Patient-Centered Comparative Effectiveness of Colorectal Cancer Surveillance in IBD

 描述(由申请人提供)：炎症性肠病(IBD)与发展为结直肠癌(CRC)的风险增加有关。监视结肠镜检查降低了发生结直肠癌的风险，增加了结直肠癌的早期发现。然而，只有一小部分符合条件的IBD患者按照当前实践指南的建议进行监视结肠镜检查。有必要确定监测结肠镜检查的有效方法，以及如何有效地向IBD患者传达个性化的结直肠癌风险，以减少这种致命的IBD并发症的死亡负担。我的长期目标是进行和实施研究，以降低IBD相关性CRC的发病率和死亡率。我的中心假设是，患者的经历影响了对结直肠癌监视结肠镜检查的接受，IBD患者亚组从监视结肠镜检查中受益，使用这些因素的以患者为中心的沟通工具可以帮助患者做出关于结直肠癌监视的决策。我建议的具体目标是：目标1：明确IBD患者在整个监测结肠镜检查过程中的经历。目的2(A)：在全国IBD患者队列中，比较结肠镜监测策略在异型增生或结直肠癌发生率、结直肠癌分期、治疗和结直肠癌相关死亡率方面的有效性。目标2(B)：确定从监测结肠镜检查中受益(或有害)的IBD患者亚组。目的3：将患者的结肠镜检查经验和监测结肠镜检查的有效性转化为IBD CRC通信工具，用于决策支持。未来的研究将测试通信工具在遵守CRC监测、早期CRC检测和患者对决策的满意度方面的有效性。我将通过与美国克罗恩和结肠炎基金会的合作来实现这些目标，对IBD患者进行深入访谈，了解他们使用结肠镜检查的经验，并进行患者共识小组，以开发和完善用于CRC监测决策的沟通工具。我将比较结肠镜检查策略在国家退伍军人健康管理局数据集中约63,000名IBD患者中对CRC结果的有效性，并辅以自然语言处理，以确定目前缺乏使用自动化管理数据的关键IBD变量。我是一名胃肠病专家，正在追求我的职业目标，即成为一名独立资助的IBD研究员，专门致力于开发患者与提供者的沟通工具，以改善CRC的结果。为了实现我的职业目标，我将需要有保护的时间、指导和在定性方法、比较有效性分析、患者参与和交流工具开发方面的正式研究培训。在AHRQ PCOR K08奖的支持和保护下，我将能够完成我提出的研究和职业培训目标，并获得独立资金。

 DESCRIPTION (provided by applicant): Inflammatory bowel disease (IBD) is associated with an increased risk of developing colorectal cancer (CRC). Surveillance colonoscopy decreases the risk of developing CRC and increases the detection of CRC at an early stage. However, only a small proportion of eligible patients with IBD engage in surveillance colonoscopy as recommended by current practice guidelines. There is a need to identify effective approaches to surveillance colonoscopy and how to effectively communicate individualized CRC risk to IBD patients in order to reduce the mortality burden of this fatal IBD complication. My long-term goal is to conduct and implement research to reduce the incidence and mortality of IBD-associated CRC. My central hypotheses are that patient experiences influence acceptance of CRC surveillance colonoscopy, subgroups of IBD patients benefit from surveillance colonoscopy, and that a patient-centered communication tool using these factors can aid patient decision making regarding CRC surveillance. The specific aims of my proposal are: Aim 1: Define IBD patient experiences throughout the process of surveillance colonoscopy. Aim 2(a): Compare the effectiveness of colonoscopy surveillance strategies on the yield of dysplasia or CRC, CRC stage, treatment, and CRC-related mortality in a national cohort of patients with IBD. Aim 2(b): Identify subgroups of patients with IBD who derive benefit (or harm) from surveillance colonoscopy. Aim 3: Translate patient experiences of colonoscopy and effectiveness of surveillance colonoscopy effectiveness into an IBD CRC communication tool for decision support. Future studies will test the effectiveness of the communication tool on CRC surveillance adherence, early stage CRC detection, and patient satisfaction with decision making. I will achieve these aims through a partnership with the Crohn's and Colitis Foundation of America to conduct in-depth interviews with patients with IBD regarding their experiences with colonoscopy and to conduct patient consensus panels to develop and refine a communication tool for CRC surveillance decision making. I will compare the effectiveness of colonoscopy surveillance strategies on outcomes of CRC in a cohort of approximately 63,000 patients with IBD in the national Veterans Health Administration datasets aided by natural language processing to define key IBD variables currently lacking using automated administrative data. I am a gastroenterologist pursing my career goal of becoming an independently funded investigator in IBD, with a specific focus on the development of patient-provider communication tools to improve CRC outcomes. To achieve my career goals, I will require protected time, mentorship, and formal research training in qualitative methods, comparative effectiveness analyses, patient engagement, and development of communication tools. With the support and protected time from the AHRQ PCOR K08 Award, I will be able to complete my proposed research and career training goals and secure independent funding.