Addressing shared decision making related to cancer prevention and control for individuals with Alzheimer's disease and related dementia and caregivers in rural primary care

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PROJECT SUMMARY/ABSTRACT This supplement aims to address shared decision making related to cancer prevention and control for rural- dwelling individuals with Alzheimer's disease and related dementias (ADRD), their family caregivers/care partners, and primary care stakeholders, using the expertise and existing infrastructure of the Colorado Implementation Science Center for Cancer Control (ISC3), funded by NCI P50CA24468, PI: Russell Glasgow, PhD. The Colorado ISC3 Center is developing, validating, and disseminating innovative pragmatic models and methods related to the costs, benefits, and value of translating evidence-based cancer programs into rural primary care settings. Thus, within the scope of our Center theme of `Pragmatic implementation science approaches to assess and enhance the value of cancer prevention and control in rural primary care', this Alzheimer's disease supplement will conduct a mixed methods study with multiple ADRD stakeholders in rural primary care settings to understand value considerations and pragmatic shared decision making approaches related to cancer screening and prevention. As examples of specific shared decision making issues affected by dementia, we will investigate patient and care partner perceptions of over- or under-screening and approaches to pragmatic care partner involvement in shared decision making like agenda setting. This will be guided by our enhanced RE-AIM/PRISM framework that includes costs, benefits and value considerations as well as contextual factors. In four rural primary care clinics engaged in our `Implementation Laboratory', we will interview and survey: a) patients with ADRD and their care partners (12-16 dyads), b) care partners of persons with ADRD who lack decision making capacity (8-10 care partners), and c) primary care stakeholders (n=24, including practitioners and staff). The study will address: Aim 1 - Identify the most salient risks, benefits, costs, and relative value of CPC activities in rural primary care settings from the perspectives of patients with ADRD, care partners, and primary care stakeholders, and Aim 2 - Identify potential pragmatic adaptations to implementing shared decision making approaches to cancer screening and smoking cessation for the specific needs of patients with ADRD, care partners, and primary care stakeholders to facilitate shared decision making and implementation strategies in rural primary care settings. Upon completion of the Alzheimer's supplement activities, we will integrate findings into the Colorado ISC3 Center to inform adaptation of pragmatic approaches to shared decision making that meet the needs of patients and care partners affected by ADRD. We will disseminate findings across the NCI-funded Implementation Science Center network and the NIA- funded IMPACT Collaboratory. Findings will inform future pragmatic research and grant proposals related to shared decision making for CPC in rural primary care focused on ADRD.