MULTIPLE RISKS, DECISIONS & BEHAVIORS IN THE GENOMIC ERA

这个提议是为了让卡伦·赫尔利博士成为一名 遗传性癌症风险的独立行为调查员。它解决了两个挑战， 基因组革命：1）在同一个基因组中解释多种相互关联的降低风险的行为结果， 人，和2）占预测变量和行为之间的关系的个体差异 结果。遗传性综合征通常会同时对几个器官造成风险，但研究通常只评估一个器官。 一次筛查结果。同样，社会心理因素也常常被作为独立的预测因素进行分析; 然而，在一个特定的人，它们是相互依存的。制定新的评估和统计策略， 了解患者如何处理复杂的信息，并分析相互关联的行为结果，将 提高研究结果的准确性和临床实用性。研究1将评估 在HNPCC患者中遵守（完全，部分或无）全面的多器官筛查指南。 聚类分析将产生感知/风险担忧类型的分类（例如，选择性地担心一种类型的 癌症与普遍的担忧），将用于预测随时间的依从性轨迹。在研究2中， BRCA 1/2携带者将获得基于计算机的遗传教育，以降低两种癌症风险 等位基因（RAD 51放大BRCA相关风险; APCI 1307 K指示结肠癌风险）。我们将评估基因 测试摄取水平，并使用自动分析方法探索预测变量之间的关系模式。 交互检测（AID）。我们的目标是识别有不同咨询需求的患者群体， 检查咨询对满意度的不同影响，痛苦，坚持降低风险， 这些团体。该培训计划支持拟议的研究与癌症遗传学，遗传学， 流行病学，分子生物学和高级统计学（潜在类别分析，生长曲线分析， 分层线性模型和自动交互检测）。长期目标是促进癌症 通过加强健康保护来预防和控制遗传性癌症综合症 高风险个体的行为;然而，这里开发的研究方法可以应用于平均 接受多个筛查建议的风险个体（例如，50岁以上的女性 常规乳腺癌、结肠直肠癌、宫颈癌和皮肤癌监测）。

This proposal is for advanced training and mentored researchfor Dr. Karen Hurley to become an independent behavioral investigator in hereditary cancer risk. It addresses two challenges posed by the genomic revolution: 1) accounting for multiple, interrelated risk-reducing behavior outcomes in the same person, and 2) accounting for individual variation in the relations between predictor variables and behavioral outcomes. Hereditary syndromes often confer risk to several organs at once, yet studies usually assess one screening outcome at a time. Similarly, psychosocial factors are often analyzed as independent predictors; yet within a given person they are interdependent. Developing new assessment and statistical strategies to understand how patients process complex information, and to analyze interrelated behavioral outcomes, will enhance the accuracy and clinical utility of researchfindings. Study 1will assess longitudinal patterns of adherence (full, partial or none) to comprehensive, multi-organ screening guidelines in HNPCC patients. Cluster analysis will yield a taxonomy of perceived/risk worry types (e.g., selective worry about one type of cancer vs. pervasive worry) that will be used to predict trajectories of adherence over time. In Study 2, BRCA1/2 carriers will be offered computer-based genetic education for two low penetrance cancer risk alleles (RAD51 amplifies BRCA-related risk; APCI1307K indicates colon cancer risk). We will assess genetic testing uptake levels, and explore patterns of relations between predictor variables using automatic interaction detection (AID). We aim to identify groups of patients with different counseling needs, and to examine the differential impact of counseling on satisfaction, distress, and adherence to risk reduction in these groups. The training plan supports the proposed research with coursework in cancer genetics, genetic epidemiology, molecular biology and advanced statistics (latent class analysis, growth curve analysis, hierarchical linear models, and automatic interaction detection). The long-term goal is promote cancer prevention and control efforts in hereditary cancer syndromes by increasing adherence to health-protective behaviors in high risk individuals; however, the research methods developed here may be applied to average risk individuals who receive multiple recommendations for screening (e.g., women over 50 undergoing routine breast, colorectal, cervical, and skin cancer surveillance).