An Interactive E-Health Program to Promote Health Behaviors among Cancer Survivor

描述（由申请人提供）：癌症幸存者需要医疗保健提供者的帮助，以戒烟，并在治疗后癌症护理的背景下改善他们的身体活动和饮食行为。医生的建议已被证明可以激励行为改变，然而临床医生报告在帮助患者实施这些改变方面存在多种障碍。这个试点项目将研究在癌症患者向生存过渡期间促进健康生活方式行为的干预措施的可行性和潜在影响。我们将使用一种系统的方法，将现有的基于印刷和电话的干预措施适应为自我指导的家庭使用的交互式电子健康格式。该程序以DVD格式为基础，可以通过提供教育和行为改变策略，很容易地整合到临床治疗中，以增强临床医生的建议。在与四家后续护理诊所的合作下，我们将招募具有最常见癌症病史的参与者样本。采用临床内、前后设计，对所有患者进行吸烟、饮食和身体活动行为筛查。我们将在癌症幸存者的后续门诊预约时招募他们，并向健康交流项目提供在家使用的指导。健康行为的变化和与健康行为变化相关的理论驱动变量将在参与者预约三个月后通过电话获取。该项目是一项重要的努力，通过一种廉价但未得到充分利用的传播媒介，向高危癌症幸存者传播最佳做法。

DESCRIPTION (provided by applicant): Cancer survivors need assistance from their healthcare providers in quitting smoking, and improving their physical activity and dietary behaviors within the context of their post-treatment cancer care. Physician advice has been shown to motivate behavior change, yet clinicians report multiple barriers in assisting patients to implement such changes. This pilot project will examine the feasibility and potential impact of an intervention for promoting healthy lifestyle behaviors as cancer patient's transition to survivorship. We will use a systematic methodology to adapt existing print and telephone-based interventions to an interactive e-health format for self- directed home use. The program, based on DVD format, will be able to be readily integrated into the clinical encounter as an enhancement to clinician advice by providing education and behavior change strategies. In collaboration with four follow-up care clinics, we will recruit a sample of participants with a history of the most prevalent cancers. Using a within-clinic, pre-post design, all patients will be screened for smoking, dietary, and physical activity behaviors. We will recruit cancer survivors at the time of their follow-up clinic appointments and provide the health communication program with instruction to use it at home. Changes in health behaviors and theory-driven variables related to health behavior change will be accessed via phone three months following participants' appointments. This project represents an important effort to disseminate best-practices for a high-risk population of cancer survivors using an inexpensive, yet underutilized communication medium. PUBLIC HEALTH RELEVANCE: There are an estimated 10.8 million persons in the United States who have a history of cancer, a number that has been steadily increasing due to progress in detection and treatment and the overall aging of the population. The 5-year expected survival rate now averages 66% for all cancers and is as high as 98% for early stage breast and prostate cancers. The lives of cancer survivors, however, are often marked by health problems including comorbidities such as cardiovascular disease, diabetes and osteoporosis, as well as treatment sequelae and functional deficits. Cancer survivors are more likely to be older, to die from non-cancer causes, and to suffer functional impairments of daily living than those who have not had a cancer diagnosis. Despite their increased vulnerability, significant percentages of cancer survivors remain nonadherent to lifestyle behavior recommendations, suggesting the need for follow-up care that more fully addresses preventive healthcare and management of comorbid conditions. Although numerous surveys indicate that most survivors are interested in improving their health, several studies have found that a diagnosis of cancer does not necessarily result in increased adherence to healthy lifestyles. A range of interventions is clearly needed to meet the needs of cancer survivors in adopting healthy lifestyle changes. Since most cancer survivors prefer to receive health-related information from their oncologists and/or primary care providers, they need to have the capacity to deliver the assistance that survivors expect. Physician advice has been shown to motivate behavior change, yet clinicians report multiple barriers (e.g., time and training) in assisting patients to implement such changes. This proposed study will address this need by developing and pilot testing an interactive e-health behavior change tool that clinicians can give to patients recently completing cancer treatment that will provide a). Information about the benefits of healthy lifestyle behaviors in survivorship and b). Evidence-based strategies for making desired behavior changes. We will use a carefully planned qualitative and quantitative methodology for adapting evidence-based interventions to the e-health format, thereby supporting a much-needed effort to create a viable survivor-targeted intervention that meets both providers' and survivors' needs. Ultimately, if this theory-based, targeted enhancement is disseminated, it promises to achieve significant impact in reducing behavioral risk factors by reaching a large number of survivors.