Innovative Approaches Using Mixed-Methods Procedures in Clinical Cancer Research - 混合研究方法在癌症临床研究中的创新应用

费麦克
富布赖特项目社会科学杰出讲席教授
中国医学科学院肿瘤研究所
CICAMS 1/5/2017
北京市海淀区学院路38号，北京大学医学部，100191
电子邮件：mfetters@umich.edu
手机: 188-1172-8603
微信: MikeFetters

结肠直肠癌网站项目
Michigan Department of Community Health
Colorectal Cancer Screening Behavioral Interventions.
Michigan Department of Community Health
Multi-media Decision Aid to Promote Colorectal Cancer

 大多数美国人没有认识到他们应该关心CRC，或
者不知道选择哪种筛查方法 MostAmericans not aware
that they should be concerned about CRC or which screening method
to choose
 对选择筛查方法有效的CRC网站可能提高公众的
认识，并且促使他们采取行动 An effective CRC Web
site to choose a screening approach might improve awareness and
prompt action
 目标：建立网站来促进CRC筛查，并且确定网站
的有效性 Objective: Develop aWeb site to promote CRC
screening and to determine Web site effectiveness

三阶段混合方法研究（MMR）项目的目标
Purpose of 3-phase MMR project:
1) 评估之前没有筛查过CRC的非裔美国人和白种人个体的态度
和观点，开发网站内容 to assess attitudes and perspectives of African
American and Caucasian individuals not previously screened for CRC to
develop content
2) 开发、测试并优化交互性网站，关注其内容、可用性以及网
址导航，并且 to develop, pilot and refine the interactive website with
attention to content, usability, and navigation, and
3) RCT中，将作为先前未筛查患者的干预的交互式网站与促进
结肠直肠癌筛查的非交互式标准网站进行比较，以评估CRC
筛查的依从性 to compare interactive website with standard website in
RCT with unscreened patients to assess compliance with CRC screening

调查关于CRC筛查
的知识、态度以及
想法 Survey on
Knowledge, attitudes,
beliefs on CRC screening
焦点小组：患者希
望在网站上获得的
信息 Focus Groups：
information patients
want on website
定量Quantitative
定性Qualitative
开展CRC预防网
站访谈、调查以
及观察 Develop
CRC prevention
website
Interviews, surveys,
observations
定性 Qualitative
RCT：比较“新
网站”与标准网
站 RCT
comparing “new
website” with
standard
定量Quantitative

Ruffin MT IV, Creswell JW, Jimbo M, Fetters MD. Factors influencing choices for
colorectal cancer screening. J Community Health, 34:79-89, 2009. PM19082695.

以前未筛查的非裔
美国人和白种人美
国人，其来自郊区、
城区和农村地区，年
龄≥50岁 Previously
unscreened African
American and Caucasian
American people ≥50 years
of age from suburban,
urban and rural areas
定性
QUALITATIVE
总体的结果以及
解读 Overall Results
and Interpretation
步骤 Procedures
•10个焦点小组 10 Focus groups
成果 Product
•关于CRC筛查的定性观点
Qualitative views about CRC screening
步骤 Procedures
•对焦点小组内93个对象的
调查 Survey of 93 focus group
subjects
成果 Product
•认识、想法以及人口统计信息
Knowledge, beliefs, demographics
定量quantitative
Ruffin MT IV, Creswell JW, Jimbo M, Fetters MD. Factors influencing choices for colorectal
cancer screening among previously unscreened African and Caucasian Americans: Findings
from a triangulation mixed methods investigation.J Community Health, 34:79-89, 2009.

Fetters MD, Ivankova NV, Ruffin MT, Creswell JW, Power D. Developing
a website in primary care. Fam Med, 36(9):651-9, 2004.PM15467943

Ruffin M, Fetters MD, Jimbo M. Preference-based electronic decision aid to promote
colorectal cancer screening: Results of a RCT. Prev Med, 45:267-73, 2007. PM17689600.

OR +3.23 (2.7-3.50 95% CI for probability of being screened
for Colorectal Web site compared to control

NIH (NCI) #3R03LM010052-0151
NIH (NCATS) #5R44TR000360
State ofWisconsin SBIR-Advance Grant

主要研究者 Co PIs
 FrederickW. Kron
 Michael D. Fetters
合作者 Collaborators
 Mark W. Scerbo
 Casey B.White
 Monica L. Lypson
 MiguelA. Padilla
 Gayle A. Gliva-McConvey, Lee
Belfore Lee, II
 TempleWest
 Amelia M.Wallace
 Timothy C. Guetterman
 Lauren S. Schleicher
 Rebecca A. Kennedy
 Rajesh S. Mangrulkar
 James F. Cleary
 Stacy C. Marsella
 Daniel M. Becker
顾问 Consultants
 Paul Ekman
 Erika Rosenberg
 Michael Chmilar
 C. Donald Combs
 Mekbib Gemeda
 Thomas Hubbard
 Stacie Buckler
 Michael Lukela
 Kelly Poszywak
 Joel Purkiss
 Sally Santen
 Jamie Schingeck
 Leslie Blackhall
 Randy Canterbury
 Anne Chapin
 Francis Nelson
 Norman Oliver
 Connie Dresser
 EricYoung
 Rebecca Hill
 JeffYoung

沟通不良
Poor Communication
满意度降低
Decreased
Satisfaction
患者流失
Patient
attrition
团队运作变
差
Poorer team
functioning
收入降低
Poorer
Outcomes
有关伤害/
错误/医疗
过失的诉讼
Harm/errors/
malpractice
lawsuits

医学生和教师使用虚拟人
BBN模块来检查定量得分，
并且暴露后的访谈用于评
估经验 Medical students and
faculty take Virtual Human BBN
Module to examine quan score,
and post-exposure interviews to
assess experience
在住院医师之间的双向
组间比较，用于评估关
于癌症护理中姑息治疗
的沟通改善 Two-way group
comparison among residents to
assess improvement in
communicating about palliation
for cancer care
MMR
焦点小组构建关
键特征：虚拟人
的外貌、声音、
类型Focus Groups to
build key features look,
voice, type of virtual
human
定性Qualitative
在现实临床情景中，在
接触虚拟人模拟的学生
和暴露于CBL对照的学
生之间进行RCT，考
察高级沟通表现 RCT
examining advanced
communication performance
in realistic clinical scenario
between students exposed to
virtual human simulation and
students exposed to CBL
control
MMR
定量Quantitative

 设计：单盲、混合方法、多站点RCT
 Design: Single-blinded, mixed-methods, multisite RCT
 地点：东弗吉尼亚医学院，密歇根大学和
弗吉尼亚大学医学院
 Setting: EasternVirginia Medical School, University of Michigan, &
University ofVirginia Med Schools
 参与者：在合乎标准的二年级医学生中，
421名(87.5%) 参与了本研究
 Participants: Of eligible 2nd-year med students, 421 (87.5%)
participated

OSCE
Evaluation
OSCE
Evaluation
H1 H1
H2MMRQ3

 H1: 与培训前相比，Mpathic组的得分在培训后
在跨文化沟通以及专业间沟通场景中得到改善
 MPathic score improved pre-post, intercultural and inter-professional
scenarios (p<.001)
 H2: 在多个组中，Mpathic组的OSCE综合得分
较佳 (p=.01)
 OSCE composite score between groups better for MPathic (p=.01)
 MMRQ: MPathic 组中的学生在态度量表测试
中表现更好(p<.001)
 Student attitudes’ scale more positive for MPathic (p<.001)

• 受到MPathic-VR 培训的学生看重：Students
who trained with MPathic-VR valued
• 其将非语言沟通技能传授给学生 its teaching nonverbal
communication skills,
• 提供及时反馈，并且 providing immediate feedback, and
• 让学生对于带情绪的沟通对象有所准备 preparing
them for emotionally charged encounters (p < .0001)

 MPathic-VR能有效地进行高级沟通技能培训
 MPathic-VR effective in training advanced communication skills
 M-PathicVR 学生将技能迁移到不同的临床场境
 M-PathicVR students transferred skills into a different clinical scenario
 MMR 评价表明，交互性受到重视
 MMR evaluation illustrates interactivity strongly valued
 研究示例性地说明了MMR在创新癌症医学教育研
究中的价值
 Research exemplifies value of MMR in innovative cancer medical education
research

中国、日本和泰国关于癌症的
医患沟通

美国USA
 Michael D. Fetters, MD, MPH, MA; U of M, USA
中国China
 Yali Cong, PhD, PUHSC
 Hongling Chu
 Qiong Luo
 Yinong Wei
日本Japan
 Hisako Kakai, PhD, Aoyama Gakuin University
 Nobutaro Ban, MD, PhD, Nagoya University
 ShihoTeshigawara, MD, Nagoya University
泰国Thailand
 Kittitouch Soontornwipast, EdD,Thammasat University
 Watcharaporn Paorohit, PhD, Bhumibol Adulyadej Hospital, RoyalThai
Air Force Nursing College

 西方哲学和文化强调患者在家属的支持下作出决定
 Western philosophy and culture emphasizes the patient making the decision with
support of the family
 东方哲学和文化强调家属为病人做决
 Eastern philosophy and culture emphasizes the family in decision making for a
patient
 对共同决策模式的兴趣在增强
 Growing interest in shared decision making model
 利用这个机会考察家属在决策过程中的作用，从而
思考不同策略之间的细微差别
 Opportunity to examine family in decision making to consider nuances in
different approaches

 本研究旨在了解在中国、日本和泰国关于
癌症的医患沟通方法以及经验
 This research seeks to understand physician approaches to and
experiences with cancer communication in China, Japan andThailand.

来自日本的历史调
查研究发现 Previous
Survey Findings From
Japan
基于文化困境，
起草调查表并优
化 Draft
Survey & Update
based on Cultural
Dilemmas
中国、日本和泰国关于癌症的医患沟通：多相混合方法研究计划
Physician Cancer Communication in China, Japan andThailand: A
Multiphase Mixed Methods Research Proposal
定量QUAN
Procedure: review most
releant findings
Outcome: Identify most
critical issues, delete
irrelevant; update for Japan
中国的半结构化
访谈 Semi-
Structured
Interviews
In China
Procedures: 11 triad inter-
views of Doc/Pt/Fam (n=33)
Outcome: Culturally
Important issues relative
to cancer communication
In China
定性QUAL
Procedures: Draft project
instrument based on
previous experience, DM
literature, and recent QUAL
research from China; sumbit
IRR; Translate back/translate
finstrument to identify
translation dilemmas
Outcome: IRB review, and
translation into cultural ;
cultural adaptation baseed
on translation procedures
2) Ready for pilot distribution
in Chinese, Japanese and
Thai
在中国、日本
和泰国分发调
查表Distribute
survey in
China, Japan &
Thailand
定量+定性
QUAN + qual
Procedures: Distribute
instrument to all physicians
in university-affiliated
hospital
Outcome: Prevalence of
attitudes about cancer
communication items in
China and Japan
医生在关于癌症的沟
通经验，以及医生有
关癌症的沟通态度的
普遍性Physician
experiences with cancer
communication, and
prevalence of physician
communication, DM
Shared DM in 3 countries
Outcomes: Prevalence of
communication items in
China and Japan; Binational
contemporary comparison of
China and Japan; Historical
comparisions with US data
from 1961 and 1979
对调查表进行
实验性测试，
并且定稿 Pilot
and Finalize
Instrument
定性+定量
qual + quan
Procedures:Cognitive test
draft instrument; Pilot-test
draft instrument; incorporate
findings into instrument
Outcome: Survey finalized
and ready for distribution in
Chinese,Japanese & Thai
languages
共同决策方面
的文献
Literature on shared
decision making
Procedure: Identify relevant
literature
Outcome: Identify most
critical issues, updates for
Chna, Japan & Thailand
定性qual
定性qual

 在过去三十年中，混合方法研究成为一门
新兴学科 Mixed Methods Research emerged as a new discipline
over the past 3 decades
 多门学科在使用MMR方面非常活跃，尤其
是医学 Various Disciplines, especially the health Sciences very
actively using MMR
 可能在癌症研究中得到广泛应用 Many possible
applications in cancer research

Asia Regional Mixed Methods International Research Association
Third Japan Society of Mixed Methods Research Meeting Osaka, 8/4-6, 2017
Designing Participatory Mixed Methods
Research: Community-Engaged
Approaches to Address Complex Problems
Featuring as a keynote speaker
Barbara Israel, Dr.P.H.
University of Michigan, School of Public Health
National Leader and Author in
Community Based Participatory Research
Visit www.mixedmethods.org Questions? smotohar@umich.edu | 734-998-7120 x328
Presented by the Michigan Mixed Methods Research and Scholarship Program faculty including:
John W. Creswell, PhD & Michael D. Fetters, MD, MPH, MA
Spr in g 20 17 Wor k sh op
March 30 - April 1, 2017 | University of Michigan, Ann Arbor
In thisworkshop, you will engage in:
• Applying the features of a rigorous Community-Based
Participatory Research (CBPR) approach
• Using cutting-edge advances in Mixed Methods Research (MMR)
• Mapping CBPRand MMRonto your pr oject in the social or
health sciences
• Sharing your project with other workshop participants
• Receiving feedback on your project from national/international
scholars in CBPRand MMRand faculty afﬁliated with the
Michigan Mixed Methods Research and Scholarship Program
Through an interactive approach, you will apply your learning
to design a participatory mixed methodsstudy.
Discounted feesfor teamsof two that include a community partner

行为与社会科学研究办公室 The Office of Behavioral and Social Sciences Research (OBSSR)
Helen I. Meissner, Ph. D., Office of Behavioral and Social Sciences Research
http://obssr.od.nih.gov/mixed_methods_research/pdf/Best_Practices_for_Mixed_Methods_Research.pdf

Innovative Approaches Using Mixed-Methods Procedures in Clinical Cancer Research - 混合研究方法在癌症临床研究中的创新应用

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Innovative Approaches Using Mixed-Methods Procedures in Clinical Cancer Research - 混合研究方法在癌症临床研究中的创新应用