Multimorbidity and Cancer Screening: Achieving Patient Understanding

描述（由申请人提供）：美国预防服务工作组最近建议75岁及以上的人不要进行常规结直肠癌（CRC）筛查，因为平均而言风险大于收益。这些建议得到了合作开发此应用程序的两个团队正在进行的研究的支持。然而，停止癌症筛查的想法与多年来强调癌症筛查必要性的公共卫生信息背道而驰。可以理解的是，患有多种疾病的老年人可能会对这一新消息感到困惑，他们需要了解不进行结直肠癌筛查的决定背后的理由，以避免被遗弃或年龄歧视的感觉。目前尚不清楚如何最好地向老年患者介绍结直肠癌筛查的净危害，从而使这些困难的概念被理解和接受。拟议研究的总体目标是确定如何向可能无法从筛查中获益的个体患者提供CRC筛查信息。这一目标将通过以下目标实现：目标1：对患有多种疾病的老年人进行定性访谈，探讨他们因健康状况而不接受癌症筛查的态度。目的2：使用定性数据来完善两种不同的书面教育工具，传递患者不太可能从筛查中受益的信息。一种方法是基于耶鲁的收益时间方法。第二种方法将基于UNC方法，即多重疾病患者的风险大于收益。目的3：在来自三个初级保健机构的100名75岁以上或70岁的两种慢性疾病患者样本中测试两种不同的教育工具，以了解，感知不敏感，以及在接触每种工具后，他们是否希望接受筛查。最近的美国预防工作小组建议以及UNC和耶鲁大学的独立模型研究将确定很大一部分人口可能不会从CRC筛查中受益。迫切需要对这一目标人群进行教育，以避免对这些建议的潜在抵制。拟议的申请将汇集两个研究团队，他们已经对多种疾病患者的CRC筛查进行了大量的形成性研究。在拟议的研究中，他们将确定一种教育工具的最佳内容，用于对不能从筛查中获益的多种疾病的老年人进行结直肠癌筛查。这将直接导致更多的研究来测试临床环境中的教育工具。

DESCRIPTION (provided by applicant): The U.S. Preventive Services Task Force recently recommended against routine colorectal cancer (CRC) screening for those age 75 and older because on average the risks outweigh the benefits. These recommendations are supported by the ongoing research of the two teams collaborating on this application. However, the idea of stopping cancer screening opposes years of public health messages that emphasize the need for cancer screening. Understandably, older adults with multimorbidity may be confused by this new message and will need to understand the rationale behind the decision not to perform CRC screening to avoid feelings of abandonment or ageism. It is currently not known how to best present information to older patients about the net harm of CRC screening so that these difficult concepts are understood and accepted. The overall goal of the proposed research is to determine how to present CRC screening information to individual patients who are likely not to benefit from screening. This goal will be accomplished with the following aims: Aim 1: To conduct qualitative interviews of older persons with multimorbidity to explore their attitudes about not undergoing cancer screening due their health status. Aim 2: To use the qualitative data to refine two different written educational tools with messages relaying that the patient will unlikely benefit from screening. One approach will be based the Yale approach of payoff time. The second approach will be based on the UNC approach that the risks outweigh the benefits in patients with multi-morbidities. Aim 3: To test the two different educational tools in a sample of 100 patients age 75+ or age 70 with 2 chronic conditions from three primary care settings for understanding, perceived insensitivity, and whether, after exposure to each tool, they would want to undergo screening. The recent U.S. Preventive Task Force Recommendations and both UNC and Yale's independent modeling studies will identify a significant proportion of the population who will likely not benefit from CRC screening. The need to educate this targeted population is urgent to avoid a potential backlash against these recommendations. The proposed application will bring together two research teams who have performed much of the formative research for CRC screening in patients with multimorbidities. In the proposed research, they will determine the optimal content of an educational tool for CRC screening in older adults with multi-morbidities who would not benefit from screening. This will directly lead to additional studies to test the educational tool in the clinical setting.