Colorado PROFILES, The Colorado Clinical and Translational Sciences Institute (CCTSI)
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Accelerating adoption of CER results with patient decision support interventions

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The promise of comparative effectiveness research (CER) is that it will lead to improved clinical decision-making and better performance of the US healthcare system. However, for CER to fulfill its potential there is an urgent need to overcome the translational gap between evidence-based clinical decisions and real world clinical practice. Decision support interventions (DESIs) that translate CER results into usable information for patients have been shown to improve clinical decision making in clinical trials and have the potential to bridge the translational gap into clinical practice. But, effective and efficient methods for implementing DESIs are paramount to promoting the adoption of CER by patients at the point of care. We propose two studies using innovative approaches based in social marketing and behavioral economics to address this need along the care continuum for prostate cancer. Prostate cancer is an ideal clinical paradigm for studying the use of DESIs to increase the uptake of CER results. For both initial prostate cancer screening among asymptomatic men, as well as subsequent treatment decisions, CER has not demonstrated a clearly superior option. Therefore, multiple professional organizations recommend that men carefully weigh the risks and benefits of screening and treatment before making a decision. Prostate cancer screening and treatment DESIs have been proven to facilitate the complex decision making process. We will conduct two separate but closely related studies that focus on the continuum of prostate cancer care, from initial screening to subsequent treatment decisions. In the first study, we will compare 3 strategies for systematic delivery of prostate cancer screening DESIs focusing on 2 distinct populations: (1) men over 50 and (2) men turning 50. In the second study, we will determine the effect of providing treatment DESIs to men with low risk prostate cancer. These studies build on a strong foundation of preliminary work, giving them a very high likelihood of success. Our combination of rigorous experimental methods with diverse practice settings maximizes the real-world relevance of the research and thereby promises to bridge the translational gap between CER and routine clinical practice.

PUBLIC HEALTH RELEVANCE: Prostate cancer is the most common cancer among men, besides skin cancer. Because the benefits of screening and treatment are uncertain and treatment can lead to reductions in quality-of-life, clinical guidelines recommend that men weigh the risks and benefits of screening and treatment in order to make informed decisions. The proposed study will rigorously evaluate the effects of systematically delivering decision support interventions that help men make informed decisions along the continuum of prostate cancer care, from screening to treatment.

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