Development of a Conjoint Analysis Instrument for Lung Cancer Screening Decisions

描述(申请人提供)：肺癌是美国癌症死亡的主要原因，2008年估计有161,840人死亡。尽管肺癌筛查的倡导者和那些认为筛查效果未经证实的人之间存在争议，但肺癌筛查的受欢迎程度和可用性在美国有所增加。媒体广泛报道了CT筛查试验，如I-ELCAP、NLST和Nelson试验。此外，媒体还报道了新的筛查方法，如遗传和肺血清检测。然而，关于筛查是否会降低肺癌死亡率，目前还没有达成一致意见，筛查存在风险。随着筛查程序变得更广为人知和更广泛地使用，更多的人将面临是否接受肺癌筛查以及通过何种方法进行筛查的艰难决定。对于这种情况，知情的决策是至关重要的，但目前人们对哪些因素对个人做出肺癌筛查决策的重要性知之甚少。这项研究的长期目标是开发一种在无症状高危人群中进行肺癌筛查的知情决策辅助工具。本申请的具体目标是开发和探索一种联合调查工具，该工具可用于收集有关影响肺癌筛查决策的筛查属性的信息。联合方法论是一种创新的偏好诱导方法，近年来在卫生保健研究中的应用越来越多。 本研究的主要目的是：(1)确定过程和结果的范围 (2)确定每个肺癌筛查情景属性的重要性和实用性；(3)确定个体特征与筛查兴趣之间的关联。为了实现这些目标，我们将首先对目标人群和医疗保健提供者进行半结构化访谈，以获得各种肺癌筛查检查的属性信息，这些检查对个人的筛查决策非常重要。我们将使用锯齿软件开发一种联合调查工具，并编制一份调查，其中还包括可能与筛查兴趣相关的各种个人特征。我们将使用认知访谈技术对这项调查进行试点测试，然后通过具有全国代表性的基于网络的调查进行初步调查。这项研究中开发的调查工具将用于未来的研究，其目标是开发一种可以根据个人特征量身定做的肺癌决策辅助工具。联合工具将是决策辅助工具的重要组成部分，因为它帮助个人集中他们的偏好，并在复杂的、多属性的情况下促进决策。 与公共卫生相关：2008年，肺癌将在美国导致超过16万人死亡。肺癌筛查可能会将诊断转移到癌症更容易治疗的早期阶段。然而，考虑到筛查益处的不确定性和重大风险，以患者为中心的筛查知情决策至关重要。这项研究将使我们能够开发一种个性化的知情决策辅助工具，以促进关于肺癌筛查的知情决策，并导致患者满意度和福利的改善。

DESCRIPTION (provided by applicant): Lung cancer is a leading cause of cancer death in the United States, with an estimated 161,840 deaths in 2008. The popularity and availability of lung cancer screening has increased in the United States, despite controversy between advocates of screening and those who believe the efficacy of screening is unproven. There has been extensive media coverage of CT screening trials such as the I-ELCAP, NLST and NELSON trials. In addition, there has been media coverage of new screening methodologies such as genetic and lung serum testing. Nevertheless, there is no agreement on whether screening will reduce lung cancer mortality, and screening carries risks. As screening procedures become better known and more widely available, more individuals will face difficult decisions about whether to be screened for lung cancer and by what method. For such situations, informed decision making is critical, but little is currently known about what factors are important to individuals in making decisions about lung cancer screening. The long term goal of this line of research is to develop an informed decision making aid for lung cancer screening among asymptomatic high risk individuals. The specific objective of this application is to develop and explore a conjoint survey instrument that can be used to collect information on screening attributes that affect decisions about lung cancer screening. The conjoint methodology is an innovative approach to preference elicitation and its use in health care research has been increasing in recent years. The primary aims of this research are to: (1) Determine the range of process and outcome attributes of lung cancer screening that affect interest in being screened for lung cancer and develop and pilot test a conjoint survey instrument to evaluate these attributes; (2) Determine the importance and utility of each of the lung cancer screening scenario attributes; and (3) Determine the association of individual characteristics with interest in screening. To accomplish these aims we will first conduct semi-structured interviews with the target population and health care providers to gain information on the attributes of various lung cancer screening examinations that are important in individuals' screening decisions. We will use Sawtooth Software to develop a conjoint survey instrument and compile a survey which also includes various individual characteristics that also may be associated with screening interest. We will pilot test this survey using cognitive interviewing techniques, and then conduct a preliminary survey via a nationally representative web-based survey. The survey instrument developed in this research will then be used in future research which will have as its aim the development of a lung cancer decision aid that can be tailored to individual characteristics. The conjoint instrument will be an essential part of the decision aid as it helps individuals focus their preferences and facilitates decision making in complex, multi-attribute situations. PUBLIC HEALTH RELEVANCE: Lung cancer will lead to over 160,000 deaths in the United States in 2008. Screening for lung cancer may have the potential to shift diagnoses to an earlier stage where cancer is more treatable. However, given the uncertainty of screening benefits and significant risks, patient centered informed decision making about screening is critical. This research will allow us to develop an individually-tailored informed decision making aid to promote informed decision making about lung cancer screening, and lead to improvements in patient satisfaction and welfare.