Impact of Emotions on Treatment Decisions About Low-Risk Thyroid Cancer

项目总结 K08职业发展奖将解决申请者培训方面的重要差距，同时 同时产生关于情绪在癌症相关治疗决策中的作用的新知识， NCI的优先级。甲状腺癌发病率的增长速度比其他任何癌症都要快，主要是 由于小型、低风险癌症的诊断增加，≤2厘米，10年死亡率接近于零。 在这些患者中，绝大多数都发生了甲状腺全切除术的过度治疗，导致显著的 危害、过度发病率和对患者和社会的成本，而没有明显的好处。目前，缺乏 对患者为什么喜欢这种广泛治疗的理解限制了我们减少过度治疗的能力 低风险疾病。这项拟议的研究试图通过调查情绪对 关于小型、低风险甲状腺癌的治疗决定。协调研究和培训提案旨在 TO：1)描述患者和外科医生之间的情感和认知交流 治疗决策；2)确定治疗结果与接受治疗的患者的相对价值 在决定时与术后一年进行甲状腺切除术的比较；以及3)测试 外科医生情感支持沟通的增加与患者偏好的降低有关 做全甲状腺切除手术。中心假设是，情绪，如恐惧和焦虑，会影响 患者-外科医生关于治疗小型、低风险甲状腺癌的决策导致 过度款待。完成这些目标将促进决策科学的指导培训，这对皮特博士的 职业目标。拟议的培训将填补决策心理学方面的关键教育和经验空白。 制造和行为经济学，这将伴随着定性研究的方法论培训， 偏好测量、选择实验和析因设计。申请者将利用 拥有国内和国际公认的多学科导师的不同群体的优势 在实验心理学、外科决策、行为经济学和甲状腺癌方面的专业知识 治疗。这种有指导的培训将支持申请者成为一名成功的外科医生-科学家， 独特的研究技能。拟议的研究结果将提供对具体情况的新理解 情绪和情感支持性沟通在低风险癌症治疗决策中的作用。在 在拟议的培训期结束后，皮特博士将拥有获得R01所需的结果和经验 提供资金，以适应和测试纳入情绪支持的行为和教育干预措施，从而 减少过度治疗的危害和成本。

PROJECT SUMMARY This K08 Career Development Award will address important gaps in the training of the applicant while simultaneously generating new knowledge about the role of emotions in cancer-related treatment decisions, a priority of the NCI. The incidence of thyroid cancer has increased at a rate faster than any other cancer, largely due to increased diagnosis of small, low-risk cancers ≤ 2 cm with a 10-year mortality close to zero. Overtreatment with total thyroidectomy occurs in the vast majority of these patients, resulting in significant harms, excess morbidity, and costs to both patients and society without a clear benefit. Currently, a lack of understanding about why patients prefer this extensive treatment limits our ability to reduce overtreatment of low-risk disease. The proposed research seeks to address this gap by investigating the impact of emotions on treatment decisions about small, low-risk thyroid cancer. The coordinated research and training proposal aims to: 1) characterize the emotional and cognitive communication between patients and surgeons during treatment decision making; 2) determine the relative value of treatment outcomes to patients undergoing total thyroidectomy at the time of the decision compared to one year postoperatively; and 3) test the extent to which increased emotionally supportive communication by surgeons is associated with decreased patient preference for total thyroidectomy. The central hypothesis is that is that emotions, such as fear and anxiety, influence patient-surgeon decision making about treatment for small, low-risk thyroid cancer leading to decisions that over treat. Completion of these aims will facilitate mentored-training in decision science that is vital to Dr. Pitt's career goals. The proposed training will fill key educational and experiential gaps in the psychology of decision making and behavioral economics, which will be accompanied by methodologic training in qualitative research, preference measurement, choice experimentation, and factorial design. The applicant will draw upon the strengths of a diverse group of nationally and internationally recognized mentors with multidisciplinary expertise in experimental psychology, surgical decision-making, behavioral economics, and thyroid cancer treatment. This mentored training will support the applicant in becoming a successful surgeon-scientist with unique research skills. The results of the proposed research will provide new understanding about the specific role of emotions and emotionally supportive communication in treatment decisions in a low-risk cancer. At the end of the proposed training period, Dr. Pitt will have the results and experience necessary to obtain R01 funding to adapt and test behavioral and educational interventions that incorporate emotional support, thus reducing the harms and costs of overtreatment.