A Personalized Digital Outreach Intervention for Lung Cancer Screening

肺癌筛查的个性化数字外展干预措施

• 批准号: 10062917
• 负责人: David P Miller
• 金额: $ 56.72万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10062917
• 关键词: Address; Advisory Committees; Affect; American; Appointment; Awareness; Behavior; Benefits and Risks; Cancer Etiology; Catchment Area; Cessation of life; Chest; Clinic; Colorectal Cancer; Data; Data Analyses; Decision Aid; Decision Making; Disease; Dose; Education; Electronic Health Record; Electronic Mail; Eligibility Determination; Enrollment; Ensure; Exercise; Future; Goals; Guidelines; Health; Health Personnel; Health Technology; Health system; Individual; Intention; Internet; Intervention; Interview; Knowledge; Lung; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medicare; Methods; Modeling; Morbidity - disease rate; Online Systems; Outpatients; Participant; Patient Care; Patient risk; Patient-Centered Care; Patients; Preventive service; Primary Health Care; Procedures; Provider; Randomized; Randomized Controlled Trials; Risk; Risk Factors; Schedule; Screening Result; Screening for cancer; Structure; Surveys; System; Text Messaging; Time; United States; Visit; X-Ray Computed Tomography; care providers; chest computed tomography; demographics; design; digital; digital intervention; former smoker; high risk; implementation outcomes; innovation; lung basal segment; lung cancer screening; malignant breast neoplasm; mortality; outreach; outreach program; patient portal; patient screening; primary outcome; programs; recruit; routine screening; screening; secondary outcome; shared decision making; social; theories

Using annual chest CTs to screen for lung cancer, the leading cause of cancer death in the United States, can reduce mortality by up to 20%; however, fewer than 4% of eligible Americans are screened. The US Preventive Services Task Force endorses lung cancer screening (LCS) for high risk current and former smokers. At the same time, LCS poses significant risks, such as false positives and invasive procedures. Accordingly, guidelines recommend and Medicare requires that patients engage in a shared decision making visit prior to screening. Unfortunately, primary care providers rarely discuss, and consequently patients rarely receive, LCS. Patient, provider, and system barriers contribute to low LCS rates. Many patients are unaware that LCS exists, that it is effective, or that they qualify for screening. The risks and benefits of LCS vary substantially according to patients’ risk factors making general education about LCS difficult. Healthcare providers have poor understanding of the screening criteria and lack the time and personalized information needed for shared decision making discussions. Decision aids for LCS are a partial solution; they can increase patient awareness, deliver personalized information, and help patients make a screening decision. However, they fail to address many provider and system barriers. Our team has developed an innovative digital outreach strategy called mPATH-Lung (mobile Patient Technology for Health – Lung) based on Social Ecological Theory and the Integrative Model of Behavior. mPATH-Lung has multilevel functionality: it (a) queries the electronic health record to identify potential screening candidates, (b) sends those individuals electronic invitations to visit a web-based LCS decision aid that helps them make a screening decision concordant with their values, and (c) empowers patients to electronically request an LCS clinic appointment for the mandated shared decision making and subsequent screening. Electronic program summaries are sent to patients and providers, ensuring shared decision making visits occur with informed participants. This project will determine the impact of mPATH-Lung on patient decision making and receipt of LCS in a pragmatic randomized controlled trial using a mixed methods design. The Specific Aims of the proposal are to: 1) Determine the effect of mPATH-Lung on receipt of LCS in a pragmatic randomized-controlled trial of 1318 primary care patients in two large health networks with a catchment area extending to 5 states; 2) Elucidate the drivers of patients’ LCS decisions and screening behavior using a values clarification exercise and semi-structured interviews with at least 60 patients selected to represent the spectrum of decision-behavior concordance; and 3) Explore implementation outcomes that will impact the sustainability and dissemination of mPATH-Lung using program data, surveys, and interviews. This project could decrease lung cancer morbidity and mortality by broadening the use of LCS while simultaneously supporting patient-centered care. Importantly, our digital outreach design could have broad applicability to other health conditions, expanding the impact of this proposal beyond LCS.

使用年度胸部CT筛查肺癌，肺癌是美国癌症死亡的主要原因， 降低死亡率高达20%;然而，只有不到4%的合格美国人接受筛查。美国预防 服务工作组赞同为高风险的当前和以前的吸烟者进行肺癌筛查。在 与此同时，LCS也带来了巨大的风险，如假阳性和侵入性手术。因此，委员会认为， 指南建议，医疗保险要求患者在接受治疗前进行共同决策访问， 筛选不幸的是，初级保健提供者很少讨论，因此患者很少接受LCS。 患者、提供者和系统障碍导致LCS发生率较低。许多患者不知道LCS的存在， 它是有效的，或者他们有资格进行筛选。LCS的风险和益处因 患者的危险因素使LCS的一般教育变得困难。医疗保健提供者的穷人 了解筛选标准，缺乏共享所需的时间和个性化信息 决策讨论。LCS的决策辅助是部分解决方案;它们可以增加患者 提高患者的认知度，提供个性化的信息，并帮助患者做出筛查决定。然而，他们失败了。 以解决许多供应商和系统障碍。我们的团队制定了一项创新的数字推广战略 称为mPATH-Lung（移动的患者健康技术-肺），基于社会生态理论和 行为的综合模型。mPATH-Lung具有多层次功能：它（a）查询电子健康 记录以识别潜在的筛选候选人，（B）向这些个人发送访问a的电子邀请 基于网络的LCS决策辅助工具，帮助他们做出与其价值观一致的筛选决策，以及（c） 使患者能够以电子方式请求LCS诊所预约，以进行强制共享决策 制作和随后的筛选。将电子程序摘要发送给患者和提供者，确保 与知情的参与者进行共同决策访问。该项目将确定 mPATH-Lung对患者决策和接受LCS的影响：一项使用 混合方法设计。该提案的具体目的是：1）确定mPATH-Lung对 在两个大型健康中心的1318名初级保健患者中进行了一项实用的随机对照试验， 网络的集水区延伸到5个州; 2）阐明患者LCS决策的驱动因素， 使用价值观澄清练习和至少60名患者的半结构化访谈筛选行为 选择代表决策行为一致性的频谱; 3）探索实施 使用项目数据、调查， 和采访。该项目可以通过扩大LCS的使用来降低肺癌的发病率和死亡率 同时支持以病人为中心的护理。重要的是，我们的数字外展设计可以 广泛适用于其他健康状况，将该提案的影响扩展到LCS之外。