Improving shared decision making in cancer screening

改善癌症筛查的共同决策

• 批准号: 10246459
• 负责人: Sigrid Carlsson
• 金额: $ 23.45万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246459
• 关键词: Affect; Affective; Age; Applications Grants; Attitude; Award; Behavioral Sciences; Breast Cancer Detection; Cancer Center; Cancer Research Infrastructure; Complement; Complex; Comprehension; Computerized Medical Record; Conflict (Psychology); Data; Decision Aid; Decision Making; Development; Disasters; Education; Effectiveness; Epidemiologist; Erectile dysfunction; Evaluation; Funding; Goals; Guidelines; Health; Individual; Interview; Knowledge; Lead; Left; Life; Literature; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Medical; Memorial Sloan-Kettering Cancer Center; Modernization; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Participant; Patient Preferences; Patients; Persons; Process; Process Measure; Property; Provider; Psychology; Psychometrics; Qualitative Methods; Quality of life; Randomized; Reading; Recommendation; Reporting; Research; Research Personnel; Review Literature; Risk Estimate; Sampling; Science; Screening for Prostate Cancer; Screening for cancer; Series; Surveys; Techniques; Testing; Time; Transition Career Development Award (K22); United States National Institutes of Health; Validity and Reliability; cancer surgery; career; career development; clinical practice; cognitive interview; cognitive load; design; eighth grade; experience; feasibility testing; improved; individual patient; instrument; literacy; malignant breast neoplasm; man; mathematical ability; men; mortality; ninth grade; novel; practical application; preference; programs; response; risk stratification; screening; shared decision making; skills; support tools; theories; therapy design; tool

ABSTRACT Shared decision making (SDM) is a routine recommendation made by many guidelines when medical decisions are preference-sensitive, such as choosing to undergo prostate cancer or breast cancer screening. SDM typically includes provision of a decision aid, ie, an educational tool such as a written information sheet. However, many such tools are only weakly grounded in behavioral science research theory and often disregard knowledge from numeracy and literacy research. Literature on health numeracy is quite clear that many patients struggle to understand a single risk estimate, let alone multiple countervailing estimates. While the average person reads at a 7–8th grade level, decision aids are typically written at a 9th grade or higher reading level. Additionally, while decision aids often ask patients to clarify their values, behavioral science research on affective forecasting has shown that eliciting preferences for unfamiliar health states is challenging and error prone. Further, although theoretical approaches to decision making emphasize verbatim representations and numerical detail, modern approaches, including dual-process theory and fuzzy-trace theory, emphasize understanding the bottom-line “gist.” We hypothesize that decision aids that involve complex information sharing, along with preference elicitation for numerous unfamiliar health states, place a substantial burden on people that leads to “information overload,” which hinders the ability to make good decisions. The objective of this proposal is to conduct a series of studies around participants’ comprehension of the information presented in cancer screening decision aids and determine how it relates to information overload. Knowing this will inform optimization of SDM delivery and the design of patient decision aids. Dr. Sigrid Carlsson is an Assistant Attending Epidemiologist at Memorial Sloan Kettering Cancer Center, one of the world’s premier cancer centers with a strong cancer research infrastructure. This K22 Transition Career Development Award is a logical progression from the candidate’s prior research in prostate cancer screening, and will allow her to gain additional skills and experience to reach independent investigator status. Through the proposed career development activities, the applicant seeks to complement her medical background and quantitative expertise with skills in qualitative methods, behavioral sciences, and SDM. Dr. Carlsson’s long- term career goal is to become an independent, NIH-funded investigator with a research program committed to improving the practical application of SDM and optimization of risk-stratified approaches to cancer screening. Pursuing this award will give her the skills, experience, and preliminary data needed to submit 2 larger competitive R01 grant applications to 1) develop a cancer screening decision aid that avoids information overload and test its effectiveness on SDM outcomes in a randomized setting, and 2) develop a decision support tool to be integrated in the electronic medical record and test its effectiveness on health outcomes.

摘要 共享决策（SDM）是许多指南在医疗时提出的常规建议。 决策是偏好敏感的，例如选择接受前列腺癌或乳腺癌筛查。 SDM通常包括提供决策辅助，即教育工具，如书面信息表。 然而，许多这样的工具在行为科学研究理论中的基础很薄弱， 忽视来自算术和识字研究的知识。关于健康计算的文献很清楚， 许多患者很难理解单一的风险估计，更不用说多个抵消估计了。而 一般人的阅读水平是7- 8年级，而决策辅助工具的书写水平通常是9年级或更高 阅读水平。此外，虽然决策辅助工具经常要求患者澄清他们的价值观，但行为科学 情感预测的研究表明，引发对不熟悉的健康状态的偏好是具有挑战性的， 而且容易出错此外，尽管决策的理论方法强调逐字逐句 表示和数值细节，现代方法，包括双过程理论和模糊跟踪 理论，强调理解底线的“要旨”。我们假设，决策辅助， 复杂的信息共享，沿着对许多不熟悉的健康状态的偏好诱导， 给人们带来巨大的负担，导致“信息过载”，这阻碍了人们实现目标的能力。 决策本提案的目的是围绕参与者的理解进行一系列研究 癌症筛查决策辅助工具中提供的信息，并确定它与信息的关系 超载。了解这一点将有助于SDM输送的优化和患者决策辅助的设计。博士 Sigrid Carlsson是纪念斯隆凯特琳癌症中心的助理流行病学家， 拥有强大的癌症研究基础设施的世界顶级癌症中心。K22转型 发展奖是候选人先前在前列腺癌筛查方面的研究的逻辑进展， 并将使她获得额外的技能和经验，以达到独立调查员的地位。通过 建议的职业发展活动，申请人寻求补充她的医学背景， 定量的专业知识与定性方法，行为科学和SDM的技能。卡尔森医生很长时间- 长期职业目标是成为一名独立的，NIH资助的研究人员，其研究计划致力于 改善SDM的实际应用并优化癌症筛查的风险分层方法。 追求这个奖项将给她的技能，经验，和初步的数据需要提交2大 竞争性R 01拨款申请，以1）开发癌症筛查决策辅助工具， 过载，并在随机设置中测试其对SDM结果的有效性，以及2）制定决策 将支持工具纳入电子病历，并测试其对健康结果的有效性。