Colorectal Cancer Decision Aids in Primary Care

描述(由申请人提供)：尽管有证据表明筛查方法在降低结直肠癌相关死亡率方面是有效的，但结直肠癌筛查的比率仍然很低。尽管有几种有效的筛查方法可用，但只有一半符合条件的美国人进行了结直肠癌筛查。增加结直肠癌筛查的一种方法是为患者提供健康决策辅助。健康决策辅助工具是一种干预措施，如小册子、视盘和计算机程序，它们作为医疗保健提供者咨询的辅助工具，旨在帮助患者在各种选择中做出选择。先前的研究已经证明，与癌症相关的决策辅助工具增加了患者对决策的了解和参与，并可能增加癌症筛查的比率。然而，检验结直肠癌筛查决策辅助的少数研究表明，对筛查的影响并不一致。当前提案的主要目标是开发一种调查工具(英语和西班牙语)，以评估结直肠癌决策辅助工具对考虑筛查的患者的有效性。这一目标将通过以下方式实现：(1)通过焦点小组确定患者对结直肠癌筛查的信念和潜在的误解；(2)开发一种基于证据的工具，以衡量患者关于筛查的知识、判断和决策冲突水平；以及(3)通过对初级保健患者的横断面研究，验证该工具，同时评估患者关于结直肠癌筛查的知识、判断和决策冲突的基线水平。我们将在此提案期间开发的工具将通过检查决策辅助工具和最终筛查行为之间的潜在中介变量，帮助阐明结直肠癌筛查决策辅助工具如何影响决策过程。因此，该仪器在当前和未来的结直肠癌辅助决策过程评估中将是一个重要的资产。这项提案中包含的研究将对提高结直肠癌筛查率具有重要意义，并将为未来对健康相关决策辅助工具的关键评估提供一个框架。此外，上述研究计划与提案中概述的职业发展计划相结合，将为迪亚兹博士提供必要的经验和培训，以实现他的职业目标，即成为一名专注于癌症控制和预防的独立调查员。

DESCRIPTION (provided by applicant): Rates of colorectal cancer screening are low despite evidence that screening methods are effective in reducing colorectal cancer-related mortality. Although several effective screening methods are available, only half of eligible Americans have been screened for colorectal cancer. One way to increase colorectal cancer screening is to provide patients with health decision aids. Health decision aids are interventions such as pamphlets, video discs, and computer programs, that act as adjuncts to a healthcare provider's counseling and are designed to help patients make choices among options. Prior research has demonstrated that cancer-related decision aids increase patients' knowledge and involvement in decision-making and may increase rates of cancer screening. The few studies examining colorectal cancer screening decision aids, however, have demonstrated inconsistent impact on screening. The primary objective of the current proposal is to develop a survey instrument (in English and Spanish) to evaluate the effectiveness of colorectal cancer decision aids for patients considering screening. This objective will be achieved by: (1) identifying patients' beliefs and potential misconceptions about colorectal cancer screening via focus groups; (2) developing an evidence-based instrument to measure patients' knowledge, judgments and level of decisional conflict regarding screening; and (3) via a cross-sectional study of primary care patients, validating the instrument and simultaneously assessing patients' baseline levels of knowledge, judgments, and decisional conflict about colorectal cancer screening. The instrument that we will develop during this proposal will help elucidate how colorectal cancer screening decision-aids impact the decision making process by examining potential mediating variables between decision aids and eventual screening behaviors. Thus, the instrument will be an important asset in the process evaluation of current and future colorectal cancer decision aids. The studies contained in this proposal will have important implications for improving colorectal cancer screening rates, and will also provide a framework for future critical assessment of health related decision aids. Furthermore, the above research plan, in conjunction with the career development plan outlined in the proposal, will provide the necessary experience and training needed for Dr. Diaz to pursue his career goal of becoming an independent investigator with an emphasis on cancer control and prevention.