Communication for personalized decision making

在这个项目中，我们建议开发和测试一个沟通策略，以支持临床决策 关于个性化乳腺癌筛查模式的关键一步， 筛选乳房X光检查的绝对益处因乳房发育风险而异 癌症，这种风险取决于多种因素，尤其是年龄。患乳腺癌风险较低的女性 从筛查中获得的绝对益处较小，但可能具有相同的假阳性风险 和其他不利影响。根据以下因素，特定筛查策略的风险-获益比的这种变化 个体特征是个性化筛选范例的基础。然而， 关于如何最好地将这些信息传达给考虑筛查的女性的证据。 拟议项目包括两个阶段。在第一阶段，我们将进行一系列实验研究， 研究不同的沟通策略对理解的影响以及 筛查意图以及情景中的绝对收益和风险。根据最近的进展， 传播理论和我们的初步工作，我们将重点放在潜在的影响范例和 涉及信息来源的专业知识和动机的信息。在第二阶段，我们将测试一个决定， 援助的基础上的结果，1期的交叉，集群随机对照试验，在初级保健 人口，研究其对知识，决策满意度和筛选的影响。 筛查的绝对效益和筛查利用率之间的关系。 PHS

In this project, we propose to develop and test a communication strategy to support clinical decision making about a key step in a personalized breast cancer screening paradigm, the age of initiating breast cancer screening. The absolute benefit of mammography screening varies according to risk of developing breast cancer, a risk that depends upon multiple factors and particularly age. Women at lower risk of breast cancer will experience smaller absolute benefits from screening, but are likely to have the same risk of false positives and other adverse effects. This variation in the risk-benefit ratio of a particular screening strategy according to individual characteristics is fundamental to the personalized screening paradigm. However, there is little evidence about how best to communicate this information to women considering screening. The proposed project includes two phases. In Phase 1, we will conduct a series of experimental studies to examine the effect of alternative communication strategies on comprehension and the correlation between screening intentions and the absolute benefit and risk in the scenarios. Based on recent advances in communication theory and our preliminary work, we will focus on the potential impact of exemplars and of information addressing the expertise and motives of the information sources. In Phase 2, we will test a decision aid based upon the results of Phase 1 in an cross-over, clustered randomized controlled trial in a primary care population, examining its effects on knowledge, decision satisfaction and screening.focusing on the correlation between the absolute benefit of screening and screening utilization. PHS