An Interactive Video Doctor to Encourage Cancer Screening

描述(申请人提供)：癌症筛查挽救生命，建议对50岁及以上的男性和女性进行多种癌症的常规筛查。对妇女的癌症筛查包括乳腺癌筛查、结直肠癌筛查和定期宫颈癌筛查(通常比妇女接受筛查的频率要低)。男性的癌症筛查包括结直肠癌筛查，由于关于前列腺癌筛查的争议，建议采取共同决策的方法。虽然建议进行筛查，但许多人没有接受筛查，需要采取新的方法来提高筛查率。 在初级保健诊所环境中进行干预是具有挑战性的。患者来就诊时会遇到其他医疗问题，而且时间和系统都有限制。我们建议开发一种新的工具，该工具将在繁忙的诊所环境中在系统内运行，并将从特定患者获得的信息与提供者的提示整合在一起，将是有效的，将缓解时间限制的负担，并将针对个别患者量身定做。 为了响应癌症计划宣布决策；单一事件决策，并与R 21资助机制保持一致，我们计划开发一种创新工具，旨在提高癌症筛查的比率和关于癌症筛查的讨论。该工具将是一个多媒体交互式视频医生，它将评估个人在癌症筛查方面的变化阶段，并将以可行和有效的方式提供针对个人变化阶段的信息。该工具的创新之处在于：1)它将专注于为特定个人推荐的所有癌症筛查；2)它将根据个人的变化阶段和筛查的个人障碍而量身定做；3)它以前从未在初级保健诊所环境中进行过测试，以促进癌症筛查，因此是一种提高癌症筛查率和讨论癌症筛查的新方法。拟议研究的具体目标如下： 1.开发一种多分量交互式视频医生干预，其包括：a)癌症筛查行为和变化阶段的评估，b)交互式视频医生，以及c)个性化提供者提示表(提供者警报)的生成。 2.在初级保健环境中对80名患者进行多分量交互式视频医生干预的可行性和可接受性的初步测试。 3.在这项对80名患者进行的初步研究中，评估视频医生干预前后的筛查意向、筛查兴趣和变化阶段。 在未来的一项研究中，我们计划进行一项随机对照试验，以确定多组件交互式视频医生干预的有效性，其中包括对变化阶段和癌症筛查的评估、交互式视频医生以及针对三个结果的个性化提供者提示表(提供者警报)的生成：1)增加乳腺癌和结直肠癌筛查的比率，2)增加参与者接受乳腺癌和结直肠癌筛查的准备，以及3)增加医患之间关于宫颈癌和前列腺癌筛查的讨论。 适用于50至70岁女性的癌症筛查包括乳房X光检查乳腺癌、结直肠癌筛查和定期宫颈癌筛查。男性癌症筛查包括结直肠癌筛查，由于前列腺癌筛查存在争议，建议采用共同决策方法。非常需要有效的干预措施来提高癌症筛查率，我们建议开发一种多组件交互式视频医生，用于提高适合年龄的癌症筛查率。然后，我们将在初级保健诊所对80人进行试点测试，以评估在干预前后询问提供者有关筛查的意向和对筛查的兴趣。在未来的一项研究中，我们将在随机临床试验中测试干预措施，以确定其在提高癌症筛查率和增加关于癌症筛查的讨论方面的有效性。如果干预成功，它可以在许多其他环境中使用，以提高癌症筛查率。

DESCRIPTION (provided by applicant): Cancer screening saves lives and routine screening for several cancers is recommended for men and women aged 50 and over. Cancer screening for women includes breast cancer screening, colorectal cancer screening and periodic cervical cancer screening (often less frequently than the woman has been receiving it). Cancer screening for men includes colorectal cancer screening and because of the controversy about prostate cancer screening, a shared decision making approach is recommended. Although screening is recommended, many individuals are not being screened and novel approaches to increasing rates of screening are needed. Conducting interventions in a primary care clinic setting is challenging. Patients come in with other medical problems, and there are time and system limitations. We propose developing a novel tool that will function within the system in a busy clinic setting, and will integrate information obtained from a particular patient with provider cues and will be efficient, will relieve the burden of time constraints and will be tailored to the individual patient. In response to the program announcement Decision Making in Cancer; Single Event Decisions and consistent with the R 21 funding mechanism, we plan to develop an innovative tool which will be designed to increase rates of cancer screening and discussions about cancer screening. This tool will be a multimedia interactive Video Doctor that will assess an individual's stage of change with respect to cancer screening and will give messages targeted to individual stage of change in a feasible and efficient manner. This tool is innovative in that 1) it will focus on all recommended cancer screening for a particular individual and 2) it will be tailored to an individual's stage of change and individual barriers to screening and 3) it has not been previously been tested in a primary care clinic setting to facilitate cancer screening and is thus a novel approach to increasing rates of cancer screening and discussions about cancer screening. The specific aims of the proposed study are as follows: 1. To develop a multi-component interactive Video Doctor intervention that includes: a) assessment of cancer screening behavior and stage of change, b) an interactive Video Doctor, and c) the generation of individualized provider cue sheets (Provider Alerts). 2. To pilot test the multi-component interactive Video Doctor intervention with 80 patients for feasibility and acceptability in a primary care setting. 3. In this pilot study of 80 patients, to assess intention to be screened, interest in screening and stage of change before and after the Video Doctor intervention. In a future study, we plan to conduct a randomized controlled trial to determine the effectiveness of a multi- component interactive Video Doctor intervention which includes assessment of stage of change and cancer screening, an interactive Video Doctor, and generation of individualized provider cue sheets (Provider Alerts) on three outcomes: 1) increasing rates of breast and colorectal cancer screening, 2) increasing participants' readiness to be screened for breast and colorectal cancer, and 3) increasing physician-patient discussions about screening for cervical cancer and prostate cancer. Appropriate cancer screening for women aged 50 to 70 includes breast cancer screening with mammography, colorectal cancer screening and periodic cervical cancer screening. Cancer screening for men includes colorectal cancer screening and because prostate cancer screening is controversial, a shared decision making approach is recommended. There is a great need for effective interventions to improve rates of cancer screening and we propose developing a multi-component interactive Video Doctor that will be used to increase rates of age appropriate cancer screening. We will then pilot test it in a primary care clinic setting with 80 individuals to assess intention to ask providers about screening and interest in screening before and after the intervention. In a future study, we will test the intervention in a randomized clinical trial to determine its effectiveness in increasing rates of cancer screening and in increasing discussions about cancer screening. Should the intervention be successful, it can be used in many other settings in order to increase rates of cancer screening.