Health Services Career Development: Improving Medical Decisions in Ovarian Cancer

 描述（由申请人提供）：这是一份K 07奖的申请，申请人是德克萨斯大学医学博士安德森癌症中心的妇科肿瘤学家拉里萨·迈耶博士。迈耶博士正在建立自己作为一个年轻的研究人员在卫生服务研究妇科恶性肿瘤。该K 07奖将为Meyer博士提供必要的受保护的研究时间和支持，以实现以下目标：1）利用大型国家数据库获得先进的分析和统计技术的经验; 2）建立决策分析模型; 3）用定性研究方法设计和分析研究; 4）获得实践经验，为共享医疗决策建立工具; 5）在卫生服务研究中发展独立的研究事业。为了实现这些目标，Meyer博士组建了一个指导团队，由主要导师Sharon Giordano博士（卫生服务研究主席）和两名共同导师组成：Scott Cantor博士，临床决策分析师，专注于肿瘤学决策分析;罗伯特·沃尔克博士，他在决策方面的专业知识涵盖了对患者偏好和价值观的研究，以及对患者决策支持和决策辅助的应用研究，以促进知情选择。 尽管人们普遍认为晚期卵巢癌的最佳治疗仍然是肿瘤减瘤手术和铂/紫杉烷化疗的组合，但国际上仍然存在激烈的争论，重点是是否更好地从原发性减瘤手术（PDS）或新辅助化疗（NAC）开始。Meyer博士的研究将集中在1）建立一个决策分析模型，该模型结合了国家数据库和高质量MD安德森卵巢癌数据库中PDS或NAC结局的主要分析补充的最佳已发表证据（目标1），以及患者开始接受原发性减瘤手术或新辅助化疗治疗时的偏好和经验（症状负担评估）（目标2）。目标3将需要设计和迭代测试一个共享的医疗决策工具原型，该原型将预测性临床因素与交互式价值澄清方法相结合，以支持患者和医生在决定晚期卵巢癌主要治疗的复杂过程中。 这项重点研究和培训计划将为Meyer博士提供通过有意义的、以患者为中心的健康服务研究影响妇科恶性肿瘤妇女所需的技能，并将为原型决策工具奠定基础，以在前瞻性、多中心、随机对照试验中测试晚期卵巢癌妇女。这项研究将在R 01补助金申请中提出，该申请将在职业发展奖励期结束前提交。

 DESCRIPTION (provided by applicant): This is an application for a K07 award for Dr. Larissa Meyer, a gynecologic oncologist at The University of Texas MD Anderson Cancer Center. Dr. Meyer is establishing herself as a young investigator in health services research of gynecologic malignancies. This K07 award will provide Dr. Meyer with the necessary protected research time and support to accomplish the following goals: 1) to gain experience with advanced analytic and statistical techniques utilizing large national databases; 2) to build decision analytc models; 3) to design and analyze studies with qualitative research methods; 4) to obtain practical hands on experience building tools for shared medical decision making; 5) to develop an independent research career in health services research. To achieve these goals, Dr. Meyer has assembled a mentoring team comprised of a primary mentor, Dr. Sharon Giordano, Chair of Health Services Research, who conducts analyses of large administrative databases, and two co-mentors: Dr. Scott Cantor, a clinical decision analyst who focuses on decision analyses in oncology; and Dr. Robert Volk, whose expertise in decision-making spans research on patients' preferences and values to applied studies in patient decision support and decision aids for promoting informed choice. Although it is well accepted that optimal therapy for advanced ovarian cancer remains a combination of tumor debulking surgery and platinum/taxane based chemotherapy, there is still an ongoing heated international debate focused on whether it is better to start with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC). Dr. Meyer's research will focus on 1) building a decision analytic model that incorporates the best published evidence supplemented by primary analyses of outcomes with PDS or NAC in national databases and the high quality MD Anderson ovarian cancer database (Aim 1), and patient preferences and experiences (assessment of symptom burden) when starting treatment with primary debulking surgery or neoadjuvant chemotherapy (Aim 2). Aim 3 will entail the design and iterative testing of a shared medical decision tool prototype that combines predictive clinical factors with interactive values clarification methodology to support patients and physicians in the complex process of deciding on primary treatment for advanced ovarian cancer. This focused research and training plan will provide Dr. Meyer with the skills needed to impact women with gynecologic malignancies through meaningful, patient centered, health services research, and will form the basis for a prototype decision tool to test in a prospective, multi-site, randomized controlled trial for women with advanced ovarian cancer. This study will be proposed in an R01 grant application that will be submitted before the end of the career development award period.