Patient Preferences and Adherence in Adolescents and Young Adults with Cancer

 描述(由申请人提供)：麦克格雷迪博士是一名儿科心理学家，他的首要职业目标是通过有针对性地坚持下去，改善患有癌症的青少年和年轻成年人(15-24岁)的健康结果。在所有患有癌症的AYA中，近一半的人表现出药物不依从性，并增加了治疗失败和死亡的风险。对于患有癌症的AYA，没有任何干预措施可以提高依从性并防止这些毁灭性的后果。麦迪博士的研究计划有可能为坚持对生存至关重要的人群带来一种新的坚持促进干预。候选人：麦迪博士是辛辛那提儿童医院医学中心(CCHMC)行为医学和临床心理学(BMCP)部门的儿科学助理教授。麦迪博士在辛辛那提大学和CCHMC完成了她的博士培训，在那里她为患有慢性疾病的AYA提供临床护理，这些AYA在经历AYA时期的发展转型(即社会压力和日益增长的自主性)时，难以坚持严格的药物治疗方案。目睹这些AYA的健康因不遵守而恶化，迫使McGrady博士将她的研究重点放在了解和改善坚持，并在CCHMC完成了儿科坚持科学的T32奖学金。2014年，麦迪博士被招募加入CCHMC，担任BMCP和癌症与血液疾病研究所(CBDI)健康中心的研究员。麦迪博士的教职员工职位是为了支持一个研究项目，该项目的重点是改善癌症患者的生活质量和健康结果。在这一职位上，麦克格雷迪博士正在利用她在行为经济学方面的独特兴趣来理解依从性，并为患有癌症的AYA开发一种新的依从性促进干预措施。这一创新的研究计划有可能降低44%-48%的患有癌症的AYA面临的复发和死亡增加的风险，这些AYA是非依从性的，因此直接符合NCI关于癌症控制的呼吁，即在行为科学方面进行研究，以降低癌症风险、发病率、发病率和死亡率。培训目标：为了成功地从事这一重要的研究，并实现她成为一名独立资助的癌症控制研究人员的职业目标，麦迪博士必须填补她在内容和程序知识方面的空白。拟议的K07将为McGrady博士提供填补这些空白的机会，并使她能够：1)获得应用行为经济学方法来坚持的专业知识；2)发展对Aya癌症的治疗和健康结果的知识；3)加强她在随机临床试验设计方面的培训。导师：麦迪博士的主要导师，Ahna Pai博士，是NCI R01资助的研究人员，在坚持和癌症AYA方面具有专业知识。在派博士的指导下，麦克格雷迪博士组建了一支由行为经济学、依从性、Aya癌症、行为干预和伦理学领域的国际公认领导者组成的专家团队，他们补充了派博士的专业知识，并将提供宝贵的指导。环境：CCHMC和辛辛那提大学(UC)拥有独特的设备，可以促进像McGrady博士这样的初级研究人员的职业发展。通过加州大学临床与翻译科学奖(由McGrady博士的顾问Joel Tsevat博士共同指导)、BMCP(即心理学审查小组，Data Core)和CBDI(即沉浸式学习、研讨会)，McGrady博士拥有当地资源来实现她的培训目标并完成拟议的研究。当当地没有最佳的培训时，麦迪博士会用国际认可的课程来补充这些经验。CBDI是这项拟议研究的理想临床环境，因为它目前的优先事项包括调查“青少年和年轻人护理的创新方法”。CBDI还提供了接触大量患者的途径。麦迪博士将利用她目前与CBDI教职员工的关系(即，Fouladi博士，共同导师；Perentesis博士，顾问；Nagarajan博士，顾问)来实施拟议的研究。研究：动机是成年乳腺癌患者不坚持治疗的主要驱动因素，但尚未在AYA中进行检查。这一差距的一个主要原因可能是现有的测量方法没有评估患有癌症的AYA患者的坚持相关动机。研究1包括行为经济学方法的创新应用，以确定患者的偏好，这是与坚持相关的动机的表现。患者偏好是进一步研究的理想目标，因为它们可以通过行为干预进行修改，并解释了可能由于治疗方案、诊断等不同而导致的患者层面动机的广泛差异。研究1的结果将量化患者偏好和依从性之间的关系，并确定循证干预的目标。在研究2中，将使用以患者为中心的定性方法来开发一种新的依从性促进干预措施，用于治疗患有癌症的AYAS。在第四年，麦迪博士将向NCI提交一份R系列提案，以检查这种干预的有效性。鉴于可用于促进癌症的遵守-促进干预措施的有效性有限，这些努力有可能显著改善数以万计与不遵守规定作斗争的年度援助计划的健康结果。

 DESCRIPTION (provided by applicant): Dr. McGrady is a pediatric psychologist whose overarching career goal is to improve health outcomes for adolescents and young adults (AYAs, ages 15-24 years) with cancer by targeting adherence. Medication non- adherence is demonstrated by nearly half of all AYAs with cancer and increases the risk of treatment failure and mortality. There are no interventions for AYAs with cancer that improve adherence and prevent these devastating consequences. Dr. McGrady's program of research has the potential to result in a novel adherence-promotion intervention for a population in which adherence is critical for survival. Candidate: Dr. McGrady is an Assistant Professor of Pediatrics in the Division of Behavioral Medicine and Clinical Psychology (BMCP) at Cincinnati Children's Hospital Medical Center (CCHMC). Dr. McGrady completed her doctoral training at the University of Cincinnati and CCHMC where she provided clinical care to AYAs with chronic medical conditions who struggled to adhere to demanding medication regimens while undergoing the developmental transitions (i.e., social pressures, increasing autonomy) of the AYA period. Witnessing the health of these AYAs deteriorate as a result of non-adherence compelled Dr. McGrady to focus her research on understanding and improving adherence and complete a T32 fellowship in pediatric adherence science at CCHMC. In 2014, Dr. McGrady was recruited to join CCHMC as a researcher in BMCP and the Wellness Center of the Cancer and Blood Diseases Institute (CBDI). Dr. McGrady's faculty position was created to support a research program focused on improving quality of life and health outcomes of AYAs with cancer. In this position, Dr. McGrady is applying her unique interest in behavioral economics to understand adherence and develop a novel adherence-promotion intervention for AYAs with cancer. This innovative research program has the potential to reduce the increased risk of relapse and mortality faced by the 44-48% of AYAs with cancer who are non-adherent and thus directly aligns with NCI's call for cancer control "research in the behavioral sciences that...reduces cancer risk, incidence, morbidity, and mortality." Training Objectives: To successfully pursue this important line of research and meet her career goal of becoming an independently-funded cancer control researcher, Dr. McGrady must fill gaps in her content and procedural knowledge. The proposed K07 will provide Dr. McGrady with the opportunity to fill these gaps and enable her to: 1) gain expertise in the application of behavioral economics methods to adherence; 2) develop knowledge of the treatment and health outcomes of AYA cancers; and 3) enhance her training in randomized clinical trial design. Mentors: Dr. McGrady's primary mentor, Ahna Pai, PhD, is an NCI R01-funded researcher with expertise in adherence and AYAs with cancer. Under Dr. Pai's mentorship, Dr. McGrady has assembled an expert team of internationally recognized leaders in behavioral economics, adherence, AYA cancer, behavioral interventions, and ethics who complement Dr. Pai's expertise and will provide valuable mentorship. Environment: CCHMC and the University of Cincinnati (UC) are uniquely equipped to facilitate the career development of junior researchers like Dr. McGrady. Through UC's Clinical and Translational Science Award (co-directed by Dr. McGrady's consultant, Dr. Joel Tsevat), BMCP (i.e., Psychology Review Group, Data Core), and the CBDI (i.e., immersive learning, seminars), Dr. McGrady has the local resources to achieve her training objectives and complete the proposed research. When optimal training is not available locally, Dr. McGrady will supplement these experiences with internationally-recognized courses. The CBDI is the ideal clinical setting for the proposed research as its current priorities include investigating "innovatve approaches to care for adolescents and young adults." The CBDI also provides access to a large patient population. Dr. McGrady will capitalize on her current relationships with CBDI faculty (i.e., Dr. Fouladi, Co-Mentor; Dr. Perentesis, Consultant; Dr. Nagarajan, Consultant) to implement the proposed research. Research: Motivation is the primary driver of non-adherence among adults with breast cancer but has not been examined among AYAs. A primary reason for this gap may be that available measures do not assess adherence-related motivation among AYAs with cancer. Study 1 includes an innovative application of behavioral economic methods to identify patient preferences, a manifestation of adherence-related motivation. Patient preferences are an ideal target for further investigation as they can be modified with behavioral intervention and account for the wide range of patient-level variability in motivation that may be due to differences in treatment regimens, diagnoses, etc. Results of Study 1 will quantify the relationship between patient preferences and adherence and determine targets for an evidence-based intervention. In Study 2, patient-centered qualitative methods will be used to develop a novel adherence-promotion intervention for AYAs with cancer. In Year 4, Dr. McGrady will submit an R-series proposal to NCI to examine the effectiveness of this intervention. Given the limited effectiveness of available adherence-promotion interventions for AYAs with cancer, these efforts have the potential to significantly improve health outcomes for the tens of thousands of AYAs who struggle with non-adherence.