EFFECTIVENESS OF PRAGMATIC PHYSICIAN HEALTH HABIT ADVICE

通过改变个人健康做法，癌症发病率和死亡率的巨大负担可能是可以预防的。初级保健医生为大多数美国人提供基本医疗保健，他们提出的健康习惯建议有望成为改变癌症相关健康习惯的战略。然而，初级保健研究方法之前的局限性以及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针对癌症的特定健康习惯建议；提供的建议的内容；将有效的健康习惯建议方法纳入日常实践相互竞争的需求的可行性；以及关于患者行为改变的建议的有效性。我的职业目标是使自己成为一名独立的调查者和初级保健环境中癌症预防和控制研究的多方法方法方面的专家，并进行对卫生保健政策和实践有影响的严格的癌症预防研究。拟议的癌症预防、控制和人口科学职业发展奖将结合指导、培训和重点研究，以实现3个目标：1)成为初级保健环境中癌症预防和控制研究的定量和定性方法整合的方法专家，2)使用这些多方法技术来确定将癌症特定健康习惯建议整合到初级保健实践相互竞争的需求中的实用方法，以及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。第一项研究将通过对两个丰富的现有数据集的深入人种学研究和对10名模范医生的嵌套样本的新研究，确定用于将针对癌症的特定健康习惯建议整合到初级保健实践中的实用方法。由此产生的发现将被用来开发初级保健医生使用的健康习惯建议方法的新的扎根衡量标准。基于跨理论模型的原则，将构建一个沿着变化的连续体的进步的度量，该变化捕捉到患者行为中微小但具有临床意义的变化，作为结果。这些措施将在具有代表性的初级保健医生样本中进行测试，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务实和有效的方法提供重要的新见解，并将确定干预机会，以提高初级保健实践中针对癌症的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.