Patient Risk Perception and Decision-Making about Adherence to Repeat Cancer Scr

患者对重复癌症 Scr 坚持的风险认知和决策

• 批准号: 10310741
• 负责人: Christopher Gillespie
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310741
• 关键词: Adherence; Affect; Age; Area; Benefits and Risks; Biopsy; Breast Cancer Detection; Caring; Clinical; Collaborations; Communication; Complex; Data; Decision Making; Development; Elements; Eligibility Determination; Evaluation; Failure; Family; Focus Groups; Frequencies; Goals; Health; Health Promotion; Healthcare; Image; Interview; Knowledge; Malignant Neoplasms; Malignant neoplasm of lung; Methodology; Modeling; Oncology; Outcome; Participant; Patient risk; Patient-Centered Care; Patients; Perception; Preventive; Process; Provider; Qualitative Research; Recommendation; Recording of previous events; Reporting; Research; Risk; Risk Factors; Screening Result; Screening for cancer; Source; Symptoms; Testing; Time; To specify; Tobacco use; Uncertainty; Variant; Veterans; Woman; Work; cancer risk; compliance behavior; design; disorder prevention; empowered; empowerment; experience; follow-up; health belief; improved; innovation; insight; lung cancer screening; malignant breast neoplasm; outreach; patient oriented; preference; process repeatability; programs; risk perception; routine screening; screening; screening program; shared decision making; success; uptake

Background: VA seeks to promote patient-centered care in which Veterans' personal values and goals drive health care plans. Involving patients in their care can produce better health outcomes. We currently have little understanding of how Veterans make decisions about returning for repeat screening, including how results of prior screening tests affect their risk perceptions, and how other sources of information influence adherence decisions. The Knowledge-Empowerment-Values and Health Belief models have been applied to decisions about screening uptake. This study will extend that model to account for repeat screening decisions. Significance: Patients' decisions to engage in routine screening and return for repeat screening are at the core of the success or failure of VA initiatives to improve screening. Using breast cancer screening (BCS) and lung cancer screening (LCS) as cases, this work will generate greater understanding of how perceptions of risk change throughout the screening process. We will develop patient-driven materials for information that can given to patients prior to screening, as well as included in the reporting of screening results, that can inform communication between providers and patients decision-making that is Veteran-centered. These findings will also be able to be extended beyond lung and breast cancer screening to other cancer screening programs. Innovation and Impact: This study is unique in that we will be using multiple programs of cancer screening as cases to understand repeat screening decision-making. Lung cancer and breast cancer screening are cases with important similarities and differences that offer opportunities to more fully examine the many factors that Veterans consider when deciding to return, or not, for repeat screening. In doing so, we will develop a broader understanding of how Veterans engage with the screening process and how perceptions of risk change throughout this process. This may also inform the implementation of shared decision-making and patient-centered care in screening programs for other conditions that involve repeated routine screenings. Specific Aims: Aim 1-Characterize elements that influence patients' decisions about repeat cancer screening. Aim 1a – Ascertain how veterans who are undergoing lung and breast cancer screening interpret the results of screening exams, revise their perceptions of risk, and make decisions about repeat LCS and BCS. Aim 1b – Identify factors that influence how Veterans make decisions about repeat cancer screening. The focus will be on determining the variety of sources of information Veterans have utilized as they refine their perceptions of risk and vulnerability, and an evaluation of the styles and formats they feel would be useful. Aim 2 – Contrast the perceptions of risk and the screening experiences of Veterans undergoing lung and breast cancer screening to specify a model of decision-making in repeat cancer screening. Aim 3 – Develop patient-driven materials and that will optimize patient-centered decisions about repeat cancer screening. Methodology: This is a longitudinal qualitative study of Veterans' decisions about returning for repeat screening for LCS and BCS. The study is designed to optimize informative comparisons between LCS and BCS toward the development of a generalized understanding of repeat cancer screening decision-making. We will interview 35 Veterans who have initiated LCS and 35 Women Veterans who have initiated BCS. We will attempt to interview participants at 3 time points: 1) before initial screening, 2) shortly after initial screening, and 3) after recommended repeat screening (annual, or surveillance). We will compare and contrast these experiences to inform development of a conceptual model of repeat cancer screening decision-making. Next Steps/Implementation: We will work with an expert panel to develop patient-centered materials to assist Veterans in making decisions about repeat cancer screening. Our operational partners will assist with disseminating materials to patients and providers through messaging campaigns and other outreach efforts.

背景：退伍军人管理局致力于促进以患者为中心的护理，其中退伍军人的个人价值观和目标驱动 医疗保健计划。让患者参与护理可以产生更好的健康结果。我们目前拥有的很少 了解退伍军人如何决定返回进行重复筛查，包括结果如何 先前的筛查测试会影响他们的风险认知，以及其他信息来源如何影响依从性 决定。知识赋权价值观和健康信念模型已应用于决策 关于筛选吸收率。这项研究将扩展该模型以考虑重复筛选决策。 意义：患者参与常规筛查和返回重复筛查的决定取决于 VA 改善筛查举措成败的核心。使用乳腺癌筛查 (BCS) 和 以肺癌筛查（LCS）为例，这项工作将加深人们对风险认知的理解 整个筛选过程中都会发生变化。我们将开发以患者为主导的信息材料，这些材料可以 在筛查前向患者提供，以及包含在筛查结果报告中，可以告知 提供者和患者之间的沟通以退伍军人为中心的决策。这些发现将 还能够扩展到肺癌和乳腺癌筛查之外的其他癌症筛查项目。 创新和影响：这项研究的独特之处在于我们将使用多种癌症筛查项目 作为案例来了解重复筛选决策。肺癌和乳腺癌筛查是 具有重要相似点和差异的案例为更全面地研究许多因素提供了机会 退伍军人在决定是否返回进行重复筛查时会考虑这一点。在此过程中，我们将开发一个 更广泛地了解退伍军人如何参与筛查过程以及对风险的看法 在这个过程中发生变化。这也可以为共同决策的实施和 在涉及重复常规筛查的其他疾病筛查计划中以患者为中心的护理。 具体目标： 目标 1 - 描述影响患者重复癌症筛查决策的因素。 目标 1a – 确定正在接受肺癌和乳腺癌筛查的退伍军人如何解释 筛查检查的结果，修正他们对风险的看法，并做出关于重复 LCS 和 BCS 的决定。 目标 1b – 确定影响退伍军人如何做出重复癌症筛查决定的因素。 重点将是确定退伍军人在完善他们的信息时所使用的各种信息来源。 对风险和脆弱性的看法，以及对他们认为有用的风格和格式的评估。 目标 2 – 对比退伍军人接受肺和肺检查的风险认知和筛查经历 乳腺癌筛查，以指定重复癌症筛查的决策模型。 目标 3 – 开发以患者为导向的材料，优化以患者为中心的癌症复发决策 筛选。 方法：这是对退伍军人关于返回复读的决定的纵向定性研究 LCS 和 BCS 筛查。该研究旨在优化 LCS 和 BCS 致力于发展对重复癌症筛查决策的普遍理解。我们 将采访 35 名发起 LCS 的退伍军人和 35 名发起 BCS 的女性退伍军人。我们将 尝试在 3 个时间点采访参与者：1) 初次筛选前，2) 初次筛选后不久， 3) 在建议的重复筛查（每年或监测）之后。我们将比较和对比这些 为重复癌症筛查决策概念模型的开发提供信息的经验。 后续步骤/实施：我们将与专家小组合作开发以患者为中心的材料，以 协助退伍军人做出有关重复癌症筛查的决定。我们的运营合作伙伴将协助 通过信息宣传活动和其他外展工作向患者和提供者传播材料。