1. ©PPRNet 2014 Designing a PPRNet PCORI Application to Improve Adherence to USPSTF Grade D Recommendations for Cancer Screening

2. ©PPRNet 2014 PCORI Communication and Dissemination Fall Research Announcement Seeking research that: Compares strategies meant to generate conversations between patients and providers about what is appropriate and necessary treatment based on patients’ preferences and conditions. Compares innovative approaches in the use of existing electronic clinical data and other electronic modalities (e.g., electronic health records) to enhance clinical decision making by patients and providers.

3. ©PPRNet 2014 PCORI’S PATIENT- CENTERED STANDARDS Patients, clinicians and other stakeholders should be engaged in the processes of: Formulating research questions Defining study design Identifying outcomes of interest Monitoring study progress Suggesting plans for dissemination

4. ©PPRNet 2014 BACKGROUND Inappropriate screening occurs frequently in ambulatory care Given rising health care costs, increasing national effort to reduce overuse of medical services for which harms outweigh benefits http://youtu.be/FqQ-JuRDkl8

5. ©PPRNet 2014 BACKGROUND USPSTF and Choosing Wisely campaign recommend against routine screening for: Prostate cancer Cervical ca in women 65, or HPV testing in women<30 National rates of inappropriate PSA screening or pap testing are high Over 2/3 of women age>65 have had a pap smear Inappropriate PSA screening rate between 16-36% even before new D recommendation

6. ©PPRNet 2014 BACKGROUND Barriers include: Lack of time and skills needed for discussing potential risks of screening Lack of awareness of recommendations Lack of knowledge of harms of screening Over-estimation of benefits of screening tests by patients

7. ©PPRNet 2014 BACKGROUND Choosing wisely intended to promote conversations between physicians and patients to help patients choose care that is evidence- based, necessary and free from harm. USPSTF recognizes common use of PSA screening. “Decision to initiate or continue PSA screening should reflect understanding of the possible benefits and harms and respect patient’s preferences.”

8. ©PPRNet 2014 RESEARCH QUESTION Can a primary care model be developed to promote conversations between patients and providers about what cancer screening tests are appropriate and necessary based on patients’ preferences and conditions?

9. ©PPRNet 2014 Designing a project to improve adherence to USPSTF Grade D Recommendations for Cancer Screening Should we study other Grade D or Choosing Wisely recommendations?

10. ©PPRNet 2014 Designing a project to improve adherence to USPSTF Grade D Recommendations for Cancer Screening What strategies or tools could be used to improve patient-centered communication about adhering to Grade D/Choosing Wisely recommendations?

11. ©PPRNet 2014 Designing a project to improve adherence to USPSTF Grade D Recommendations for Cancer Screening What outcomes are important to study?

12. ©PPRNet 2014 Designing a project to improve adherence to USPSTF Grade D Recommendations for Cancer Screening How do we engage patients to be our advisors for this study?

13. ©PPRNet 2014 NEXT STEPS September 2014- Additional stakeholder input (patients, clinicians) on study design October 2014- Letters of Support needed November 2014- Application deadline July/August 2015- Earliest project start date