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

描述(申请人提供)：癌症幸存者需要他们的医疗保健提供者帮助他们戒烟，并在他们治疗后的癌症护理的背景下改善他们的体力活动和饮食行为。医生的建议已被证明可以促进行为的改变，但临床医生报告说，在帮助患者实施这种改变方面存在多个障碍。这项试点项目将考察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，使现有的基于印刷和电话的干预措施转变为供自我指导的家庭使用的交互式电子健康格式。该计划基于DVD格式，通过提供教育和行为改变策略，将能够很容易地整合到临床接触中，作为对临床医生建议的增强。我们将与四家后续护理诊所合作，招募一批有最常见癌症病史的参与者。采用诊所内、事后设计，所有患者将接受吸烟、饮食和体力活动行为的筛查。我们将在癌症幸存者的后续诊所预约时招募他们，并为健康沟通计划提供在家中使用的指导。健康行为的变化以及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得。该项目代表着一项重要的努力，即利用一种廉价但未得到充分利用的传播媒介，向癌症幸存者的高危人群传播最佳做法。 与公共卫生有关：据估计，美国有1080万人有癌症病史，由于检测和治疗方面的进步以及人口的整体老龄化，这个数字一直在稳步增加。目前，所有癌症的5年预期存活率平均为66%，早期乳腺癌和前列腺癌的存活率高达98%。然而，癌症幸存者的生活往往以健康问题为标志，包括心血管疾病、糖尿病和骨质疏松症等共病，以及治疗后遗症和功能缺陷。癌症幸存者比那些没有被诊断出癌症的人更有可能年纪更大，死于非癌症原因，以及遭受日常生活功能障碍。尽管癌症幸存者的脆弱性增加，但相当大比例的癌症幸存者仍然不遵守生活方式行为建议，这表明需要后续护理，以更充分地解决预防性保健和共病情况的管理。尽管许多调查表明，大多数幸存者对改善自己的健康感兴趣，但几项研究发现，癌症的诊断并不一定会导致更多人坚持健康的生活方式。显然，需要一系列干预措施来满足癌症幸存者改变健康生活方式的需要。由于大多数癌症幸存者更愿意从他们的肿瘤学家和/或初级保健提供者那里获得与健康相关的信息，他们需要有能力提供幸存者所期望的援助。医生的建议已被证明可以促进行为的改变，但临床医生报告说，在帮助患者实施这种改变方面存在多个障碍(例如，时间和培训)。这项拟议的研究将通过开发和试点测试一种交互式电子健康行为改变工具来满足这一需求，临床医生可以将该工具提供给最近完成癌症治疗的患者，这将提供一种。关于健康生活方式行为在生存中的益处的信息和b)。以证据为基础的策略，以做出所需的行为改变。我们将使用精心规划的定性和定量方法，使循证干预适应电子健康模式，从而支持亟需的努力，以创建可行的以幸存者为目标的干预，满足提供者和幸存者的需求。最终，如果这种基于理论的、有针对性的增强得到传播，它有望通过接触到大量幸存者，在减少行为风险因素方面产生重大影响。

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.