Cancer Treatment Disparities in the HIV Population: Exploring the Impact of HIV on Physician and Patient Decision-Making

项目摘要 NCI K08提案的总体目标是促进Gita Suneja博士发展成为独立的 研究人员将重点放在提高艾滋病毒感染癌症患者的癌症治疗率和结果上。 癌症现在是艾滋病毒人群中非艾滋病死亡的主要原因。癌症存活率显著增加 与普通人群相比，艾滋病毒携带者的情况更糟，部分原因是他们经常 接受适当的癌症治疗。Suneja博士之前的工作表明，肿瘤学家不太可能提供 艾滋病毒感染者的癌症治疗；然而，关于艾滋病毒诊断如何影响的经验数据 医生的决策以及如何将治疗建议传达给这些患者 缺乏。NCI K08应用程序的研究目标是：(1)确定癌症的决定因素 肿瘤学家的治疗决策，(2)评估医患沟通的质量，以及(3) 为肿瘤学家设计一个决策支持工具，以促进艾滋病毒感染患者的适当治疗。这个 长期目标是减少艾滋病毒人群中的癌症治疗差距。为了实现这些目标，Dr。 Suneja将利用杜克大学的现有资源，她是杜克大学 放射肿瘤科。她的职业发展计划包含了混合方法的培训 研究、决策科学、医患沟通和干预设计-嵌套在 组织严密的多学科指导环境-这将使她成为一名独特的学者 从事癌症健康服务研究。 在拟议研究的目标1中，研究人员将直接观察肿瘤学家与患者的互动，以 对医生对癌症的决策和沟通有独特而详细的理解 艾滋病毒患者的治疗选择。在目标2中，他们将对确定的全国肿瘤学家样本进行调查 从基于人群的艾滋病毒/艾滋病癌症配对研究系统地确定癌症的决定因素 治疗决策并征求临床决策支持工具的参数输入。数据结合在一起 目标1和目标2将产生关于医生关键要素的详细和概括的知识 作为适当干预目标的决策和沟通过程。在目标3中， 研究人员将利用以用户为中心的参与式设计框架来开发临床决策支持 肿瘤学家促进循证治疗建议和有效沟通的工具 对向艾滋病毒感染患者提供高质量癌症护理不可或缺的战略。这项研究将填补 在我们对癌症治疗差异的理解中存在一个关键空白，即由于有效的治疗而寿命更长的人群 抗逆转录病毒治疗。此外，职业发展奖将为Suneja博士提供分析 竞争R01级别奖项以衡量真实世界所需的培训和研究成果 干预对HIV人群癌症治疗率的影响。

PROJECT ABSTRACT The overall goal of this NCI K08 proposal is to facilitate Dr. Gita Suneja’s development into an independent investigator focused on improving cancer treatment rates and outcomes among HIV-infected cancer patients. Cancer is now the leading cause of non-AIDS death in the HIV population. Cancer survival is significantly worse in people living with HIV compared with the general population, in part because they frequently do not receive appropriate cancer treatment. Dr. Suneja’s prior work revealed that oncologists are less likely to offer cancer treatment to HIV-infected patients; however, empiric data on how the diagnosis of HIV influences physician decision-making and how treatment recommendations are communicated to these patients is lacking. The research objectives of this NCI K08 application are to (1) identify determinants of cancer treatment decision-making by oncologists, (2) evaluate the quality of physician-patient communication, and (3) design a decision support tool for oncologists to promote appropriate treatment for HIV-infected patients. The long-term goal is to reduce cancer treatment disparities in the HIV population. To achieve these goals, Dr. Suneja will capitalize on the resources available at Duke University, where she is a faculty member in the Department of Radiation Oncology. Her career development plan incorporates training in mixed methods research, decision-making science, physician-patient communication, and intervention design – nested within a structured environment of strong multidisciplinary mentorship – that will uniquely position her for an academic career in cancer health services research. In Aim 1 of the proposed study, the investigators will directly observe oncologist-patient interactions to generate a unique and detailed understanding of physician decision-making and communication of cancer treatment options to patients with HIV. In Aim 2, they will survey a national sample of oncologists identified from the population-based HIV/AIDS Cancer Match Study to systematically identify determinants of cancer treatment decision-making and solicit input on parameters for a clinical decision support tool. Together, data from Aims 1 and 2 will produce detailed and generalizable knowledge on the key elements of the physician decision-making and communication processes that are appropriate intervention targets. In Aim 3, the investigators will utilize a User-Centered Participatory Design framework to develop a clinical decision support tool for oncologists to promote evidence-based treatment recommendations and effective communication strategies that are integral to the delivery of high quality cancer care to HIV-infected patients. This study will fill a critical void in our understanding of cancer treatment disparities in a population living longer due to effective antiretroviral therapy. In addition, the career development award will provide Dr. Suneja with the analytic training and research deliverables necessary to compete for an R01 level award to measure the real world impact of the intervention on cancer treatment rates in the HIV population.