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可有效降低结直肠癌相关死亡率，但结直肠癌筛查率仍较低。虽然有几种有效的筛查方法，但只有一半符合条件的美国人接受了结直肠癌筛查。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干预措施，如小册子，视频光盘和计算机程序，作为医疗保健提供者咨询的参考，旨在帮助患者在选项中做出选择。先前的研究表明，癌症相关的决策辅助工具增加了患者的知识和参与决策，并可能提高癌症筛查率。然而，少数研究检查结直肠癌筛查决策辅助工具，已经证明了对筛查的不一致影响。目前提案的主要目标是开发一种调查工具（英语和西班牙语），以评估考虑筛查的患者的结直肠癌决策辅助工具的有效性。这个目标将通过以下方式实现：（1）通过焦点小组确定患者对结肠直肠癌筛查的信念和潜在误解;（2）开发一个以证据为基础的工具，以衡量患者对筛查的知识，判断和决策冲突的程度;以及（3）通过对初级护理患者的横断面研究，验证该工具并同时评估患者的基线知识水平，判断和决策冲突的结直肠癌筛查。我们将在本提案中开发的工具将有助于阐明结直肠癌筛查决策辅助工具如何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来影响决策过程。因此，该仪器将成为当前和未来结直肠癌决策辅助过程评估的重要资产。本提案中包含的研究将对提高结直肠癌筛查率产生重要影响，并将为未来对健康相关决策辅助工具的关键评估提供框架。此外，上述研究计划与提案中概述的职业发展计划一起，将为迪亚兹博士提供必要的经验和培训，以实现其职业目标，成为一名独立的研究者，重点是癌症控制和预防。

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.