Approaches and Outcomes of Shared Decision-making and Patient Centered Care Delivery in Barrett's Esophagus

PROJECT SUMMARY
This is a resubmission application for a five-year mentored patient-oriented research career development award
(K23). The candidate is a motivated clinical researcher at the University of North Carolina Chapel Hill (UNC)
with a background in digestive disease epidemiology, a strong publication record, and an established
commitment to the study of esophageal diseases, specifically Barrett’s esophagus (BE). The objective of the
K23 proposal is to obtain advanced mentored training in patient-oriented research methodologies required to
achieve the candidate’s long-term career goal of becoming an independently funded physician-scientist
improving detection of esophageal adenocarcinoma (EAC) by implementing patient-centered and shared
decision care pathways in BE. Specifically, the candidate’s proposed career development goals are: 1) to
obtain training in implementation science and development of patient decision aids; 2) to gain experience in the
development of patient-reported outcomes (PRO) measures; 3) to develop knowledge in conducting comparative
effectiveness research using large real-world databases; and 4) to transition to independence. To achieve these
career development goals, the candidate will 1) take advanced, graduate level coursework in implementation
science, decision aid design, PRO measures, and comparative effectiveness research; 2) participate in scholarly
activities designed to foster independence and national recognition; and 3) conduct mentored research. The
candidate’s mentoring team consists of internationally recognized, independently-funded investigators with
expertise in Barrett’s esophagus and gastrointestinal epidemiology (Shaheen), implementation science and
decision aids (Reuland), PROs (Keefer) and comparative effectiveness (Lund). Each mentor has a track record
of commitment to mentoring junior faculty. The specific aims of the research project are: 1) to develop and test
a web-based, patient-directed BE screening decision aid to improve screening rates screen-eligible patients; 2)
to develop a BE-specific PRO instrument using in-depth interviews for concept elicitation to generate instrument
items and perform cognitive interviews to ensure content validity; 3) to evaluate the comparative effectiveness
of endoscopic surveillance versus ablation for BE patients with low-grade dysplasia (LGD) using administrative
claims data to aid in shared decision making. Finally, the candidate’s research and training environment at
UNC, a preeminent academic research institution, is strong and well-established. For fiscal year 2020, UNC
ranked sixteenth for National Institutes of Health (NIH) research funding to domestic institutions of higher
education, and has access to NIH funded centers (Translational and Clinical Sciences Institute and Center for
Gastrointestinal Biology and Disease) that are tailored to support the proposed studies. This collaborative
environment, mentorship, didactics, and research experience will provide the candidate with the strong
foundation and unique skillset to successfully achieve the proposed research and training goals. Support from
the K23 is critical to achieve the candidate’s goal of transitioning to an independent physician-scientist.