PHYSICIAN RECOMMENDATION AND COLORECTAL CANCER SCREENING

描述(由申请人提供)： 来自我们自己和其他人的数据表明，不同的医生在推荐癌症筛查时会讨论不同的事情。美国预防服务工作组(USPSTF)虽然不支持特定风格的医患互动，但最近倡导在向个别患者提出预防服务建议时使用共享决策。我们建议使用混合方法，包括定性和定量的数据收集和分析，以了解当医生建议在初级保健中进行CRC筛查时，共享决策的不同方面的使用和效用。首先，我们将使用直接观察和例行保健访问的录音(n=900)来描述初级保健(目标1)中关于CRC筛查讨论的性质和内容。这些定性工作的结果将被用来得出定量的衡量标准，以表征初级保健中医生与患者之间关于结直肠癌筛查的讨论。在第二阶段，我们将结合这些定性衍生的措施，将医生和患者讨论的结直肠癌筛查与自动化索赔/实验室数据结合起来，以确定它们与就诊后12个月的结直肠癌筛查使用的关系(目标2)。访问前和访问后的联合患者调查将使我们能够评估患者在筛查方式、信息和参与决策方面的偏好与所观察的访问中发生的情况的一致性。然后，我们将能够评估这些一致性对就诊后12个月的CRC筛查使用的影响(目标3)。我们将使用亨利·福特健康系统(HFHS)，这是一个服务于底特律及其周边郊区的大型综合配送系统，作为这些努力的背景。HFHS初级保健医生和患者群体的多样性和规模，加上全面的、现有的自动化数据系统，使其成为开展拟议工作的理想环境。通过将医生和患者对初级保健现实世界中的CRC筛查讨论的贡献与随后的CRC筛查使用和患者报告的偏好结合起来，拟议项目的结果将为旨在提高CRC筛查参与度的新一代干预措施提供信息。它们将为培训医生和患者如何有效地讨论结直肠癌筛查以及促进为不同人群制定决策助手和政策提供有价值的信息。

DESCRIPTION (provided by applicant): Data from our own efforts and those of others indicate that different physicians discuss different things when recommending cancer screening. The U.S. Preventive Services Task Force (USPSTF) while not endorsing a specific style of physician-patient interaction, recently advocated for the use of shared decision-making when making preventive service recommendations to individual patients. We propose to use a mixed-method approach that includes both qualitative and quantitative data collection and analyses to understand the use and utility of different aspects of shared decision-making when physicians recommend CRC screening in primary care. First, we will use direct observation and audio-recording of routine health maintenance visits (n=900) to characterize the nature and content of CRC screening discussions in primary care (Aim 1). Results from these qualitative efforts will be used to derive quantitative measures characterizing physician-patient discussions of CRC screening in primary care. In the second stage, we will join these qualitatively derived measures characterizing physician-patient discussions of CRC screening with automated claims/laboratory data to determine their relationship to 12-month post-visit CRC screening use (Aim 2). A combined pre- and post-visit patient survey will allow us to assess the concordance of patient preferences for screening modality, information, and participation in decision-making with what occurs in the observed visit. We will then be able to evaluate the effect of these concordances on 12-month post-visit CRC screening use (Aim 3). We will use the Henry Ford Health System (HFHS), a large integrated delivery system serving Detroit and its surrounding suburbs, as the setting for these efforts. The diversity and size of the HFHS primary care physician and patient populations combined with the comprehensive, existing automated data systems makes this an ideal environment in which to conduct the proposed work. By joining detailed accounts of the contribution of both physicians and patients to CRC screening discussions in the real world of primary care with subsequent CRC screening use and patient reported preferences, results from the proposed project will inform a new generation of interventions aimed at improving CRC screening participation. They will provide valuable information for training both physicians and patients how to effectively discuss CRC screening as well as facilitate the development of decision aides and policies for diverse populations.