LE 前列腺癌、肾癌和膀胱癌治疗决策中通常会遇到的权衡。我们将 分析众包联合分析数据以确定情况（基于年龄、合并症和肿瘤风险） LE 似乎推动了“非攻击性”治疗选择，这将允许针对 LE 干预措施。 (4) 第四，我们将在一项随机试验中测试患者特定的 LE 估计值是否—— 按照第一个和第二个目标确定的以患者为中心的方法进行沟通，并针对 第三个目标中确定的特定高收益情况以及 LE 特定联合分析数据 改善决策冲突、讨论的 LE 数据质量，并减少 GU 恶性肿瘤的过度治疗。我们 预计这种以患者为中心的方法将改善共同决策并最终导致 为 GU 癌症和有限 LE 患者提供更好的治疗选择。