"Using Perceptual Mapping to Develop Low Literacy CRC Screening Decision Aids"

描述（由申请人提供）：为了提高服务不足人群的结直肠癌（CRC）筛查率，需要新的决策工具。该项目将证明，可以通过使用感知映射方法和矢量信息设计技术建模和模拟患者的“心理地图”来增强患者对癌症筛查的决策，从而为读写能力有限的人群量身定制CRC决策辅助。我们的具体目标是使用这些方法来1)了解读写能力有限的患者如何感知两种最常用的CRC筛查方法，FOBT和结肠镜检查，2)基于这些感知建模和模拟信息，3)使用矢量信息方法从模拟数据中设计适合读写能力的决策辅助。用这些方法设计的决策辅助将提高50-70岁、9年级或更低文化水平人群的筛查决策。为此，我们将对筛查过的和未筛查过的男性和女性受试者进行焦点小组讨论，设计测量结直肠癌风险认知的工具。我们将收集风险感知数据，并将其用于感知映射、建模和计算机模拟。这些数据将为矢量信息设计提供数据，以开发适合读写能力有限的受试者的心理地图的决策辅助工具。为了评估这种方法在开发适合读写能力的决策工具方面的有效性，我们将进行一项试点研究，以确定研究问题的效应大小：1)使用感知映射和矢量信息设计技术的决策辅助工具的实验对象比使用现有决策辅助工具的对照组更有可能报告a) CRC筛查的意图，b)较少的决策冲突，以及d)决策辅助工具在他们的决策过程中有用。实验对象的感知地图也将显示“自我”比对照组更接近要筛选的决定。开发建模和仿真方法对改进消息设计和增强决策的影响是深远的。我们建议开发的方法在从初级预防和筛查到治疗和临终决定的癌症连续体中具有广泛的应用。如果成功，这些方法可以为不同文化水平的患者提供一种具有成本效益的基于证据的决策辅助工具。这项研究的结果将用于开发一个完全有力的随机试验，其中将包括实际的筛查结果。

DESCRIPTION (provided by applicant): To increase colorectal cancer (CRC) screening rates in underserved populations, new decision tools are needed. This project will demonstrate that patient decision-making about cancer screening can be enhanced by modeling and simulating patients' "mental maps" using perceptual mapping methods and vector message design techniques to tailor a CRC decision aid for a population with limited literacy. Our specific aims are to use these methods to 1) understand how patients with limited literacy perceive the two most commonly used CRC screening methods, FOBT and colonoscopy, 2) model and simulate messages based on those perceptions, and 3) use vector message methods to design a literacy-appropriate decision aid from the simulation data. The decision aid designed with these methods will enhance screening decision-making in a population aged 50-70 with 9th grade or lower level of literacy. To do this, we will conduct focus groups with screened and never screened male and female subjects to design instruments to measure CRC risk perception. We will collect risk perception data and use it for perceptual mapping, modeling and computer simulations. These data will yield data for vector message design to develop a decision aid tailored to the mental maps of subjects with limited literacy. To assess the effectiveness of this method for developing a literacy appropriate decision-making tool, we will conduct a pilot study to establish the effect size of the research questions: 1) Experimental subjects counseled with the decision aid designed with perceptual mapping and vector message design techniques will be more likely than controls, counseled with an existing decision aid, to report a) intent to be screened for CRC, b) less decisional conflict, and d) that the decision aid was useful in their decision-making process. Experimental subjects' perceptual maps will also show "self" closer to the decision to be screened than Controls. The impact of developing modeling and simulation methods to improve message design and enhance decision-making is far-reaching. The methods we propose developing have wide application across the cancer continuum from primary prevention and screening to treatment and end-of-life decisions. If successful, these methods can provide a cost-effective way to tailor evidence-based decision aids for patients across diverse literacy levels. Results from this study will be used to develop a fully powered randomized trial that will include actual screening outcomes.