Understanding and addressing rejection of personalized cancer risk information

了解并解决拒绝个性化癌症风险信息的问题

• 批准号: 10639183
• 负责人: Laura D. Scherer
• 金额: $ 66.05万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10639183
• 关键词: Address; Affect; Age; American Cancer Society; Area; Assessment tool; Behavior; Behavioral; Breast Cancer Detection; Breast Cancer Risk Factor; Cancer Control; Cardiovascular Diseases; Colon; Communication; Communication Methods; Communities; Comprehension; Decision Making; Demographic Factors; Development; Diagnosis; Disease; Evaluation; Family history of; Feedback; Fostering; Future; Goals; Guidelines; Harm Reduction; Health; Health Services; High Risk Woman; Individual; Interview; Knowledge; Longitudinal Studies; Longitudinal Surveys; Lung; Maintenance; Malignant Neoplasms; Mammographic screening; Mammography; Medical; Medical History; Medicine; Nature; Outcome; Patient Care; Patients; Persons; Prevention; Preventive Medicine; Process; Process Assessment; Prostate; Psychological Factors; Race; Randomized; Recommendation; Research; Risk; Risk Assessment; Risk Estimate; Risk Factors; Risk Marker; Risk Reduction; Sampling; Science; Screening for cancer; Surveys; Testing; Translating; United States Preventative Services Task Force; Woman; Work; cancer risk; clinical application; clinical practice; cognitive interview; distrust; experimental study; high risk; improved; individual patient; information seeking behavior; patient screening; precision cancer prevention; precision medicine; precision oncology; psychologic; risk minimization; risk prediction model; risk stratification; screening; screening guidelines; tailored health care; theories

PROJECT SUMMARY/ABSTRACT We are entering an era of precision medicine for cancer screening in which screening initiation and maintenance is based on personal risk estimates that incorporate multiple risk factors, with the goal of maximizing screening benefits and minimizing the harms. One increasingly common clinical application involves using cancer risk prediction models to inform which patients are screened, how often they are screened, and at which ages screening occurs (i.e., risk-based screening). For breast cancer screening with mammography, the U.S. Preventive Services Task Force recommends informed choice about when to begin regular screening for women age 40-49. Making an informed choice means determining whether, for an individual woman, the likelihood of receiving a screening benefit outweighs the likelihood of harms such as false positive results and overdiagnosis. A critical component of informed choice is a woman’s personal cancer risk, because the expected benefit of screening depends on a woman’s personal risk of breast cancer, with women at lower risk being less likely to benefit and more likely to be harmed than women at higher risk. Hence, incorporating informed choice into the mammography screening decision-making process means that women are asked to make decisions about screening based on their personalized breast cancer risk estimates. However, a critical barrier to implementing guideline-recommended informed choice in mammograpy screening is that many people reject that their risk estimate is true for them personally, a phenomenon we refer to as risk rejection. While previous research has focused on risk comprehension as a high-impact target for improving medical decisions, we argue that risk rejection is also a high impact target for improving health decision making because people who reject their risk are unlikely to make health decisions based on that risk estimate, even when they comprehend the estimate. An estimated 1-in-4 women believe that their breast cancer risk estimate is not accurate for them, and little is known about why, or the implications for screening decisions. In Aim 1, we will use a longitudinal survey to understand the scientific nature of risk rejection. Aim 1a will identify key demographic and psychological predictors of risk rejection. In particular, we will test 4 theory-informed hypotheses about why people reject their risk: motivated reasoning, prior knowledge, distrust, and lack of perceived personal relevance. Aim 1b will identify the impact of risk rejection on risk-concordant screening behavior. In Aim 2, we will conduct interviews and use experiments to identify communication strategies to reduce risk rejection. These studies will provide a comprehensive understanding of a phenomenon – risk rejection – which, if not addressed, will impede the implementation of informed patient choice in breast cancer screening and personalized, risk-based medicine more broadly.

项目总结/摘要 我们正在进入一个癌症筛查的精准医学时代，在这个时代， 维护基于个人风险评估，其中包含多种风险因素，目标是 最大化筛查的益处并最小化危害。一个越来越普遍的临床应用 包括使用癌症风险预测模型来告知哪些患者接受筛查， 筛选，以及筛选发生的年龄（即，基于风险的筛选）。乳腺癌筛查 美国预防服务工作组建议在知情的情况下选择何时开始进行乳房X光检查 定期筛查40-49岁的女性。做出知情选择意味着确定， 对于女性个体而言，接受筛查获益的可能性大于伤害的可能性，例如 假阳性结果和过度诊断。知情选择的一个关键组成部分是妇女的个人癌症 风险，因为筛查的预期益处取决于女性患乳腺癌的个人风险， 风险较低的妇女比风险较高的妇女更不可能受益，更可能受到伤害。 因此，将知情选择纳入乳房X光检查决策过程意味着， 妇女被要求根据她们个人的乳腺癌风险来决定是否进行筛查 估算然而，实施指南建议的知情选择的一个关键障碍， 乳房X光检查筛查的另一个问题是，许多人拒绝接受他们的风险估计对他们个人来说是真实的， 我们称之为风险拒绝。虽然以前的研究集中在风险理解作为一个 高影响目标，以改善医疗决策，我们认为，风险拒绝也是一个高影响目标， 改善健康决策，因为拒绝风险的人不太可能做出健康决策 基于风险评估，即使他们理解评估。估计有四分之一的女性认为， 他们的乳腺癌风险估计对他们来说是不准确的，并且很少有人知道为什么，或者影响 筛选决策。在目标1中，我们将使用纵向调查来理解风险的科学性 排斥反应目标1a将确定风险拒绝的关键人口统计学和心理学预测因素。我们尤其 我将测试4个关于人们为什么拒绝风险的理论假设：动机性推理，先验 知识，不信任，缺乏个人相关性。目标1b将确定风险拒绝的影响 风险一致性筛查行为的研究在目标2中，我们将进行访谈并使用实验来识别 沟通策略，以减少风险拒绝。这些研究将提供一个全面的了解 一种现象-风险拒绝-如果不解决，将阻碍知情患者的实施 乳腺癌筛查和个性化的选择，更广泛的基于风险的医学。