Approaches and Outcomes of Shared Decision-making and Patient Centered Care Delivery in Barrett's Esophagus

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PROJECT SUMMARY This is a resubmission application for a five-year mentored patient-oriented research career development award (K23). The candidate is a motivated clinical researcher at the University of North Carolina Chapel Hill (UNC) with a background in digestive disease epidemiology, a strong publication record, and an established commitment to the study of esophageal diseases, specifically Barrett’s esophagus (BE). The objective of the K23 proposal is to obtain advanced mentored training in patient-oriented research methodologies required to achieve the candidate’s long-term career goal of becoming an independently funded physician-scientist improving detection of esophageal adenocarcinoma (EAC) by implementing patient-centered and shared decision care pathways in BE. Specifically, the candidate’s proposed career development goals are: 1) to obtain training in implementation science and development of patient decision aids; 2) to gain experience in the development of patient-reported outcomes (PRO) measures; 3) to develop knowledge in conducting comparative effectiveness research using large real-world databases; and 4) to transition to independence. To achieve these career development goals, the candidate will 1) take advanced, graduate level coursework in implementation science, decision aid design, PRO measures, and comparative effectiveness research; 2) participate in scholarly activities designed to foster independence and national recognition; and 3) conduct mentored research. The candidate’s mentoring team consists of internationally recognized, independently-funded investigators with expertise in Barrett’s esophagus and gastrointestinal epidemiology (Shaheen), implementation science and decision aids (Reuland), PROs (Keefer) and comparative effectiveness (Lund). Each mentor has a track record of commitment to mentoring junior faculty. The specific aims of the research project are: 1) to develop and test a web-based, patient-directed BE screening decision aid to improve screening rates screen-eligible patients; 2) to develop a BE-specific PRO instrument using in-depth interviews for concept elicitation to generate instrument items and perform cognitive interviews to ensure content validity; 3) to evaluate the comparative effectiveness of endoscopic surveillance versus ablation for BE patients with low-grade dysplasia (LGD) using administrative claims data to aid in shared decision making. Finally, the candidate’s research and training environment at UNC, a preeminent academic research institution, is strong and well-established. For fiscal year 2020, UNC ranked sixteenth for National Institutes of Health (NIH) research funding to domestic institutions of higher education, and has access to NIH funded centers (Translational and Clinical Sciences Institute and Center for Gastrointestinal Biology and Disease) that are tailored to support the proposed studies. This collaborative environment, mentorship, didactics, and research experience will provide the candidate with the strong foundation and unique skillset to successfully achieve the proposed research and training goals. Support from the K23 is critical to achieve the candidate’s goal of transitioning to an independent physician-scientist.