The Breast Cancer and the Workforce Communication App: A randomized controlled trial of an English/Spanish intervention to promote long-term job retention

摘要 在与乳腺癌诊断相关的许多压力因素中，失业是最具影响力的因素之一 替补演员长期的财务后果可能包括难以支付账单，债务积累， 破产重要的是，癌症幸存者的破产与治疗依从性下降有关 和死亡率的增加。有机会获得工作便利的妇女，如时间表灵活性， 可能在化疗期间工作，并长期保留工作。同样，妇女有足够的 病假可以选择请假，同时保持工作保障。然而，低收入的少数民族 可能有这样的住宿，导致失业率和财务困境更高。为这些 对于患者来说，找到一种在治疗期间继续工作的方法至关重要。乳腺癌与劳动力 研究，重点是移民和少数民族妇女、症状负担和缺乏工作便利 都与失业有关。只有57%的诊断前就业的低收入妇女在诊断后保留了工作。 完成治疗，而高收入妇女的这一比例为93%。在没有工作的人中，84%的人认为他们的工作 缺乏就业对癌症症状或治疗。低收入妇女的可能性不到一半， 高收入妇女的雇主很难通融，只有四分之一的妇女有可能保住自己的工作。 然而，随着时间的推移，要求工作便利的信心有所改善的患者超过 相比那些信心没有改善的人，他们保住工作的可能性是他们的五倍。有令人信服的 需要采取有效的干预措施，支持低收入移民和少数民族在治疗期间工作 乳腺癌患者，以提高长期的工作保留和财务稳定。的目标 一项拟议的研究是评估一个移动的应用程序（app）的有效性，该应用程序旨在促进工作 辅助（治愈性）乳腺癌化疗期间。该应用程序有一个双管齐下的方法：它将帮助 妇女与临床医生沟通，以优化症状控制，这将有助于他们与 雇主为住宿进行谈判。我们的研究是建立在证据的基础上的， 可以教给不同英语水平的病人，从而提高对病人语言的反应能力。 需求此外，患者-医生沟通策略可以适用于工作环境。 我们的应用程序将这些原则应用于工作场所和诊所。使用应用程序来提供 鉴于我们的目标人群在获得支持方面面临的障碍， 智能手机的普及率。我们将随机分配讲英语和西班牙语的女性， 接受I-III期乳腺癌化疗以收到应用程序或信息小册子（对照）。 参与者将在基线和化疗期间完成调查，以评估症状负担和工作 住宿。治疗后4个月、1年和2年的调查将衡量长期工作保留情况。

ABSTRACT Of the many stressors associated with a breast cancer diagnosis, job loss is one of the most impactful yet understudied. Long-term financial consequences can include difficulty paying bills, accumulation of debt, and bankruptcy. Importantly, bankruptcy in cancer survivors has been linked to decreased treatment adherence and increased mortality. Women with access to work accommodations, such as schedule flexibility, are more likely to work during chemotherapy and to retain their jobs in the long term. Similarly, women with adequate sick leave may choose to take time off while maintaining job security. However, low-income minorities are less likely to have such accommodations, leading to higher rates of job loss and financial distress. For these patients, finding a way to continue to work during treatment is critical. In the Breast Cancer and the Workforce study, which focuses on immigrant and minority women, symptom burden and lack of work accommodations were both linked to job loss. Only 57% of pre-diagnosis employed low-income women retained their jobs after treatment completion, compared to 93% of higher-income women. Of those not working, 84% attributed their lack of employment to cancer symptoms or treatment. Low-income women were less than half as likely as higher-income women to have accommodating employers and only one-fourth as likely to retain their jobs. However, patients whose confidence in asking for work accommodations improved over time were more than five times as likely to retain their jobs than those whose confidence did not improve. There is a compelling need for an effective intervention to support working during treatment in low-income immigrant and minority breast cancer patients in order to improve long-term job retention and financial stability. The goal of the proposed study is to evaluate the effectiveness of a mobile application (app) developed to promote working during adjuvant (curative) breast cancer chemotherapy. The app has a two-pronged approach: it will help women communicate with clinicians to optimize symptom control, and it will help them communicate with employers to negotiate for accommodations. Our study is grounded in evidence that communication behaviors can be taught to patients of varying English proficiency, resulting in improved responsiveness to patients' needs. Furthermore, patient-physician communication strategies can be adapted for use in the work setting. Our app applies these principles to the workplace as well as the clinic. The use of an app to deliver the intervention is appealing in light of barriers our target population faces in accessing support and the high prevalence of smartphone use. We will randomly assign English- and Spanish-speaking women who are about to undergo chemotherapy for stage I-III breast cancer to receive the app or an informational booklet (control). Participants will complete surveys at baseline and during chemotherapy to assess symptom burden and work accommodations. Surveys 4 months and 1 and 2 years post-treatment will measure long-term job retention.