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TELEhealth Shared decision-making COaching for lung cancer screening in Primary care (TELESCOPE)

TELEhealth 初级保健中肺癌筛查的共享决策辅导 (TELESCOPE)

基本信息

批准号：
10597180
负责人：
Richard Michael Hoffman
金额：
$ 70.05万
依托单位：
RUTGERS BIOMEDICAL AND HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597180
关键词：
Address Adherence Adult Age Awareness Cancer Burden Cancer Etiology Caring Cessation of life Characteristics Clinical Cluster randomized trial Conflict (Psychology)Counseling Decision Aid Decision Making Diagnosis Diagnostic Procedure Diagnostic tests Disparity Eligibility Determination Ethnic Origin Exclusion Goals Guidelines Health Personnel Health Services Accessibility Incidental Findings Individual Intervention Knowledge Longitudinal Studies Lung Malignant neoplasm of lung Medical Methods Minority Modeling Nurses Pathway interactions Patient Care Patients Persons Policy Maker Population Heterogeneity Practical Robust Implementation and Sustainability Model Primary Care Provider Quality of Care Race Radiation exposure Recommendation Recording of previous events Reporting Research Resources Smoker Smoking System Telemedicine Testing Time Tobacco Tobacco use Training Trust Uncertainty Underserved Population United States Preventative Services Task Force Woman X-Ray Computed Tomography black men cancer risk care delivery comparison intervention computed tomography screening cost disparity reduction distrust effective intervention effectiveness testing effectiveness/implementation hybrid ethnic diversity expectation experience feasibility testing follow-up high risk hybrid type 1 trial implementation evaluation improved interest low dose computed tomography lung cancer screening meetings mortality novel strategies patient engagement patient navigation primary care clinician primary care practice primary care setting primary outcome quitline racial diversity randomized trial screening screening guidelines screening services shared decision making smoking abstinence smoking cessation social stigma socioeconomics telehealth tobacco control treatment as usual trial design uptake

项目摘要

ABSTRACT Screening with low-dose CT (LDCT) scans reduces lung cancer mortality. However, the potential harms associated with screening include false-negative and false-positive results, incidental findings, overdiagnosis, radiation exposure, and complications from invasive diagnostic procedures and treatments. Given the complexity of lung cancer screening (LCS) decisions, the United States Preventive Services Task Force strongly recommends that patients receive counseling about smoking cessation and shared decision-making (SDM) with a health care provider before being referred for LDCT. The SDM discussion about LCS should address the benefits and harms of screening, the importance of adhering to annual lung cancer LDCT screening and recommended diagnostic testing and treatment, and tobacco avoidance. Yet, there is uncertainty about how to most effectively engage patients in SDM for LCS. Both patients and primary care clinicians perceive important barriers to LCS decision making and accessing health service. When screening discussions are conducted, they often fail to meet expectations for SDM. We propose to address these deficiencies by implementing a workflow aware telemedicine SDM intervention that includes decision coaching and patient navigation that is a potentially scalable and efficient approach to meeting national screening recommendations. The study’s long-term goal is to reduce disparities and the burden of lung cancer among heavy smokers by supporting high-quality decision making about LCS and smoking cessation and abstinence. Our short-term goal is to identify an effective intervention that can readily be implemented in real-world primary care settings to support high-quality SDM in racially and ethnically diverse populations. We will conduct an effectiveness-implementation hybrid type I trial guided by the Practical, Robust Implementation and Sustainability Model (PRISM). A cluster randomized trial design including 40 primary care practices, 100 providers and 400 patients will evaluate whether a telemedicine decision coaching and navigation intervention (TELESCOPE) compared to enhanced usual care (EUC) will improve the quality of decision making, increase adherence with screening and diagnostic testing, and generate more referrals for smoking cessation. The specific aims are to: 1) Test the effectiveness of a decision coaching intervention for LCS delivered by nurse navigators vs. EUC on the quality of patient decision making about LCS, subsequent screening and diagnostic testing, and smoking cessation referrals for current smokers; 2) Evaluate the implementation potential of navigator-led decision coaching for LCS; and 3) Determine the resources and costs required to implement the navigator-led decision coaching intervention for LCS. This highly impactful research has the potential to greatly advance the field of SDM implementation and improve quality of care by providing patients with high-quality decision support about LCS, testing feasible strategies for busy PCPs to support SDM for their high-risk patients, and demonstrating for policy makers and payors new models for effective delivery of SDM for LCS.

摘要使用低剂量CT(LDCT)扫描进行筛查可降低肺癌死亡率。然而，潜在的危害与筛查相关的包括假阴性和假阳性结果、偶然发现、过度诊断、辐射暴露，以及侵入性诊断程序和治疗的并发症。考虑到复杂性关于肺癌筛查(LCS)的决定，美国预防服务工作组强烈建议患者接受戒烟咨询和分享决策(SDM) 在被转介接受LDCT之前，是一名医疗保健提供者。SDM关于LCS的讨论应该解决筛查的好处和危害，坚持每年一次的肺癌LDCT筛查和建议的诊断性检测和治疗，以及避免吸烟。然而，如何做到这一点存在不确定性最有效地让患者参与LCS的SDM。患者和初级保健临床医生都认为 LCS决策和获得卫生服务的障碍。当进行筛选讨论时，他们经常达不到对SDM的期望。我们建议通过实施工作流来解决这些缺陷感知远程医疗SDM干预，包括决策指导和患者导航，这可能是采用可扩展和高效的方法来满足国家筛查建议。这项研究的长期目标是通过支持高质量的决策来减少重度吸烟者之间的差距和肺癌负担关于LCS与戒烟和戒烟。我们的短期目标是找出一种有效的可在现实世界的初级保健环境中轻松实施的干预措施，以支持种族和民族多元化的人口。我们将进行一项有效性-实施混合第一类试验以实用、稳健的实施和可持续发展模式(PRISM)为指导。整群随机试验包括40家初级保健诊所、100名提供者和400名患者在内的设计将评估远程医疗决策指导和导航干预(望远镜)与增强型日常护理(EUC)相比将提高决策质量，提高对筛查和诊断测试的遵从性，并生成更多的戒烟转诊。具体目标是：1)测试决策指导的有效性护士导航员与EUC对LCS患者决策质量的干预对当前吸烟者进行随后的筛查和诊断测试以及戒烟转介；2) 评估领航员主导的LCS决策指导的实施潜力；以及3)确定资源和为LCS实施导航员主导的决策指导干预所需的成本。这个极具影响力的研究有可能极大地推进SDM实施领域，并通过以下方式提高护理质量为患者提供关于LCS的高质量决策支持，测试繁忙的PCP的可行策略支持针对高危患者的SDM，并为政策制定者和付款人演示新的有效交付LCS的SDM。