Facilitation of Information Exchange for Shared Decision Making for Lung Cancer Screening

摘要 我是马萨诸塞大学陈医学院的一名肺部重症监护医生，也是前美国医学会的学者。 由NIH K12奖资助的马萨诸塞州心脏病实施科学联盟项目。 我的长期目标是成为一名实施科学家，拥有应用健康信息学的专业知识， 肺癌预防和控制的循证实践。在我的K12期间，我完成了临床硕士学位 进行调查并接受执行科学方面的培训。然而，我在训练和寻求 这个K 08奖获得额外的培训和指导，成为一个成功的独立临床医生- 科学家基于我在K12项目期间开发的单一患者策略，我建议开发 并试点测试一项名为“促进共享信息交换”的多战略实施计划， 肺癌筛查的决策制定（FIX-SDM）”。虽然肺癌筛查是 建议用于高风险人群，但未得到充分利用。肺癌筛查的已知障碍是 难以识别符合肺癌筛查条件的患者，缺乏患者意识，缺乏提供者 知识，以及共同决策的需要。因为肺癌筛查既有好处也有风险， 建议共同决策。然而，共同决策很少发生在初级保健中 由于患者和提供者往往缺乏必要的信息，在就诊期间无法进行共同决策， 时间有限的访问。FIX-SDM是一个多策略技术辅助的实施方案， 旨在通过促进信息，支持肺癌筛查的共同决策和采用 在患者就诊前进行交流。使用短信，FIX-SDM将帮助患者为共享决策做好准备 通过提供信息、收集患者生成的数据并基于患者提供反馈， 生成的数据。利用患者通过短信生成的数据，FIX-SDM将提供信息和工具 初级保健提供者（PCP）需要在EHR中共享决策。在K 08期间，我将开发 目标1中的新患者策略和目标2中的PCP策略。在目标3中，我将整合患者和 将FIX-SDM的PCP策略纳入初级保健诊所的工作流程，并进行试点实施研究 比较FIX-SDM和常规护理的肺癌筛查摄取。在陈博士经验丰富的指导下。 马佐尔、休斯顿、维纳、萨达西瓦姆和克劳福德，我将与 一个结构化的培训计划，重点是移动健康，临床信息学，患者生成的数据，以用户为中心的设计， 健康传播、研究设计、统计和定性分析。在K 08奖结束时，我将 准备成功竞争R 01，进行LCS的FIX-SDM大规模实用试验， 提高对年度肺癌筛查的接受率和纵向依从性。我的总体研究目标 与NCI的使命保持一致，以促进癌症预防和控制中基于证据的实践的快速整合。

ABSTRACT I am a pulmonary critical care physician at the UMass Chan Medical School and a former scholar of the Massachusetts Consortium for Cardiopulmonary Implementation Science program funded by an NIH K12 award. My long-term goal is to be an implementation scientist with expertise in applying health informatics to promote evidence-based practice in lung cancer prevention and control. During my K12, I completed a Master’s in Clinical Investigation and received training in implementation science. However, I still have gaps in my training and seek this K08 award to obtain additional training and mentoring to become a successful independent clinician- scientist. Building upon the single patient strategy that I developed during my K12 project, I propose to develop and pilot test a multi-strategy implementation program called “Facilitation of Information eXchange for Shared Decision Making (FIX-SDM) for Lung Cancer Screening” for this K08. Although lung cancer screening is recommended for high-risk individuals, it is underutilized. The known barriers to lung cancer screening are difficulty identifying lung cancer screening eligible patients, lack of patient awareness, lack of provider knowledge, and need for shared decision making. Because lung cancer screening has both benefits and risks, shared decision making is recommended. However, shared decision making rarely happens in primary care visits since patients and providers often lack the necessary information to conduct shared decision making during the time-constrained visit. FIX-SDM is a multi-strategy technology-assisted implementation program that is designed to support shared decision making and uptake of lung cancer screening by facilitating information exchange in advance of patient visits. Using texting, FIX-SDM will help patients prepare for shared decision making by delivering the information, collecting patient-generated data and providing feedback based on patient- generated data. Leveraging patient-generated data via texting, FIX-SDM will provide the information and tools that primary care providers (PCPs) need for shared decision making in the EHR. During this K08, I will develop the new patient strategies in Aim 1 and the PCP strategies in Aim 2. In Aim 3, I will integrate both patient and PCP strategies of FIX-SDM into the workflow of primary care clinics and conduct a pilot implementation study comparing FIX-SDM and usual care of lung cancer screening uptake. Under the experienced mentorship of Drs. Mazor, Houston, Wiener, Sadasivam, and Crawford, I will carry out the proposed research plan in consort with a structured training plan focusing on mHealth, clinical informatics, patient-generated data, user-centered design, health communication, study design, and statistical and qualitative analysis. At the end of the K08 award, I will be poised to successfully compete for a R01 to conduct a large-scale pragmatic trial of FIX-SDM for LCS to improve the uptake of and longitudinal adherence to annual lung cancer screening. My overall research goals align with NCI’s mission to foster rapid integration of evidenced based practices in cancer prevention and control.