A Needs and Preference Assessment for a Colorectal Cancer Survivorship Care Plan

描述（由申请人提供）：许多癌症幸存者没有得到足够的治疗后护理。1-8为了解决治疗后（生存）护理的不足，医学研究所（IOM）提出了生存护理计划的发展，在本提案中称为“护理计划”每个护理计划都包含关于幸存者的诊断和治疗的个性化信息，推荐的持续护理，以及癌症幸存者的资源列表。这些书面计划由癌症专家提供给每个癌症幸存者，并与他们的初级保健医生分享。使用护理计划的两个目标是：1)教育癌症幸存者关于癌症幸存者的问题；2)帮助初级保健医生为癌症幸存者提供高质量的护理。护理计划具有良好的表面有效性，但它们在满足制定和传播护理计划的人（癌症专家）和接受护理计划的人（癌症幸存者和初级保健医生）的需求和偏好方面的能力尚未得到评估。为了提高癌症幸存者接受的护理质量，护理计划必须包含幸存者寻求适当的治疗后护理所需的关键信息，这将有助于初级保健医生为癌症幸存者提供高质量的护理。此外，护理计划必须便于实施。为了使护理计划的使用和效益最大化，它们需要围绕幸存者、癌症专家和初级保健医生的需求和偏好来设计。这些需求和偏好尚未得到评估。这项拟议的研究旨在通过调查癌症幸存者、初级保健医生和癌症专家来回答这些重要的问题，而不是推广护理计划。我们专注于结肠直肠癌（CRC）幸存者的护理，他们在美国大约有100万，并且在癌症后护理方面有充分记录的缺陷，包括新CRC检测率低，其他癌症检测率低，使用必要医疗护理率低，心理困扰率高。1- 8,10 -12我们的目标是开发、试点测试和管理对幸存者和医生的调查，并在描述性研究中报告他们的需求和偏好。此外，我们的目标是系统地回顾nci指定的癌症中心已经使用的结直肠癌和乳腺癌的护理计划，以描述现有护理计划的范围和内容。我们将使用IOM的护理计划建议作为评估护理计划的标准在未来的研究中，调查结果和对现有护理计划的审查将指导制定新的护理计划，以满足幸存者和医生的需求。我们将提交NIH R01拨款提案，以测试新的护理计划如何有效地提高CRC幸存者的护理质量。

DESCRIPTION (provided by applicant): Many cancer survivors do not receive adequate post-treatment care.1-8 To address deficiencies in post- treatment (survivorship) care, the Institute of Medicine (IOM) proposed the development of survivorship care plans, which will be called "care plans" in this proposal.9 Each care plan contains personalized information about the survivor's diagnosis and treatment, recommended ongoing care, and a list of resources for cancer survivors. These written plans are provided by cancer specialists to each cancer survivor and are to be shared with their primary care physician. The two goals of using care plans are to 1) educate survivors about cancer survivorship issues and 2) help primary care physicians deliver high quality care for cancer survivors. Care plans have excellent face validity, but they have not been evaluated in terms of their ability to address the needs and preferences of those who create and disseminate care plans (cancer specialists) and those who receive care plans (cancer survivors and primary care physicians). In order to improve the quality of care that cancer survivors receive, care plans must contain the critical information that survivors need to seek out appropriate post-treatment care and that will help primary care physicians provide high quality care to cancer survivors. Further, care plans must be convenient to implement. To maximize the use and benefits of care plans, they need to be designed around the needs and preferences of survivors, cancer specialists, and primary care physicians. These needs and preferences have not yet been evaluated. The proposed study aims to step back from promoting care plans and answer these important questions by surveying cancer survivors, primary care physicians, and cancer specialists. We focus on the care of colorectal cancer (CRC) survivors, who number approximately 1 million in the U.S.9 and have well-documented deficiencies in post-cancer care, including low rates of testing for new CRCs, low rates of testing for other cancers, low rates of use of necessary medical care, and high rates of psychological distress.1-8, 10-12 We aim to develop, pilot-test, and administer surveys to survivors and physicians and report their needs and preferences in a descriptive study. Further, we aim to systematically review care plans for both CRC and breast cancer that are already in use at NCI-designated cancer centers, in order to describe the reach and content of existing care plans. We will use the IOM's proposal for care plans as criteria to evaluate care plans.9 In a future study, the findings from the surveys and the review of existing care plans will guide the development of a new care plan that responds to the needs of survivors and physicians. We will submit an NIH R01 grant proposal to test how effectively the new care plan improves the quality of care for CRC survivors. PUBLIC HEALTH RELEVANCE: Although survivorship care plans are increasingly being used and disseminated to cancer survivors, this study fills in an important gap in understanding the problems care plans need to address and how care plans can best be targeted to cancer survivors and the physicians who care for them. Findings from this study will contribute to the development of a care plan that responds to the needs and preferences of these individuals, and its effectiveness in promoting high quality survivorship care will be evaluated in a future randomized clinical trial.