Cancer Registry for Understanding and Improving Survivorship Experiences (CRUISE)

项目摘要 目前美国估计有1550万癌症幸存者，预计将在 数量和种族/民族多样性。癌症幸存者面临着许多独特的挑战，包括晚期和长期的挑战。 健康影响，情绪和经济困难，以及患第二种癌症和其他癌症的风险更大 严重的健康状况。这些挑战在得不到充分服务的人口中可能更为普遍。在 2006年，医学研究所（IOM）建议广泛实施幸存者护理计划， （SCP），以促进从积极治疗到癌症生存的过渡，从肿瘤学护理到初级 在乎SCP旨在涵盖癌症治疗的细节，这些细节可以与当前和 未来的医疗提供者;对幸存者的预期教育;以及提供关于现有医疗服务的信息。 与生存需求相关的资源。这些建议要求肿瘤治疗小组审查 在癌症治疗结束时与患者进行SCP。自IOM成立以来的早期研究 建议表明，SCP的实施并不普遍，有证据表明， 结果是有限的，SCP的内容有很大的差异，许多计划未能 遵守国际移民组织的所有建议。此外，几乎没有研究表明现有的SCP是否 是否在文化或语言上适合患者，以及是否解决了关键的社会决定性障碍 服务不足的病人。需要更多的研究来彻底探索SCP的功效和可行性 在现实世界中。具体来说，虽然以前的研究已经揭示了关键的文化差异， 尽管我们的生存经验有限，但我们仍然对以下方面知之甚少： 不同种族/民族、文化和社会经济背景的癌症幸存者中的SCP。的 本提案的首要目标是调查SCP在临床护理中的实施程度 并在加州的乳腺癌和结肠直肠癌幸存者中的不同和服务不足的人群中使用。 因此，利用基于人群的癌症登记，我们提出了癌症登记，以了解 和改善生存体验（CRUISE）项目，该项目采取全面，多层次的方法 检查SCP的实施情况和患者体验，重点关注服务不足的人群。 我们的目的如下：1）检查SCP在患者报告结局中的使用和有效性， 大旧金山弗朗西斯科湾区的乳腺癌和结肠直肠癌幸存者; 2）调查 生存策略和支持的实施和内容，包括加州卫生部门使用的SCP 服务于不同癌症患者群体的系统;以及3）召集利益相关者组成的德尔菲小组， 制定提供SCP的最佳实践，以满足不同患者人群的需求。当前 建议将促进我们对SCP的实施和有效性的理解， 从幸存者和医疗保健系统的角度，特别关注得不到充分服务的患者群体。

Project Summary There are currently an estimated 15.5 million cancer survivors in the U.S., which is expected to increase in number and racial/ethnic diversity. Cancer survivors face many unique challenges, including late and long-term health effects, emotional and financial hardships, and a greater risk for developing second cancers and other serious health conditions. These challenges may be even more prevalent among underserved populations. In 2006, the Institute of Medicine (IOM) recommended the widespread implementation of survivorship care plans (SCPs) to facilitate the transition from active treatment to cancer survivorship, from oncology care to primary care. SCPs are intended to encompass the details of cancer treatment, which can be shared with current and future medical providers; anticipatory education for survivors; and provision of information about available resources relating to survivorship needs. The recommendations call for oncology treatment teams to review SCPs with patients at the conclusion of their cancer treatment. Early research in the years since the IOM recommendations has shown that implementation of SCPs is not widespread, evidence of improved survivor outcomes is limited, and there is considerable variation in the content of SCPs, with many plans failing to adhere to all of the IOM recommendations. Moreover, there is virtually no research on whether existing SCPs are culturally- or linguistically-tailored to patients and whether they address key social determinant barriers among underserved patients. More research is needed to thoroughly explore the efficacy and viability of SCPs in real-world settings. Specifically, while previous research has uncovered key cultural differences in survivorship experiences, we still know little about the appropriateness, effectiveness, and implementation of SCPs among cancer survivors from diverse racial/ethnic, cultural, and socioeconomic backgrounds. The overarching goal of this proposal is to investigate the extent to which SCPs are implemented in clinical care and used among diverse and underserved populations of breast and colorectal cancer survivors in California. Leveraging population-based cancer registries, we therefore propose the Cancer Registry for Understanding and Improving Survivorship Experiences (CRUISE) project, which takes a comprehensive, multi-level approach to examine the implementation of, and patient experiences with, SCPs, with focus on underserved populations. Our aims are as follows: 1) to examine the use and effectiveness of SCPs on patient-reported outcomes in breast and colorectal cancer survivors in the Greater San Francisco Bay Area; 2) to investigate the implementation and content of survivorship strategies and support including SCPs in use in California health systems serving diverse cancer patient populations; and 3) to convene a Delphi panel of stakeholders to develop best practices for delivering SCPs to meet the needs of diverse patient populations. The current proposal will advance our understanding of the implementation and effectiveness of SCPs from both the perspective of survivors and healthcare systems, focusing in particular on underserved patient populations.