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Comparative effectiveness of adolescent lipid screening and treatment strategies
Investigator (PI): Leslie, Laurel K; de Ferranti, Sarah
Performing Organization (PO): (Current): Tufts Medical Center / (617) 636-5000
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2017
Record Source/Award ID: PCORI/1443
Funding: Total Award Amount: $993,485
Award Type: Grant
Award Information: PCORI: More information and project results (when completed)
Abstract: PCORI's mission is to help people make informed health care decisions through research that is guided by patients, caregivers, and the broader health care community. The goal of this application, submitted by co-principal investigators Laurel K. Leslie, MD, MPH, and Sarah de Ferranti, MD, MPH, is to improve decision making regarding lipid (i.e., cholesterol) screening and treatment in adolescents. Specifically, we ask the following research question. An adolescent and his/her parent are asked by a primary care provider about their interest in a lab test for lipid screening. What is the comparative effectiveness (i.e., risks and benefits) of different lipid screening and treatment strategies, taking into account that adolescent's sociodemographic and clinical characteristics and his/her personal and parental preferences? Whether all adolescents should be screened and treated for high lipid levels is controversial. A National Heart Lung and Blood Institute (NHLBI)-funded expert panel published guidelines in November 2011 recommending universal lipid screening of children ages 9 to 11 and 17 to 21 years and consideration of treatment with statin medications when lipid levels exceed certain levels and do not respond to lifestyle (i.e., nutrition and exercise) counseling. Previous guidelines published by the American Academy of Pediatrics and the U.S. Preventive Services Task Force have concluded there is insufficient evidence regarding the risks and benefits of universal screening and statin use in children and adolescents to recommend universal screening. Which approach is best is unclear. Most screening and treatment decisions influence a variety of outcomes, such as what health problems a patient may develop as a result of a disorder or its treatment and when they might occur, how long a patient might expect to live, and how satisfied a patient is with his or her current health. Very little is known about how adolescents and parents perceive lipid screening and treatment choices or what outcomes they prefer, and no adolescents or parents were included on the NHLBI expert panel. This study is designed to engage adolescents and parents, as well as other stakeholders, to answer two of PCORI's four patient-centered questions within the context of this current controversy. Specifically, we seek to answer the questions: "What are my options and what are the potential benefits and harms of those options?" and "What can I do to improve the outcomes that are most important to me?" We will work with adolescents and parents to address our aims: 1. characterize adolescent and parent preferences with regard to lipid screening and treatment, and 2. examine the comparative effectiveness of different screening and treatment strategies. A panel of adolescents and parents and a panel of researchers, clinicians, and policy makers will guide us throughout the course of the study and ensure its relevance to patients, their caregivers, and other stakeholders.
MeSH Terms:
  • Adolescent
  • Adolescent Medicine /trends
  • Child
  • Comparative Effectiveness Research
  • Guidelines as Topic
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors /therapeutic use
  • Hyperlipidemias /diagnosis
  • /therapy
  • Lipids /*blood
  • Mass Screening
  • Outcome Assessment, Health Care
  • Parents
  • Patient-Centered Care
  • Risk
  • United States
  • Young Adult
Country: United States
State: Massachusetts
Zip Code: 02111
UI: 20142210
Project Status: Completed
Record History: ('2017: Project extended to 2017.',)