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: 10445304
• 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/10445304
• 关键词: Address; Aftercare; Age; Agreement; Area; Communication; Communities; Complex; Conflict (Psychology); Consensus; Consultations; Counseling; Data; Data Analyses; Decision Analysis; Decision Making; Elderly; 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.

项目摘要 预期寿命（LE）是男性泌尿生殖道（GU）患者治疗决策的关键因素 恶性肿瘤，因为有限的LE预测从治疗中获益的足够寿命的可能性较低， 治疗后的发病率和治疗效果下降。尽管LE在以下方面发挥着重要作用： 根据指南，有限LE患者通常对惰性癌症过度治疗，而对高风险癌症治疗不足。 癌的来自非癌症治疗机构的数据表明，这可能是由于医生层面的障碍 从而妨碍了LE的有效通信。令人惊讶的是，人们对LE目前如何传播知之甚少。 在治疗咨询以及病人和医生的观点，它应该如何理想地整合。 此外，患者和社区对LE截止值最适合“非侵入性治疗”的意见 缺乏。在本申请中，我们提出了一系列渐进式研究，其总体目标是建立 一种以患者为中心的方法，将LE整合到前列腺，肾脏， 和膀胱癌。(1)首先，我们将描述LE目前如何传达给GU癌症患者 通过对早期前列腺、肾脏、 和肌肉浸润性膀胱癌我们认为，目前的通信LE将是高度可变的， 讨论的发生率、沟通模式、访问中的时间定位、情绪 时间和时间都花在这个话题上。(2)第二，我们将聘请病人和专科医生， 利益相关者通过结构化访谈来识别改善沟通的障碍和机会 关于LE在癌症治疗决策中的信息。(3)第三，我们将利用在线众包， 联合分析（CA）作为研究患者和社区如何评价LE相对于其他 在前列腺癌、肾癌和膀胱癌治疗决策中通常遇到的权衡。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） 其中LE似乎驱动“非侵袭性”治疗选择，这将允许LE的靶向治疗 干预措施。(4)第四，我们将在一项随机试验中测试患者特异性LE估计值- 以第一和第二目标中确定的以患者为中心的方法进行沟通， 第三个目标中确定的特定高产情况-以及LE特定联合分析数据 改善决策冲突、讨论LE数据的质量，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 更好的治疗选择GU癌症和有限的LE患者。

项目成果

Variation in communication of side effects in prostate cancer treatment consultations.

前列腺癌治疗咨询中副作用沟通的变化。

• DOI: 10.1038/s41391-024-00806-2
• 发表时间: 2024
• 期刊: Prostate cancer and prostatic diseases
• 影响因子: 4.8
• 作者: Daskivich,TimothyJ;Naser-Tavakolian,Aurash;Gale,Rebecca;Luu,Michael;Friedrich,Nadine;Venkataramana,Abhi;Khodyakov,Dmitry;Posadas,Edwin;Sandler,Howard;Spiegel,Brennan;Freedland,StephenJ
• 通讯作者: Freedland,StephenJ

Patient Preferences for Communication of Life Expectancy in Prostate Cancer Treatment Consultations.

前列腺癌治疗咨询中患者对预期寿命沟通的偏好。

• DOI: 10.1001/jamasurg.2021.5803
• 发表时间: 2022
• 期刊: JAMA surgery
• 影响因子: 16.9
• 作者: Daskivich,TimothyJ;Gale,Rebecca;Luu,Michael;Khodyakov,Dmitry;Anger,JenniferT;Freedland,StephenJ;Spiegel,Brennan
• 通讯作者: Spiegel,Brennan

Variation in Communication of Competing Risks of Mortality in Prostate Cancer Treatment Consultations.

前列腺癌治疗咨询中死亡竞争风险沟通的变化。

• DOI: 10.1097/ju.0000000000002675
• 发表时间: 2022
• 期刊: The Journal of urology
• 作者: Daskivich,TimothyJ;Gale,Rebecca;Luu,Michael;Naser-Tavakolian,Aurash;Venkataramana,Abhi;Khodyakov,Dmitry;Anger,JenniferT;Posadas,Edwin;Sandler,Howard;Spiegel,Brennan;Freedland,StephenJ
• 通讯作者: Freedland,StephenJ

The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.

合并症和年龄对根治性前列腺切除术后生化复发男性雄激素剥夺治疗时机的影响。

• DOI: 10.1097/upj.0000000000000189
• 发表时间: 2021
• 期刊: Urology practice
• 影响因子: 0.8
• 作者: Moradzadeh,Ariel;Howard,LaurenE;Freedland,StephenJ;Amling,ChristopherL;Aronson,WilliamJ;Cooperberg,MatthewR;Kane,ChristopherJ;Klaassen,Zachary;Terris,MarthaK;Daskivich,TimothyJ
• 通讯作者: Daskivich,TimothyJ