Since 2011, I have been refining and testing a framework to prioritize 24 preventive interventions in a clinical context. Of these interventions, 8 are directly related to cancer: 4 cancer screenings to promote early detection (breast, cervical, colorectal, lung) and 4 healthy lifestyle attributes known to help prevent cancer (tobacco cessation, healthy diet, physical activity, alcohol reduction). I developed a decision analytic model to estimate the change in life expectancy associated with use of each intervention, tailored for each patient based on his/her risk-factors. Then, I translated model results into a clinical decision tool, integrated it with electronic health records (EHRs), and incorporated quality-of-life. After successful pilot testing, I am conducting an NIA-funded Phase III randomized controlled trial of 721 patients to compare health outcomes in those who utilize the tool with a control group.
In other work, I have studied cancer screening decision science. Many individuals are unable to obtain all guideline-recommended cancer screenings, owing to acute medical needs and time commitments for work, family, friends and hobbies. I led an international collaboration to assess how physicians should counsel populations of women who obtain some, but not all, evidence-based cancer screenings. My coauthors and I found that it was possible to reduce screening intensity to 1 carefully chosen test/year in women ineligible for lung cancer screening (2 tests/year in eligible women), while maintaining ≥94% of life-years from full guideline compliance. The manuscript was published in JAMA Oncology. In another study, I developed a mathematical framework to illustrate how individuals with varying tolerance for complications risk might decide on their preferred colorectal cancer screening strategy. Additionally, my coauthors and I developed a risk prediction model to personalize recommendations for cervical cancer screening. Earlier, I advised a number of trainees on the accurate assessment of benefits and harms from treatments for prostate cancer and brain metastases.