EFFECTIVENESS OF PRAGMATIC PHYSICIAN HEALTH HABIT ADVICE

癌症发病率和死亡率的巨大负担是可以通过改变个人保健习惯来预防的。为大多数美国人提供基本医疗保健的初级保健医生提出的健康习惯建议，作为一种改变与癌症相关的健康习惯的策略，大有希望。然而，以前初级保健研究方法的局限性和缺乏现实世界的实践实验室对以下方面的理解有限：初级保健医生如何以及何时处理癌症特定的健康习惯建议；建议的内容；将有效的健康习惯建议方法纳入日常实践的竞争性需求的可行性；以及对病人行为改变的建议的有效性。我的职业目标是成为一名独立的研究者和专家，在初级保健机构中进行多方法的癌症预防和控制研究，并进行严格的癌症预防研究，对卫生保健政策和实践产生影响。拟议的癌症预防、控制和人口科学职业发展奖将整合指导、培训和重点研究，以实现三个目标：1)成为在初级保健环境中整合定量和定性方法进行癌症预防和控制研究的方法专家；2)使用这些多方法技术来识别在初级保健实践的竞争性需求中整合癌症特定健康习惯建议的实用方法；3)评估医生提供的癌症特定健康习惯建议对患者行为改变的影响。计划进行一系列综合的多方法研究。第一批研究将通过对两个丰富的现有数据集进行深入的人种学研究，以及对10名模范医生的嵌套样本进行新的研究，确定用于将癌症特定健康习惯建议纳入初级保健实践的实用方法。由此产生的发现将被用来开发一种新的健康习惯建议方法的基础措施，由初级保健医生使用。基于跨理论模型的原则，将构建一种连续变化的进展测量方法，该方法可以捕获患者行为中微小但临床上有意义的变化。这些措施将在初级保健医生的代表性样本中进行测试，并将支持一项更大规模的研究申请，以评估社区初级保健临床医生提供的针对癌症的健康习惯建议的有效性。这一系列综合研究将为当前实践中使用的实用和有效方法提供重要的新见解，并将确定干预的机会，以增加初级保健实践中癌症特定健康习惯建议的频率和有效性。

A large burden of cancer morbidity and mortality is potentially preventable by changes in personal health practices. Health habit advice by primary care physicians, who provide basic health care to most Americans, holds great promise as a strategy to alter cancer-related health habits. However, previous limitations in primary care research methods and a lack of real world practice laboratories have limited understanding of: how and when primary care physicians address cancer-specific health habit advice; the content of the advice that is provided; the feasibility of incorporating effective health habit advice approaches into the competing demands of every day practice; and the effectiveness of the advice on patient behavior change. My career goal is to establish myself as an independent investigator and expert in multi-method approaches to cancer prevention and control research in primary care settings and to conduct rigorous cancer prevention research that has impact on health care policy and practice. The proposed Career Development Award in Cancer Prevention, Control and Population Sciences will integrate mentoring, training and focused research to meet 3 objectives: 1) to become a methods expert in the integration of quantitative and qualitative approaches to cancer prevention and control research in primary care settings, 2) to use these multi- method techniques to identify pragmatic approaches to integrating cancer-specific health habit advice among the competing demands of primary care practice, and 3) to evaluate the effect of physician-provided cancer-specific health habit advice on change in patient behavior. An integrated series of multimethod studies are planned. The first studies will identify pragmatic approaches used to integrate cancer-specific health habit advice into primary care practice through in-depth ethnographic study of two rich existing datasets and a new study of a nested sample of 10 exemplar physicians. The resultant discoveries will be used to develop a new grounded measure of health habit advice approaches used by primary care physicians. Based on the principles of the Transtheoretical Model, a measure of progression along a continuum of change that captures small but clinically meaningful change in patient behavior will be constructed as an outcome. These measures will be tested in a representative sample of primary care physicians and will support an application for a larger study to evaluate the effectiveness of cancer-specific health habit advice provided by community primary care clinicians. This integrated series of studies will provide important new insights into pragmatic and effective approaches used in current practice, and will identify opportunities for intervention to increase the frequency and effectiveness of cancer-specific health habit advice in primary care practice.