Improving Adherence to Recommended Surveillance in Breast Cancer Survivors

描述（由申请人提供）：基于证据的指南为乳腺癌幸存者推荐了四种癌症监测程序：体格检查，乳房x光检查，乳房自我检查（BSE）和妇科随访。早期发现复发和新发癌症的最佳方法是按时联合使用这四种关键监测程序。然而，数据显示，高达55%的乳腺癌幸存者没有按照建议进行这四种手术。本申请提出了一项研究和培训计划，重点是提高乳腺癌幸存者对推荐监测的依从性，重点是招募和保留非裔美国乳腺癌幸存者。拟议的研究包括两项研究。研究1将开发一种改善依从性的干预方案，以认知、情感和行为因素为目标，这些因素有助于四种推荐的癌症监测程序中的每一种的持续依从性。研究1还试图制定评估方案，用于评估这种干预措施。研究2将在一项随机试验中测试研究1中开发的改善依从性干预方案。参与者将从四家社区医院招募。在研究1中，将对30名乳腺癌幸存者进行认知访谈，以试点和完善评估材料。为了制定改善依从性干预方案，将与乳腺癌幸存者进行8个焦点小组（每组8名妇女），与卫生专业人员进行2个焦点小组（每组8名），与8名非洲裔美国妇女进行一个焦点小组，在社区开展与癌症相关的教育外展。焦点小组将用于编制干预手册和随附的参与者材料。研究2将对改善依从性方案进行随机试验；106名未坚持接受体检、乳房x光检查或妇科随访的乳腺癌幸存者将被随机分配到：1)改善依从性方案，或2)使用印刷教育材料的常规护理。评估将在治疗前后进行。干预后15个月将通过病历审查对后续监测依从性进行评估。拟议的研究有可能提供有价值的新信息，有助于选择策略，帮助乳腺癌幸存者更好地坚持推荐的监测。本申请中提出的职业发展计划侧重于癌症控制和生存培训，干预开发和测试以及有效性和传播研究。通过课程、研讨会和工作坊的结合，申请人将发展必要的技能，以建立一个独立资助的研究项目，重点是严格评估和传播干预措施，从而提高癌症幸存者对推荐护理的依从性。

DESCRIPTION (provided by applicant): Evidence-based guidelines recommend four cancer surveillance procedures for breast cancer survivors: physical examination, mammography, breast self-exam (BSE), and gynecologic follow-up. The early detection of recurrent and new cancers can best be achieved through the combined, on schedule use of these four key surveillance procedures. Yet, data suggest that up to 55% of breast cancer survivors do not undergo these four procedures as recommended. This application proposes a program of research and training focused on improving adherence to recommended surveillance in breast cancer survivors, with an emphasis on the recruitment and retention of African American breast cancer survivors. The proposed research includes two studies. Study 1 will develop an Improving Adherence intervention protocol that targets the cognitive, emotional, and behavioral factors that contribute to sustained adherence for each of the four recommended cancer surveillance procedures. Study 1 also seeks to develop the assessment protocol that will be used to evaluate this intervention. Study 2 will test the Improving Adherence intervention protocol developed in Study 1 in a pilot randomized trial. Participants will be recruited from four community hospitals. In Study 1, cognitive interviews will be conducted with 30 breast cancer survivors to pilot and refine the assessment materials. To develop the Improving Adherence intervention protocol, eight focus groups will be conducted with breast cancer survivors (8 women per group), two focus groups with health professionals (8 per group), and one focus group with eight African American women who conduct cancer-related educational outreach in the community. Focus groups will be used to develop the intervention manual and accompanying participant materials. Study 2 will conduct a pilot randomized test of the Improving Adherence protocol; 106 breast cancer survivors who have been non-adherent to physical exam, mammography, or gynecologic follow-up will be randomly assigned to: 1) the Improving Adherence protocol, or 2) usual care with printed educational materials. Assessments will be conducted pre- and post-treatment. Subsequent adherence to surveillance will be assessed via medical record review 15 months after the intervention. The proposed studies have the potential to provide valuable, new information that can aid in selecting strategies for helping breast cancer survivors better adhere to recommended surveillance. The career development plan proposed in this application focuses on training in cancer control and survivorship, intervention development and testing, and effectiveness and dissemination research. Through a combination of coursework, seminars, and workshops, the applicant will develop the necessary skills for building an independently funded program of research focused on rigorously evaluating and disseminating interventions that can increase adherence to recommended care in cancer survivors.