Behavioral Economics and Improving Chemotherapy Decisions for Advanced Cancer

描述（由申请人提供）：2012年，超过160万美国人被诊断患有癌症，约577,000人死于癌症。包括我所做的工作在内的证据表明，许多癌症患者没有得到指南推荐的治疗，而这种缺乏与更糟糕的结果有关。证据还表明，许多患者没有得到符合他们偏好的护理，特别是晚期癌症患者。本次申请NCI K24患者导向研究中期研究者奖旨在为Keating博士提供必要的保护时间，以进一步发展她在癌症相关患者导向研究方面的能力和专业知识，并扩大她在患者导向研究中指导有前途的初级研究者的能力。Keating博士之前的研究主要集中在：(1)了解影响癌症患者护理的患者、提供者和组织因素；(2)了解非试验环境下癌症患者的结果。这项工作的大部分已经确定了接受高质量护理方面的挑战。她的研究成果在顶级普通医学和肿瘤学期刊上发表了120多篇同行评议的原创研究文章。她拥有来自国家癌症研究所和基金会（包括美国癌症协会、前列腺癌基金会和Komen for the Cure基金会）的独立研究资金的强大而成功的记录。她的高质量研究已被美国临床研究学会（American Society for Clinical Investigation）认可，这是一个荣誉学会，旨在表彰45岁之前在生物医学研究领域有杰出学术成就的个人。Keating博士近期的职业目标和目标是获得行为经济学、决策科学和干预研究方面的技能，以识别和测试有希望的机会，以改善对癌症患者的护理，进一步了解向癌症患者提供次优护理的原因。并继续提供优秀的指导，吸引新的研究人员指导严格的以患者为导向的研究，重点是改善癌症治疗和结果。K24奖项将有助于实现这些目标。基廷博士的职业发展计划包括正式的课程、研讨会、有针对性的阅读和指导研究。她将学习行为经济学和决策科学理论及其在医疗保健方面的应用，特别是癌症患者的治疗决策。她还将发展干预研究方面的技能。她将在整个过程中密切合作

DESCRIPTION (provided by applicant): In 2012, more than 1.6 million Americans were diagnosed with cancer and about 577,000 died of cancer. Evidence, including work that I have conducted, suggests that many patients with cancer do not receive the care that is recommended by guidelines, and such deficiencies are associated with worse outcomes. Evidence also suggests that many patients do not receive care that is concordant with their preferences, particularly for patients with advanced cancers. This application for a NCI K24 Midcareer Investigator Award in Patient Oriented Research seeks support to provide Dr. Keating with necessary protected time to further develop her capabilities and expertise in cancer-related patient oriented research and to expand her ability to mentoring promising junior investigators in patient-oriented research. Dr. Keating's prior research has focused on: (1) understanding patient, provider, and organizational factors influencing the care delivered to patients with cancer and (2) understanding outcomes for cancer patients in non-trial settings. Much of this work has identified challenges in the receipt of high-quality care. Her research has resulted in more than 120 peer-reviewed original research articles in top general medicine and oncology journals. She has a strong and successful record of independent research funding from the National Cancer Institute and foundations, including the American Cancer Society, the Prostate Cancer Foundation, and the Komen for the Cure Foundation. The high quality of her research has been recognized by her induction into the American Society for Clinical Investigation, an honor society recognizing individuals with an outstanding record of scholarly achievement in biomedical research before the age of 45. Dr. Keating's immediate career goals and objectives are to acquire skills in behavioral economics, decision science, and intervention research to identify and test promising opportunities to improve care for patients with cancer, to further her work in understanding the reasons for sub-optimal care delivered to cancer patients, and to continue to provide outstanding mentorship and attract new investigators to mentor in the conduct of rigorous patient-oriented research focused on improving cancer care and outcomes. The K24 award will be instrumental in achieving these objectives. Dr. Keating's career development plan involves formal coursework, seminars, targeted readings, and mentored research. She will study behavioral economics and decision science theory and their applications to health care, and particularly patients' decisions about treatment for cancer. She will also develop skills in intervention research. She will work closely throughout the duration of the award with a group of highly skilled clinician researchers and scientists, including Drs. Michael Norton, Kevin Volpp, Peter Ubel, Eric Winer, and Anthony Back. Dr. Keating works in a rich environment with ready access to talented collaborators and trainees and support staff. She has demonstrated a commitment to mentoring young investigators in patient-oriented research, with 26 senior author publications since 2012, and increasing successes among her prior mentees. She has access to trainees from across the Harvard community, including students, residents, post-doctoral fellows, and junior faculty, and she has a variety of ongoing projects that provide excellent opportunities for mentoring junior investigators in patient-oriented research in oncology. Dr. Keating's research project seeks to apply behavioral economic and decision science principles to improve patients' understanding of the goals of chemotherapy for advanced cancer by updating and broadening the default information that patients receive in the chemotherapy consent form. Evidence from the fields of behavioral economics and decision science suggests that individuals do not always make rational decisions that might bring the best outcomes for them. Individuals are typically overly optimistic, are biased towards rewards in the present vs. the future, are susceptible to the way that information is framed, have a tendency to select default options, and are regret averse. Other research has shown that most patients with metastatic cancer do not understand the goals of chemotherapy. A revised consent form can serve as a "nudge" to physicians to provide patients with information about the goals of chemotherapy. It also gives patients written information about goals of chemotherapy to take home with them. Better information should make patients better informed about the goals of chemotherapy and may ultimately decrease the use of later lines of chemotherapy, where benefits are likely to be smaller. Dr. Keating's project has two aims. First, she and her mentees will revise the chemotherapy consent form based on focus groups with patients and physicians. The revised consent form will include information about the purpose of chemotherapy and information about the likely duration of life extension when life extension is a goal. Second, they will assess whether the use of this consent form can increase patients' understanding of the goals of chemotherapy and prognostic understanding and decrease use of late-line chemotherapy for advanced cancer.