Predicting Surgical Decisions of High-Risk UC Patients

描述(由申请者提供)：这份为期5年的K07奖项申请描述了一项培训和研究计划，该计划将为申请者，一名具有母婴健康心理社会研究背景的社会/健康心理学家，提供指导和“保护时间”，以建立与癌症预防和控制研究生涯相关的技能和知识。重点是建立癌症知识(例如，生物学、心理社会问题)、研究密切关系过程的方法，以及分析纵向数据的高级统计技能。在培训结束时，申请者将发展出足够的专业知识，成为一名成熟的独立调查员，处于探索医学和心理社会因素如何共同影响癌症预防和控制的研究前沿。拟议的培训包括正式和非正式的教学，以及一个创新研究的补充计划。这项研究将培训期间获得的知识和技能应用于一项基于理论和临床相关的研究，研究内容是：溃疡性结肠炎(UC)患者在检测到癌前细胞变化后，如何做出艰难的决定，接受医生的建议，切除他们的结肠和直肠，表明CRC的短期风险很高。为了解决缺乏对这一高危人群的研究，拟议的研究在逻辑上从定性研究，到回溯性、横断面研究，再到使用“每日日记”方法的前瞻性、纵向研究。对影响手术决定的三个关键因素进行了调查：1)医疗因素，2)健康信念，3)恋人。UC患者的冒险倾向也将被视为对他们决策的潜在影响。研究结果将有助于临床工作，以确保转诊为手术的UC患者能够做出知情的决定，总体目标是帮助降低这一人群中的CRC发病率和死亡率。理论进展包括将决策模型扩展到包括不可逆转的、改变生活的决策以及人际/家庭影响。这项研究将在西奈山进行，这是UC的主要转诊地点，并得到一位经验丰富的导师和一组心理和健康研究人员的支持，这位导师是一位杰出的胃肠病专家，他们将担任共同导师。该奖项将有助于申请者实现她的短期目标，即成为一名医学和心理社会对癌症预防和控制结果的影响的独立调查者，以及她的长期目标，即进行能够帮助降低癌症死亡率和发病率的创新研究。

DESCRIPTION (provided by applicant): This 5-year K07 award application describes a program of training and research that will provide the applicant, a social/health psychologist with a background in psychosocial research on maternal-fetal health, with mentoring and "protected time" to build skills and knowledge relevant to a research career in cancer prevention and control. Emphasis is on building knowledge of cancer (e.g., biology, psychosocial issues), methods for the study of close relationship processes, and advanced statistical skills for analysis of longitudinal data. At the conclusion of training, the applicant will have developed sufficient expertise to be a fully-established, independent investigator at the forefront of research exploring how medical and psychosocial factors together influence cancer prevention and control. The proposed training includes formal and informal didactics and a complementary program of innovative research. This research applies knowledge and skills gained during the training period to a theoretically-based, clinically-relevant study of how ulcerative colitis (UC) patients at high risk for colorectal cancer (CRC) make the difficult decision to accept a physician's recommendation for surgical removal of their colon and rectum after detection of pre-cancerous cell change, indicating high short-term risk for CRC. To address the lack of research on this high-risk population, the proposed research progresses logically from a qualitative study, to a retrospective, cross-sectional study, to a prospective, longitudinal study using "daily diary" methods. Three key influences on the surgical decision are investigated: 1) medical factors, 2) health beliefs, and 3) romantic partners. UC patients* dispositional tendency to take risks will also be explored as a potential influence on their decision. Findings will assist clinical efforts to ensure that UC patients referred for surgery are able to make an informed decision, with the overarching goals of helping to reduce CRC morbidity and mortality in this population. Theoretical advances include extension of decision-making models to include irreversible, life-altering decisions as well as interpersonal/family influences. The study will be conducted at Mount Sinai, a primary referral site for UC, and supported by an experienced mentor who is a distinguished gastroenterologist and a team of psychological and health researchers who will serve as co-mentors. The award will be instrumental to the applicant in achieving her short-term goal of becoming an independent investigator of medical and psychosocial influences on cancer prevention and control outcomes, as well as her longer-term objective of conducting innovative research capable of helping to reduce cancer mortality and morbidity.