Cancer Treatment Disparities in the HIV Population: Exploring the Impact of HIV on Physician and Patient Decision-Making

项目摘要 NCI K08提案的总体目标是促进Gita Suneja博士发展成为独立的 研究人员将重点放在提高艾滋病毒感染癌症患者的癌症治疗率和结果上。 癌症现在是艾滋病毒人群中非艾滋病死亡的主要原因。癌症存活率显著增加 与普通人群相比，艾滋病毒携带者的情况更糟，部分原因是他们经常 接受适当的癌症治疗。Suneja博士之前的工作表明，肿瘤学家不太可能提供 艾滋病毒感染者的癌症治疗；然而，关于艾滋病毒的诊断如何影响癌症的经验数据 缺乏医生和患者的治疗决策。本申请的研究目标是 为了(1)全面了解决策过程，(2)评估艾滋病毒的影响 关于癌症治疗决策，以及(3)设计一个决策支持工具，供肿瘤学家推广 以证据为基础的癌症治疗，并与艾滋病毒感染患者分享决策。长期目标 减少艾滋病毒人群中的癌症治疗差距。为了实现这些目标，Suneja博士将 利用杜克大学可用的资源，她是杜克大学理工学院系的教员 放射肿瘤学。她的职业发展计划包括混合方法研究、决策- 制定科学和干预设计-嵌套在具有强大多学科的结构化环境中 导师-这将使她在癌症健康服务研究的学术生涯中获得独特的地位。 在拟议研究的目标1中，研究人员将直接观察肿瘤学家与患者的互动，以 对癌症治疗决策过程及其影响有独特而详细的理解 艾滋病病毒对治疗决策的影响。在目标2中，他们将调查来自全国的肿瘤学家样本 系统识别癌症决定因素的基于人群的HIV/AIDS癌症配对研究 治疗决策并征求临床决策支持工具的参数输入。数据结合在一起 目标1和目标2将产生关于决策关键要素的详细和概括的知识-- 制定适合干预目标的流程。在目标3中，调查人员将利用以用户为中心的 参与式设计框架，为肿瘤学家开发临床决策支持工具，以促进 向艾滋病毒感染患者提供以证据为基础、以患者为中心的癌症护理。这项研究将填补一个关键的 我们对癌症治疗差异的理解是空白的，因为有效的治疗导致人群寿命更长 抗逆转录病毒治疗。此外，职业发展奖将为Suneja博士提供分析 竞争R01奖所需的培训和研究成果，以衡量 对艾滋病毒人群癌症治疗率的干预。

PROJECT ABSTRACT The overall goal of this NCI K08 proposal is to facilitate Dr. Gita Suneja's development into an independent investigator focused on improving cancer treatment rates and outcomes among HIV-infected cancer patients. Cancer is now the leading cause of non-AIDS death in the HIV population. Cancer survival is significantly worse in people living with HIV compared with the general population, in part because they frequently do not receive appropriate cancer treatment. Dr. Suneja's prior work revealed that oncologists are less likely to offer cancer treatment to HIV-infected patients; however, empiric data on how the diagnosis of HIV affects cancer treatment decision-making by physicians and patients is lacking. The research objectives of this application are to (1) develop a comprehensive understanding of the decision-making process, (2) evaluate the impact of HIV on cancer treatment decision-making, and (3) design a decision support tool for oncologists to promote evidence-based cancer treatment and shared decision-making with HIV-infected patients. The long-term goal is to reduce cancer treatment disparities in the HIV population. To achieve these goals, Dr. Suneja will capitalize on the resources available at Duke University, where she is a faculty member in the Department of Radiation Oncology. Her career development plan incorporates training in mixed methods research, decision- making science, and intervention design - nested within a structured environment of strong multidisciplinary mentorship - that will uniquely position her for an academic career in cancer health services research. In Aim 1 of the proposed study, the investigators will directly observe oncologist-patient interactions to generate a unique and detailed understanding of the cancer treatment decision-making process and the impact of HIV on treatment decision-making. In Aim 2, they will survey a national sample of oncologists identified from the population-based HIV/AIDS Cancer Match Study to systematically identify determinants of cancer treatment decision-making and solicit input on parameters for a clinical decision support tool. Together, data from Aims 1 and 2 will produce detailed and generalizable knowledge on the key elements of the decision- making process that are appropriate intervention targets. In Aim 3, the investigators will utilize a User-Centered Participatory Design framework to develop a clinical decision support tool for oncologists to promote the delivery of evidence-based, patient-centered cancer care to HIV-infected patients. This study will fill a critical void in our understanding of cancer treatment disparities in a population living longer due to effective antiretroviral therapy. In addition, the career development award will provide Dr. Suneja with the analytic training and research deliverables necessary to compete for an R01 award to measure the real world impact of the intervention on cancer treatment rates in the HIV population.