Peer Support for Young Adult Women with High Breast Cancer Risk

BRCA1/2突变携带者患遗传性乳腺癌和卵巢癌的几率极高，因为 愿他们的一级和二级亲属。美国国家科学院、工程院和医学会 基因组学与人群健康行动合作强调对携带者亲属及其吸收的检测 将筛查和降低风险手术作为遗传学有助于减少 人口癌症负担。在过去的十年中，测试的模式发生了变化，包括更年轻的和 癌症-未受影响的妇女利用这一癌症预防机会。然而，干预措施并没有 跟上这一不断变化的格局，因为目前还没有符合独特临床要求的资助试验， 突变携带者年轻成年亲属(YARs)的发育和心理需求我们的试点数据 建议YARS报告高度的痛苦和寻求HBOC风险信息的愿望和情绪 超越医疗保健提供者和家人的支持--尤其是来自知识渊博的同龄人的支持，他们能够 与他们的经历有关，并就应对策略提供中立的基础和客观的指导。同级 支持是一种很有前途的心理社会癌症护理方法，可以填补这一空白。然而，几乎没有基于证据的 标准决定了它的实践。为了应对这一癌症控制挑战，我们开发了一种新的、完全 针对YARS的手动/脚本化干预称为“同龄人和癌症赋权”(PRESS)。和平就是 以基于证据的心理社会电话咨询方案为基础，减少HBOC的痛苦。我们 通过系统的方法为我们的目标人群调整这些议定书，而不违背它们的核心 功能。和平包括由训练有素的社区同行教练提供简化的电话咨询。 会议内容包括针对HBOC减轻压力的应对培训，以及决策和问题 解决直面和管理癌症风险的培训。我们将在RCT中严格测试和平的有效性 以改善YARS的HBOC相关结果。试验参与者被随机分为干预组或等同组 控制条件，并随访长达12个月。我们假设和平能更好地降低癌症特异性 以及普遍的痛苦、不确定性和决策冲突，以及对遗传咨询的接受程度增加。这 创新项目扩大能力，以解决心理困扰管理和相关结果 患有高脂血症风险的人。

BRCA1/2 mutation carriers have highly elevated odds of developing hereditary breast and ovarian cancer, as may their first- and second-degree relatives. The National Academies of Sciences Engineering and Medicine’s Genomics and Population Health Action Collaborative highlights the testing of carriers’ relatives and their uptake of screening and risk-reducing surgeries as a primary way that genetics can contribute to the reduction of population cancer burden. Patterns of testing over the past decade have shifted to include more younger and cancer-unaffected women to capitalize on this cancer prevention opportunity. However, interventions have not kept pace with this changing landscape, as there are currently no funded trials that meet the unique clinical, developmental and psychological needs of young adult relatives (YARs) of mutation carriers. Our pilot data suggests that YARs report high levels of distress and desire to seek HBOC risk information and emotional support beyond their healthcare providers and families—especially support from knowledgeable peers who can relate to their experiences and offer neutral grounding and objective guidance about coping strategies. Peer support is a promising psychosocial cancer care approach that could fill this void. However, few evidence-based standards inform its practice. In response to this cancer control challenge, we developed a new, fully manualized/scripted intervention for YARs called “Peers and Cancer Empowerment” (PeACE). PeACE is grounded in evidence-based psychosocial telephone counseling protocols for HBOC distress reduction. We adapted those protocols for our target population through a systematic approach without contradicting their core features. PeACE includes streamlined telephone counseling delivered by well-trained community peer coaches. Session content incorporates coping training for HBOC stress reduction, and decision making and problem solving training about confronting and managing cancer risk. We will rigorously test PeACE’s efficacy in an RCT to improve HBOC-related outcomes for YARs. Trial participants are randomized to an intervention or equated control condition, and followed for up to 12 months. We hypothesize that PeACE better reduces cancer-specific and general distress, uncertainty, and decision conflict, as well as increased uptake of genetic counseling. This innovative project expands capacity to address psychological distress management and related outcomes in persons living with HBOC risk.