The FYI on MRI: A Multilevel Decision Support Intervention for Screening Breast MRI

项目总结 拟议的K08职业发展奖将为康利博士提供必要的培训和指导 成为一名独立的临床科学家，专注于利用多层次方法支持知情人士 关于不同人群中基于风险的癌症筛查的决策。她已经确定了决策 关于在黑人和拉丁裔高危女性中筛查乳腺MRI作为一个关键问题来解决 实现这一目标。这份提案描述了一项为期5年的全面培训和指导研究计划 在医学决策和基于风险的癌症筛查之间的学术生涯。这 K08将提供社区参与研究、医疗决策、多层次干预、 和癌症风险预测模型。K08 AIMS提供的密集研究经验将提供 有机会实施和实践通过培训目标获得的技能。该计划的主要目标是 建议的研究是开发和测试多级干预，以支持关于以下方面的知情决策 在黑人和拉丁裔高危女性中筛查乳房核磁共振。乳腺癌高危女性(即≥20%) 终生风险)可以决定补充乳房X光检查与MRI或继续单独乳房X光检查。 一些女性将从乳房核磁共振筛查中受益，尽管一些女性会因为较高的 活检率、假阳性结果和更高的成本。因此，关于乳房筛查的知情决策 核磁共振对高危女性至关重要。知情的决定被定义为在充分的情况下做出的决定 知识，并符合个人的喜好。做出有关乳房筛查的明智决定 对于核磁共振，高危妇女必须：(1)被确定为高危；(2)意识到乳房核磁共振是一种选择；(3) 了解MRI的优点和缺点；以及(4)根据他们的喜好做出决定。然而， 缺乏认识和接触可能会阻碍高危黑人和拉丁裔妇女做出明智的决定 关于乳房核磁共振。这项研究的具体目标是：(1)开发和提供一种通用的乳腺癌风险评估- 社区环境中的管理协议；(2)开发与文化相关的决策辅助工具，包括来自不同利益集团的意见- 持有者；以及(3)评估多级决策支持干预的效果(即风险评估+决策 援助)做出有关乳房核磁共振的明智决定。康利博士的指导团队-包括世界知名的行为- 国际科学家、临床试验专家、乳腺肿瘤学家、流行病学家和生物统计学家将提供指导 以支持她的研究目标并补充她的说教训练。这些因素，除了支持性的 乔治敦隆巴迪综合癌症中心的研究环境，将使她能够实现 建议的项目目标。这项拟议的研究将为未来的R01应用提供试点数据，以测试其效果。 这项干预在NCI社区肿瘤学研究计划中的有效性。康利博士还将拥有 利用多层次方法支持有关风险的明智决策的技能和经验- 在不同人群中进行癌症筛查。这将导致持续和有影响力的科学贡献。

PROJECT SUMMARY The proposed K08 career development award will provide Dr. Conley with the training and mentorship necessary to become an independent clinical scientist focused on leveraging multilevel approaches to support informed decision making about risk-based cancer screening in diverse populations. She has identified decision-making about screening breast MRI among high-risk Black and Latina women as a critical issue to address in order to achieve this goal. This proposal describes a 5-year comprehensive program of training and mentored research for an academic career at the intersection of medical decision making and risk-based cancer screening. This K08 will provide key training in community engaged research, medical decision making, multilevel interventions, and cancer risk prediction models. The intensive research experience provided by the K08 aims will provide the opportunity to implement and practice the skills gained through the training goals. The primary objective of the proposed research is to develop and test a multilevel intervention to support informed decision making about screening breast MRI among high-risk Black and Latina women. Women at high risk for breast cancer (i.e., ≥20% lifetime risk) can decide to supplement mammography screening with MRI or continue with mammography alone. Some women will benefit from screening with breast MRI, though some will experience harms due to the higher rate of biopsies, false-positive results, and higher costs. Thus, informed decision making about screening breast MRI is critical for high-risk women. An informed decision is defined as a decision that is made with sufficient knowledge, and is in line with the person’s preferences. To make informed decisions about screening breast MRI, high-risk women must: (1) be identified as high risk; (2) be made aware that breast MRI is an option; (3) understand MRI’s benefits and drawbacks; and (4) make a decision aligned with their preferences. However, lack of awareness and access may prevent high-risk Black and Latina women from making an informed decision about breast MRI. The study’s specific aims are: (1) develop and deliver a universal breast cancer risk assess- ment protocol in a community setting; (2) develop a culturally-relevant decision aid with input from diverse stake- holders; and (3) assess the effect of the multilevel decision support intervention (i.e., risk assessment + decision aid) on informed decisions about breast MRI. Dr. Conley’s mentorship team – including world-renowned behav- ioral scientists, clinical trialists, breast oncologists, epidemiologists, and biostatisticians – will provide guidance to support her research aims and complement her didactic training. These factors, in addition to the supportive research environment at Georgetown Lombardi Comprehensive Cancer Center, will enable her to achieve the proposed project aims. The proposed study will provide pilot data for a future R01 application to test the effec- tiveness of this intervention in the NCI Community Oncology Research Program. Dr. Conley will also possess the skills and experience to leverage multilevel approaches to support informed decision-making about risk- based cancer screening in diverse populations. This will result in sustained and impactful scientific contributions.