Younger Breast Cancer Survivors: Managing Uncertainty

描述(由申请人提供)：在这个修订的提案中，我们计划设计和测试一种新的护理干预措施，基于一种被发现成功地管理长期存活的乳腺癌老年妇女的不确定性的护理干预措施。这项研究将测试一种新版本的干预措施，对象是50岁以下的高加索人和非裔美国年轻女性，她们是2到4年的幸存者。对于这些妇女来说，在生存的最初几年，情况比长期幸存者的老年妇女更复杂和危险。干预将集中在对复发的恐惧上，并将针对由各种生活事件引发的关于复发的侵入性想法。干预还将侧重于这些女性的需求，即向支持她们的其他人传达关切，并找到生活事件的积极意义。此外，干预措施将侧重于治疗前绝经前和治疗后绝经后妇女的关切。干预将包括认知行为策略，包括两盘说明个人策略的录音带和两盘新的关于向支持他人沟通关切和促进积极生活体验的录音带。其中包括一本自学手册，其中提供了管理这些妇女最常见的绝经后症状和改变的生活经历的信息和资源。主要假设是，与注意控制组相比，接受不确定性管理干预的女性会有更好的不确定性管理，更少的症状苦恼，更积极的心理社会幸福感和可识别的积极利益。这项研究还将检查干预对与压力相关的生物行为机制的影响(皮质醇水平和昼夜斜率，以及去看肿瘤学家进行乳房检查时的皮质醇反应)。设计为2×2随机区组，重复测量设计，两个水平的干预(管理不确定性)与两个种族水平(高加索人和非裔美国人)交叉。将指导妇女使用认知行为录音带和使用手册，为期4周，然后每月由护士打电话评估触发器的暴露情况、录音带的使用和手册的使用。大多数干预都是自我实现的。将使用多变量模型进行分析。这项研究与公共卫生相关，因为它是第一次以年轻的乳腺癌幸存者为重点的干预措施，并为他们提供了一种自我指导的便携式干预措施，传授处理癌症生存问题的新技能。这种干预是便携的，可以在不同的地方使用。随着女性学习这些技能，她们可以自己使用这些技能，它们可以成为她们自然管理/应对行为的一部分。

DESCRIPTION (provided by applicant): In this revised proposal we plan to design and test a new nursing intervention based on one found to be successful in managing uncertainty in older women with breast cancer who were long term survivors. This study will test a new version of the intervention with Caucasian and African-American younger women under 50 years of age who are 2 through four-year survivors. For these women, during the early years of survival, the situation is more complex and threatening than that of older women who are long term survivors. The intervention will focus on the fears of recurrence and will target the invasive thoughts about recurrence as they are triggered by various life events. The intervention will also focus on the needs of these women to communicate concerns to supportive others and find positive meaning to life events. Furthermore, the intervention will focus on the concerns of women who were pre-menopausal prior to treatment and post menopausal due to treatment. The intervention will include cognitive behavior strategies in the form of two audiotapes illustrating an individual strategy and two new tapes on communicating concerns to supportive others and promoting positive life experiences. A self-learning manual is included which provides information and resources for managing the most common postmenopausal symptoms and altered life experiences of these women. The main hypothesis is that women who receive the uncertainty management intervention will have better uncertainty management, less symptom distress, more positive psycho-social well being with identifiable positive benefits as compared with an attentional control group. The study will also examine the effect of the intervention on biobehavioral mechanisms associated with stress (cortisol levels and diurnal slopes, and cortisol reactivity to a visit to the oncologist for a breast exam). The design is a 2 X 2 randomized block, repeated measures design with two levels of intervention (managing uncertainty) crossed with 2 levels of ethnicity (Caucasian and African-American). Women will be instructed in the use of the cognitive behavior audiotapes and use of the manual for 4 weeks followed by with monthly calls from a nurse to assess exposure to triggers, use of the audiotapes, and use of the manual. The majority of the intervention is self delivered. Multivariate models will be used for analysis. The study is relevant to public health as it is the first intervention that focuses on younger breast cancer survivors and provides them with a self-directed, portable intervention teaching new skills for handling enduring concerns of cancer survivorship. The intervention is portable and can be used in a variety of places. As women learn these skills they can use them on their own and they can become part of their natural management/ coping behavior.