Patient Preferences and Adherence in Adolescents and Young Adults with Cancer

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 DESCRIPTION (provided by applicant): Dr. McGrady is a pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents and young adults (AYAs, ages 15-24 years) with cancer by targeting adherence. Medication non- adherence is demonstrated by nearly half of all AYAs with cancer and increases the risk of treatment failure and mortality. There are no interventions for AYAs with cancer that improve adherence and prevent these devastating consequences. Dr. McGrady's program of research has the potential to result in a novel adherence-promotion intervention for a population in which adherence is critical for survival. Candidate: Dr. McGrady is an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). Dr. McGrady completed her doctoral training at the University of Cincinnati and CCHMC where she provided clinical care to AYAs with chronic medical conditions who struggled to adhere to demanding medication regimens while undergoing the developmental transitions (i.e., social pressures, increasing autonomy) of the AYA period. Witnessing the health of these AYAs deteriorate as a result of non-adherence compelled Dr. McGrady to focus her research on understanding and improving adherence and complete a T32 fellowship in pediatric adherence science at CCHMC. In 2014, Dr. McGrady was recruited to join CCHMC as a researcher in BMCP and the Wellness Center of the Cancer and Blood Diseases Institute (CBDI). Dr. McGrady's faculty position was created to support a research program focused on improving quality of life and health outcomes of AYAs with cancer. In this position, Dr. McGrady is applying her unique interest in behavioral economics to understand adherence and develop a novel adherence-promotion intervention for AYAs with cancer. This innovative research program has the potential to reduce the increased risk of relapse and mortality faced by the 44-48% of AYAs with cancer who are non-adherent and thus directly aligns with NCI's call for cancer control "research in the behavioral sciences that...reduces cancer risk, incidence, morbidity, and mortality." Training Objectives: To successfully pursue this important line of research and meet her career goal of becoming an independently-funded cancer control researcher, Dr. McGrady must fill gaps in her content and procedural knowledge. The proposed K07 will provide Dr. McGrady with the opportunity to fill these gaps and enable her to: 1) gain expertise in the application of behavioral economics methods to adherence; 2) develop knowledge of the treatment and health outcomes of AYA cancers; and 3) enhance her training in randomized clinical trial design. Mentors: Dr. McGrady's primary mentor, Ahna Pai, PhD, is an NCI R01-funded researcher with expertise in adherence and AYAs with cancer. Under Dr. Pai's mentorship, Dr. McGrady has assembled an expert team of internationally recognized leaders in behavioral economics, adherence, AYA cancer, behavioral interventions, and ethics who complement Dr. Pai's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers like Dr. McGrady. Through UC's Clinical and Translational Science Award (co-directed by Dr. McGrady's consultant, Dr. Joel Tsevat), BMCP (i.e., Psychology Review Group, Data Core), and the CBDI (i.e., immersive learning, seminars), Dr. McGrady has the local resources to achieve her training objectives and complete the proposed research. When optimal training is not available locally, Dr. McGrady will supplement these experiences with internationally-recognized courses. The CBDI is the ideal clinical setting for the proposed research as its current priorities include investigating "innovatve approaches to care for adolescents and young adults." The CBDI also provides access to a large patient population. Dr. McGrady will capitalize on her current relationships with CBDI faculty (i.e., Dr. Fouladi, Co-Mentor; Dr. Perentesis, Consultant; Dr. Nagarajan, Consultant) to implement the proposed research. Research: Motivation is the primary driver of non-adherence among adults with breast cancer but has not been examined among AYAs. A primary reason for this gap may be that available measures do not assess adherence-related motivation among AYAs with cancer. Study 1 includes an innovative application of behavioral economic methods to identify patient preferences, a manifestation of adherence-related motivation. Patient preferences are an ideal target for further investigation as they can be modified with behavioral intervention and account for the wide range of patient-level variability in motivation that may be due to differences in treatment regimens, diagnoses, etc. Results of Study 1 will quantify the relationship between patient preferences and adherence and determine targets for an evidence-based intervention. In Study 2, patient-centered qualitative methods will be used to develop a novel adherence-promotion intervention for AYAs with cancer. In Year 4, Dr. McGrady will submit an R-series proposal to NCI to examine the effectiveness of this intervention. Given the limited effectiveness of available adherence-promotion interventions for AYAs with cancer, these efforts have the potential to significantly improve health outcomes for the tens of thousands of AYAs who struggle with non-adherence.