Disease Beliefs and Cognition: Effect on Diabetes Management in Older Breast Cancer Survivors

项目摘要/摘要 疾病信念对糖尿病等慢性病患者自我管理的影响 癌症在很大程度上是未知的。此外，人们对年龄或癌症相关认知的影响知之甚少。 癌症存活者其他合并症患者自我管理行为的变化。如果没有这个 知识，我们为患有共病的癌症幸存者提供最佳自我管理支持的能力是 有限的。这项研究的目标是确定疾病对癌症和糖尿病的信念以及认知的变化 影响老年乳腺癌幸存者的DM SMB。我们将重点关注早期乳腺癌的老年幸存者 接受过化疗或激素治疗的癌症患者，因为这些患者更有可能 有年龄或癌症相关的认知变化，更有可能死于他们的 乳腺癌引起的合并症。我们将重点关注糖尿病，因为它在癌症幸存者中的发病率很高， 与更差的癌症结局和认知能力下降的关系，对竞争死亡风险的影响，及其 中小型企业的复杂性中等。研究设计植根于常识自我调节模型(CSM)，即 健康行为理论，已被用于开发干预措施，但主要应用于 围绕单个疾病的行为研究。通过理解疾病信念之间的关系 乳腺癌与糖尿病及存活者疾病信念与认知功能的关系 DM中小企业，我们将推进CSM和护理患有合并症的老年乳腺癌幸存者。这个 具体目标是：1)评估关于乳腺癌和糖尿病的信念的纵向相互关系 它对幸存者DM SMB的影响(坚持药物、饮食和运动)；2)评估认知的影响 对DM SMB的作用，并评估疾病信念是否在一定程度上调节了认知与认知之间的联系 和DM中小企业；以及3)开发和试点教育和咨询干预措施，以改善DM中小企业 在患有糖尿病的乳腺癌幸存者中。这项前瞻性队列研究将招募320名老年人(≥55 年)已完成一线化疗或正在接受治疗的既往糖尿病乳腺癌幸存者 近5年来早期(I-IIIA)乳腺癌的激素治疗。我们将首先进行 对20名幸存者进行定性访谈，以确定糖尿病和癌症的健康信念并得出具体的策略 和用于管理DM的例程。然后我们将招募300名参与者，并每6个月面试一次 24个月来评估癌症和糖尿病信念的纵向变化以及认知方面的变化以评估其影响 在DM SMB上。对于目前正在接受羟色胺治疗的女性亚群，我们还将评估信念和 认知功能对HT依从性的影响。我们将把收集到的信息整合到量化和 定性访谈以创建教育和咨询模块，并试行测试它们对 100名患有糖尿病的乳腺癌幸存者。拟议的研究涉及制定战略的必要性。 以乳腺癌和糖尿病为研究范式，优化SMB治疗癌症存活者慢性合并症。

PROJECT SUMMARY/ABSTRACT The impact of disease beliefs on self-management of chronic illness such as diabetes (DM) in the setting of cancer is largely unknown. In addition, little is known about the impact of age- or cancer-related cognitive changes on cancer survivors’ self-management behaviors (SMB) for their other comorbidities. Without this knowledge, our ability to provide optimal self-management support for cancer survivors with comorbidities is limited. The goal of this study is to determine how disease beliefs about cancer and DM and cognitive changes affect older breast cancer survivors’ DM SMB. We will focus on older breast cancer survivors with early-stage cancer who have received chemotherapy or hormonal therapy (HT) since these patients are more likely to have age- or cancer-related cognitive changes and are more likely to die from complications from their comorbidities as from their breast cancer. We will focus on DM due to its high prevalence in cancer survivors, association with worse cancer outcomes and cognitive decline, impact on competing risks of death, and its moderate SMB complexity. The study design is rooted in the Common Sense Self-Regulation Model (CSM), a theory of health behaviors that has been used to develop interventions, but has primarily been applied to research on behaviors around single diseases. By understanding the relationship between disease beliefs about breast cancer and DM and the interrelationship of disease beliefs and cognitive function on survivors’ DM SMB, we will advance both the CSM and care of older breast cancer survivors with comorbidities. The Specific Aims are to: 1) Evaluate the longitudinal interrelationship of beliefs about breast cancer and DM and its effect on survivors’ DM SMB (adherence to medications, diet and exercise); 2) Assess the effect of cognitive function on DM SMB and evaluate whether disease beliefs mediate, in part, an association between cognition and DM SMB; and 3) Develop and pilot an educational and counseling intervention to improve DM SMB among breast cancer survivors with comorbid DM. This prospective cohort study will recruit 320 older (≥55 years) breast cancer survivors with pre-existing DM who have completed first-line chemotherapy or are taking hormonal therapy for treatment of early stage (I-IIIA) breast cancer within the past 5 years. We will first conduct qualitative interviews with 20 survivors to identify DM and cancer health beliefs and to elicit specific strategies and routines used to manage DM. We will then recruit 300 participants and interview them every 6 months for 24 months to assess longitudinal changes in cancer and DM beliefs and in cognition to evaluate their impact on DM SMB. For the subgroup of women currently taking HT, we will also assess the impact of beliefs and cognitive function on HT adherence. We will integrate the information collected in the quantitative and qualitative interviews to create educational and counseling modules and pilot test their impact on SMB on a group of 100 breast cancer survivors with DM. The proposed study addresses the need to develop strategies to optimize SMB for chronic comorbidities in cancer survivors using breast cancer and DM as the paradigm.