PHYSICIAN RECOMMENDATION AND COLORECTAL CANCER SCREENING

描述（由申请人提供）： 来自我们自己和其他人的努力的数据表明，不同的医生在推荐癌症筛查时会讨论不同的事情。美国预防服务工作组（USPSTF）虽然不赞同特定风格的医患互动，但最近提倡在向个体患者提出预防服务建议时使用共同决策。我们建议使用混合方法的方法，包括定性和定量的数据收集和分析，以了解使用和效用的不同方面的共同决策时，医生建议在初级保健CRC筛查。首先，我们将使用常规健康维护访视的直接观察和录音（n=900）来描述初级保健中CRC筛查讨论的性质和内容（目标1）。从这些定性的努力的结果将被用来获得定量的措施，其特点是在初级保健中的CRC筛查的医患讨论。在第二阶段，我们将结合这些定性衍生的指标，表征医生-患者对CRC筛查的讨论与自动索赔/实验室数据，以确定其与访视后12个月CRC筛查使用的关系（目标2）。访视前和访视后的患者调查将使我们能够评估患者对筛选方式、信息和参与决策的偏好与观察访视中发生的情况的一致性。然后，我们将能够评价这些一致性对12个月访视后CRC筛查使用的影响（目标3）。我们将使用亨利福特卫生系统（HFHS），一个大型的综合服务系统，底特律及其周边郊区，作为这些努力的背景。HFHS初级保健医生和患者群体的多样性和规模，加上全面的现有自动化数据系统，使其成为开展拟议工作的理想环境。通过将医生和患者对初级保健真实的世界中CRC筛查讨论的贡献的详细描述与随后的CRC筛查使用和患者报告的偏好相结合，拟议项目的结果将为旨在改善CRC筛查参与的新一代干预措施提供信息。他们将为培训医生和患者如何有效地讨论CRC筛查提供有价值的信息，并促进为不同人群制定决策助手和政策。

DESCRIPTION (provided by applicant): Data from our own efforts and those of others indicate that different physicians discuss different things when recommending cancer screening. The U.S. Preventive Services Task Force (USPSTF) while not endorsing a specific style of physician-patient interaction, recently advocated for the use of shared decision-making when making preventive service recommendations to individual patients. We propose to use a mixed-method approach that includes both qualitative and quantitative data collection and analyses to understand the use and utility of different aspects of shared decision-making when physicians recommend CRC screening in primary care. First, we will use direct observation and audio-recording of routine health maintenance visits (n=900) to characterize the nature and content of CRC screening discussions in primary care (Aim 1). Results from these qualitative efforts will be used to derive quantitative measures characterizing physician-patient discussions of CRC screening in primary care. In the second stage, we will join these qualitatively derived measures characterizing physician-patient discussions of CRC screening with automated claims/laboratory data to determine their relationship to 12-month post-visit CRC screening use (Aim 2). A combined pre- and post-visit patient survey will allow us to assess the concordance of patient preferences for screening modality, information, and participation in decision-making with what occurs in the observed visit. We will then be able to evaluate the effect of these concordances on 12-month post-visit CRC screening use (Aim 3). We will use the Henry Ford Health System (HFHS), a large integrated delivery system serving Detroit and its surrounding suburbs, as the setting for these efforts. The diversity and size of the HFHS primary care physician and patient populations combined with the comprehensive, existing automated data systems makes this an ideal environment in which to conduct the proposed work. By joining detailed accounts of the contribution of both physicians and patients to CRC screening discussions in the real world of primary care with subsequent CRC screening use and patient reported preferences, results from the proposed project will inform a new generation of interventions aimed at improving CRC screening participation. They will provide valuable information for training both physicians and patients how to effectively discuss CRC screening as well as facilitate the development of decision aides and policies for diverse populations.