Development and Pilot Testing of a Collaborative Agenda-Setting Intervention to Promote Patient-Centered Communication in Ovarian Cancer Care

项目摘要/摘要 晚期卵巢癌患者经历一系列复杂的身体症状，并承受 心理困扰的负担高得不成比例。以患者为中心的沟通(PCC)与 具有更好的健康相关生活质量(HRQOL)的癌症患者，对高质量是必不可少的 妇科癌症护理。然而，很少有沟通干预能改善慢性阻塞性肺疾病患者的HRQOL 癌症。一种可能的解释是，大多数沟通干预措施的可扩展性有限。到目前为止，没有 已知的干预措施旨在帮助卵巢癌患者和他们的临床医生常规参与 PCC。如果没有这样的干预，PCC改善健康结果的潜力可能无法实现。 制定促进PCC的干预措施的另一个障碍是对PCC的最佳评估包括 客观评定患者和临床医生的行为。调查人员通常依靠训练有素的编码员来识别PCC 在录音诊所就诊期间的行为。这种资源密集型方法缺乏研究的可行性 大样本。需要评估PCC行为的新方法来推动这一领域的发展。自然语言 处理(NLP)大约比手动编码快十倍，并且可以识别人类 编码员失手了。然而，使用NLP来评估PCC行为的可行性尚不清楚。 拟议研究的总体目标是完善和试行协作议程设置 介入(CASI)以促进PCC在卵巢癌治疗中的作用。本项目的具体目标是：(1)评估 CASI的可用性和可接受性，并找出其实施的障碍；(2)评估 一项随机对照试验(RCT)，将CASI与常规护理进行比较；以及(3)评估使用 NLP用于评估PCC行为。数据将通过有声思考的访谈、可用性和可接受性来收集 调查，以及双臂、平行分组的试点区域工作队。 拟议的职业发展计划将使我做好准备，通过(A)申请 加强干预措施可伸缩性的实施科学原则；(B)获得设计经验， 进行、分析和传播随机试验产生的数据；(C)培养利用 NLP用于分析非结构化文本；(D)加强技能、科学交流和 (E)建立跨学科导师和合作者网络。这些目标将是 通过指导研究经验、说教培训和科学会议相结合的方式实现 达纳-法伯癌症研究所、哈佛医学院和哈佛公共卫生学院。 拟议的研究和培训计划与国家护理研究所的使命直接相关 研究。该项目将(A)试验一项创新的健康技术，以改善HRQOL；(B)使用一个人- 以中心视角实施新的护理模式，以及(C)培养21世纪的护理科学家。

PROJECT SUMMARY / ABSTRACT Patients with advanced ovarian cancer experience a complex array of physical symptoms and bear a disproportionately high burden of psychological distress. Patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with cancer and is essential to high-quality gynecologic cancer care. However, few communication interventions have improved HRQoL in patients with cancer. One possible explanation is that most communication interventions have limited scalability. To date, no known intervention has aimed to assist patients with ovarian cancer and their clinicians to routinely engage in PCC. Without such an intervention, the potential for PCC to improve health outcomes may go unrealized. Another obstacle to developing interventions to promote PCC is that optimal assessment of PCC includes objective ratings of patient and clinician behavior. Investigators typically rely on trained coders to identify PCC behaviors during audio-recorded clinic visits. This resource-intensive approach lacks feasibility for studies with large samples. Novel methods for assessing PCC behaviors are needed to advance the field. Natural language processing (NLP) is approximately ten times faster than manual coding and may identify information that human coders miss. However, the feasibility of using NLP to assess PCC behaviors is unknown. The overall objective of the proposed research is to refine and pilot test a collaborative agenda-setting intervention (CASI) to facilitate PCC in ovarian cancer care. The specific aims of this project are to (1) assess the usability and acceptability of the CASI and identify barriers to its implementation; (2) assess the feasibility of a randomized controlled trial (RCT) comparing the CASI to usual care; and (3) assess the feasibility of using NLP to assess PCC behaviors. Data will be collected through think-aloud interviews, usability and acceptability surveys, and a two-arm, parallel-group pilot RCT. The proposed career development plan will prepare me to advance toward independence by (a) applying principles of implementation science to enhance intervention scalability; (b) gain experience designing, conducting, and analyzing and disseminating data resulting from randomized trials; (c) develop expertise in using NLP to analyze unstructured text; (d) strengthening skills in grantsmanship, scientific communication, and leadership; and (e) building a network of interdisciplinary mentors and collaborators. These objectives will be achieved through a combination of mentored research experiences; didactic training; and scientific meetings at Dana-Farber Cancer Institute, Harvard Medical School, and the Harvard School of Public Health. The proposed research and training plan relates directly to the mission of the National Institute of Nursing Research. This project will (a) pilot test an innovative health technology to improve HRQoL, (b) use a person- centered perspective to implement new models of care, and (c) train the nurse scientists of the 21st century.