Optimizing adherence to lung cancer screening: Applying theory and implementation science to participant engagement

项目总结 在美国，肺癌是癌症死亡的主要原因，大多数肺癌确诊为晚期 各阶段。对高危个体进行低剂量CT筛查是唯一可用于诊断的循证工具 肺癌的早期阶段，此时存在可治愈的治疗选择。可喜的降低死亡率的好处 肺癌筛查(LCS)目前由于以人口为基础的不太理想而无法实现 遵守年度筛查指南。在研究环境之外，遵守年度LCS的比例低于 在实践改变的、具有里程碑意义的临床试验中观察到的比率的一半。迫切需要有效的 和可行的干预措施，以提高LCS的依从性，实现最佳的个人和人群健康 福利。F99阶段的研究将利用创新的、多阶段的混合方法设计来 描述LCS患者如何处理有关健康保护行为的健康信息，并利用这些信息 与符合LCS资格的个人一起开发和评估提醒消息的信息。使用四步法 过程中，在对LCS计划参与者的调查中收集的数据(步骤1)将为制定 候选人提醒消息(步骤2)。在最后两步中，提醒消息将由LCS进行评估 专家(步骤3)，并与LCS计划参与者一起使用混合方法进一步评估和改进(步骤4)， 包括调查和访谈。按人口学划分的健康信息处理结构的差异 或者，在步骤1中发现的显著临床特征将成为消息目标的重点(组级别) 和/或裁剪(个人层面)。在F99阶段结束时，我将有一套正式的清晰、 引人入胜的、高效的信息，以支持LCS的年度依从性，准备在临床环境中进行评估。 在K00阶段提出的研究将侧重于获得混合有效性的实际经验 实施研究设计和务实的成果衡量标准，以同时评估有效性和 实施成果。具体地说，我提出了一种有指导的职前第一类混合有效性- 实施试验，在母公司试验范围内，允许同时评估有效性和 F99提醒策略在现实世界LCS项目中的实施结果。有效性将得到测试 使用事前设计，比较筛查参与者遵守年度筛查指南的百分比 在实施提醒策略前后。二次执行成果(即， 可接受性和可行性)将通过调查和对参与的人员的关键线人访谈进行评估 提醒系统的实施(例如，LCS计划总监、导航员、协调员)。这具身体 研究将为我的职业生涯做好准备，成为一名专注于癌症的独立干预科学家，拥有 制定和实施有效、低负担的干预措施，目的是改善遵守LCS的情况， 最大限度地提高筛查效益，降低肺癌死亡率。

PROJECT SUMMARY Lung cancer is the leading cause of cancer death in the US, with most lung cancer diagnosed at advanced stages. Low-dose CT screening of high-risk individuals is the only evidence-based tool available to diagnose lung cancer at an early stage when curable treatment options exist. The promising mortality reduction benefit of lung cancer screening (LCS) is presently overwhelmingly unfulfilled due to suboptimal population-based adherence to annual screening guidelines. Outside of research settings, adherence to annual LCS is less than half of the rates observed in the practice-changing, landmark clinical trials. There is an urgent need for effective and feasible interventions to improve LCS adherence and achieve optimal individual and population health benefits. Research during the F99 phase will leverage an innovative, multi-phase, mixed methods design to describe how LCS patients process health information regarding health protective behavior and utilize this information to develop and evaluate reminder messages with individuals eligible for LCS. Using a four-step process, data collected in a survey of LCS program participants (step 1) will inform the development of a pool of candidate reminder messages (step 2). In the final two steps, the reminder messages will be evaluated by LCS experts (step 3) and further evaluated and refined with LCS program participants (step 4) using mixed methods, including surveys and interviews. Differences between health information processing constructs by demographic or clinical characteristics found to be significant from step 1 will be the focus for message targeting (group level) and/or tailoring (individual level). At the conclusion of the F99 phase, I will have a formalized set of clear, engaging, and efficient messages to support LCS annual adherence, ready to be evaluated in a clinical setting. Research proposed in the K00 phase will focus on gaining real-world experience with hybrid effectiveness implementation study designs and pragmatic outcome measures to simultaneously assess effectiveness and implementation outcomes. Specifically, I propose a mentored pre-post type 1 hybrid effectiveness- implementation trial, within a parent trial, that will allow concurrent assessment of effectiveness and implementation outcomes of the F99 reminder strategy in real-world LCS programs. Effectiveness will be tested using a pre-post design, comparing percent screening participants adherent to annual screening guidelines before and after implementation of the reminder strategy. Secondary implementation outcomes (i.e., acceptability and feasibility) will be assessed with surveys and key informant interviews of personnel involved in the reminder system implementation (e.g., LCS program directors, navigators, coordinators). This body of research will prepare me for a career as an independent cancer-focused intervention scientist with expertise in the development and implementation of effective, low-burden interventions aimed at improving LCS adherence, maximizing screening benefit, and reducing lung cancer mortality.