Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement

项目摘要 肺癌是美国癌症死亡的主要原因，大多数肺癌在晚期被诊断出来。 阶段对高危人群进行低剂量CT筛查是唯一可用于诊断的循证工具 在存在可治愈的治疗选择的早期阶段肺癌。降低死亡率的好处是， 肺癌筛查（LCS）目前绝大多数未实现，由于次优的人口为基础的 遵守年度筛查指南。在研究环境之外，对年度LCS的遵守率低于 在改变实践的里程碑式临床试验中观察到的比率的一半。迫切需要有效的 和可行的干预措施，以提高LCS的依从性，并实现最佳的个人和群体健康 效益F99阶段的研究将利用创新的、多阶段的、混合的方法设计， 描述LCS患者如何处理有关健康保护行为的健康信息，并利用这些信息， 信息，以制定和评估与符合LCS条件的个人的提醒消息。使用四步 在这一过程中，LCS计划参与者调查（第1步）中收集的数据将为开发 候选提醒消息（步骤2）。在最后两个步骤中，LCS将评估提醒消息 专家（步骤3），并使用混合方法与LCS计划参与者（步骤4）进行进一步评估和改进， 包括调查和访谈。按人口统计学分类的健康信息处理结构之间的差异 或第1步中发现的重要临床特征将成为消息定位的重点（组级别） 和/或剪裁（个人层面）。在F99阶段结束时，我将有一套正式的明确的， 吸引人的、有效的信息，以支持LCS的年度依从性，随时可以在临床环境中进行评估。 在K 00阶段提出的研究将侧重于获得混合有效性的实际经验 执行研究设计和务实的成果措施，同时评估有效性和 执行成果。具体来说，我建议一个指导前后类型1混合有效性- 在母试验中进行实施试验，允许同时评估有效性， F99提醒策略在现实世界LCS项目中的实施结果。有效性将得到检验 使用前后设计，比较符合年度筛查指南的筛查参与者百分比 在执行提醒战略之前和之后。次级执行成果（即， 可接受性和可行性）将通过调查和参与人员的关键知情人访谈进行评估， 提醒系统实现（例如，LCS项目主管、导航员、协调员）。这个身体 研究将为我的职业生涯做好准备，成为一名独立的以癌症为重点的干预科学家， 制定和实施有效的、低负担的干预措施，旨在提高LCS依从性， 最大化筛查益处，降低肺癌死亡率。

PROJECT SUMMARY Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective and feasible interventions to improve LCS adherence and achieve optimal individual and population health benefits. Research during the F99 phase will leverage an innovative, multi-phase, mixed methods design to describe how LCS patients process health information regarding health protective behavior and utilize this information to develop and evaluate reminder messages with individuals eligible for LCS. Using a four-step process, data collected in a survey of LCS program participants (step 1) will inform the development of a pool of candidate reminder messages (step 2). In the final two steps, the reminder messages will be evaluated by LCS experts (step 3) and further evaluated and refined with LCS program participants (step 4) using mixed methods, including surveys and interviews. Differences between health information processing constructs by demographic or clinical characteristics found to be significant from step 1 will be the focus for message targeting (group level) and/or tailoring (individual level). At the conclusion of the F99 phase, I will have a formalized set of clear, engaging, and efficient messages to support LCS annual adherence, ready to be evaluated in a clinical setting. Research proposed in the K00 phase will focus on gaining real-world experience with hybrid effectiveness implementation study designs and pragmatic outcome measures to simultaneously assess effectiveness and implementation outcomes. Specifically, I propose a mentored pre-post type 1 hybrid effectiveness- implementation trial, within a parent trial, that will allow concurrent assessment of effectiveness and implementation outcomes of the F99 reminder strategy in real-world LCS programs. Effectiveness will be tested using a pre-post design, comparing percent screening participants adherent to annual screening guidelines before and after implementation of the reminder strategy. Secondary implementation outcomes (i.e., acceptability and feasibility) will be assessed with surveys and key informant interviews of personnel involved in the reminder system implementation (e.g., LCS program directors, navigators, coordinators). This body of research will prepare me for a career as an independent cancer-focused intervention scientist with expertise in the development and implementation of effective, low-burden interventions aimed at improving LCS adherence, maximizing screening benefit, and reducing lung cancer mortality.