Approaches and Outcomes of Shared Decision-making and Patient Centered Care Delivery in Barrett's Esophagus

项目总结 这是一份为期五年的以患者为导向的研究事业发展奖的重新提交申请。 (K23)。候选人是北卡罗来纳大学教堂山分校(UNC)的一名积极的临床研究人员。 具有消化系统疾病流行病学的背景，良好的出版记录，以及 致力于食道疾病的研究，特别是巴雷特食道(BE)。该计划的目标是 K23提案是获得以患者为导向的研究方法方面的高级指导培训，所需的 实现候选人的长期职业目标，成为一名独立资助的内科医生-科学家 以患者为中心，共享提高食管腺癌检测水平 BE中的决策关怀路径。具体来说，候选人提出的职业发展目标是：1) 获得实施科学和患者决策辅助工具开发方面的培训；2)获得 开发患者报告的结果(PRO)措施；3)发展进行比较的知识 使用大型真实世界数据库进行有效性研究；以及4)过渡到独立。要实现这些目标 职业发展目标，候选人将参加1)高级，研究生水平的课程实施 科学、决策辅助设计、预测量和比较有效性研究；2)参与学术研究 旨在促进独立和国家认可的活动；以及3)开展有指导的研究。这个 候选人的指导团队由国际公认的、独立资助的调查人员组成， 巴雷特食道和胃肠道流行病学的专业知识(沙欣)、实施科学和 决策辅助(Reuland)、专业(Keefer)和比较有效性(Lund)。每位导师都有过往的履历 致力于指导初级教员。研究项目的具体目标是：1)开发和测试 基于网络的、以患者为导向的BE筛查决策辅助工具，以提高筛查率；2) 使用深入访谈的概念启发开发特定于BE的PRO工具以生成工具 项目，并进行认知访谈，以确保内容的有效性；3)评估相对有效性 内窥镜监测与消融治疗BE合并低度异型增生(LGD)的对比研究 声明数据可帮助制定共享决策。最后，候选人的研究和培训环境在 北卡罗来纳大学是一所卓越的学术研究机构，实力雄厚，历史悠久。2020财年，北卡罗来纳大学 美国国立卫生研究院(NIH)对国内高等院校的研究资助排名第16位 美国国立卫生研究院资助的中心(翻译和临床科学研究所和中心 胃肠生物学和疾病)，是为支持拟议的研究而量身定做的。这种协作性 环境、指导、教学和研究经验将为应聘者提供强有力的 为成功实现拟议的研究和培训目标奠定了基础和独特的技能。支持来自 K23对于实现候选人向独立内科科学家过渡的目标至关重要。

PROJECT SUMMARY This is a resubmission application for a five-year mentored patient-oriented research career development award (K23). The candidate is a motivated clinical researcher at the University of North Carolina Chapel Hill (UNC) with a background in digestive disease epidemiology, a strong publication record, and an established commitment to the study of esophageal diseases, specifically Barrett’s esophagus (BE). The objective of the K23 proposal is to obtain advanced mentored training in patient-oriented research methodologies required to achieve the candidate’s long-term career goal of becoming an independently funded physician-scientist improving detection of esophageal adenocarcinoma (EAC) by implementing patient-centered and shared decision care pathways in BE. Specifically, the candidate’s proposed career development goals are: 1) to obtain training in implementation science and development of patient decision aids; 2) to gain experience in the development of patient-reported outcomes (PRO) measures; 3) to develop knowledge in conducting comparative effectiveness research using large real-world databases; and 4) to transition to independence. To achieve these career development goals, the candidate will 1) take advanced, graduate level coursework in implementation science, decision aid design, PRO measures, and comparative effectiveness research; 2) participate in scholarly activities designed to foster independence and national recognition; and 3) conduct mentored research. The candidate’s mentoring team consists of internationally recognized, independently-funded investigators with expertise in Barrett’s esophagus and gastrointestinal epidemiology (Shaheen), implementation science and decision aids (Reuland), PROs (Keefer) and comparative effectiveness (Lund). Each mentor has a track record of commitment to mentoring junior faculty. The specific aims of the research project are: 1) to develop and test a web-based, patient-directed BE screening decision aid to improve screening rates screen-eligible patients; 2) to develop a BE-specific PRO instrument using in-depth interviews for concept elicitation to generate instrument items and perform cognitive interviews to ensure content validity; 3) to evaluate the comparative effectiveness of endoscopic surveillance versus ablation for BE patients with low-grade dysplasia (LGD) using administrative claims data to aid in shared decision making. Finally, the candidate’s research and training environment at UNC, a preeminent academic research institution, is strong and well-established. For fiscal year 2020, UNC ranked sixteenth for National Institutes of Health (NIH) research funding to domestic institutions of higher education, and has access to NIH funded centers (Translational and Clinical Sciences Institute and Center for Gastrointestinal Biology and Disease) that are tailored to support the proposed studies. This collaborative environment, mentorship, didactics, and research experience will provide the candidate with the strong foundation and unique skillset to successfully achieve the proposed research and training goals. Support from the K23 is critical to achieve the candidate’s goal of transitioning to an independent physician-scientist.