Developing and Piloting a Patient Navigation Program for Breast Cancer Survivors

为乳腺癌幸存者开发和试点患者导航计划

• 批准号: 8243390
• 负责人: Kristen Jennifer Wells
• 金额: $ 17.79万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2012-12-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8243390
• 关键词: Address; Adherence; Adverse effects; Breast Cancer Detection; Breast Cancer Treatment; Cancer Diagnostics; Cancer Patient; Cancer Survivor; Cancer Survivorship; Caring; Caucasians; Caucasoid Race; Communities; Data; Detection; Development; Devices; Diagnostic Neoplasm Staging; Diagnostic Services; Evaluation; Event; Goals; Health Professional; Healthcare; Hormonal; Hormone Receptor; Improve Access; Individual; Intervention; Interview; Language; Life; Malignant Neoplasms; Mammography; Measures; Medical; Medical Records; Medicine; Minority Groups; Modeling; Monitor; National Cancer Institute; Nurses; Operative Surgical Procedures; Outcome; Pamphlets; Patient Self-Report; Patients; Pharmaceutical Preparations; Phase; Prevention; Public Health; Qualitative Research; Quality of Care; Quality of life; Radiation; Randomized; Recommendation; Recurrence; Recurrent Malignant Neoplasm; Research; Research Design; Resources; Second Primary Cancers; Services; Socioeconomic Status; Stress; Structure; System; Testing; Woman; cancer therapy; chemotherapy; evidence base; experience; follow-up; health disparity; improved; innovation; literacy; low socioeconomic status; malignant breast neoplasm; medication compliance; meetings; mortality; oncology; programs; research study; survivorship; therapy design; treatment as usual

DESCRIPTION (provided by applicant): Despite life-saving benefits of anti-hormonal medications, surveillance mammography, and physical exams, many breast cancer survivors do not adhere to these recommendations and experience decreased physical quality of life due to the adverse effects of cancer and its treatment. Research also indicates that some racial and ethnic minority women and women of low socioeconomic status (hereafter described as underserved), are less likely to get optimal health care following treatment for breast cancer than Caucasian women and women of higher socioeconomic status. Patient navigation, a barrier-focused intervention designed to reduce health care disparities, has demonstrated some degree of efficacy in improving adherence to breast cancer screening and diagnostic services. No known research has focused on development and evaluation of patient navigation interventions during the cancer survivorship period. Therefore, the objectives of the proposed project are to develop and pilot test a culturally relevant patient navigation program focused on underserved breast cancer survivors prescribed anti-hormonal medications. It is expected that a nurse patient navigation intervention can improve access and adherence to breast cancer survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors who have completed surgery, chemotherapy, and radiation. The proposed project will be conducted in two phases. In Phase I, a patient navigation intervention will be developed using the structure of two existing patient navigation programs combined with information obtained from qualitative data collected through in-depth interviews. In Phase II, the patient navigation intervention will be pilot-tested to evaluate its feasibility and potential in improving adherence to survivorship care recommendations and quality of life for underserved breast cancer survivors by comparing it to receipt of usual medical care plus the National Cancer Institute's booklet entitled Facing Forward: Life After Cancer Treatment. Hormone receptor positive breast cancer survivors randomized to patient navigation will receive the services of a patient navigator for 8 months. Adherence and quality of life outcomes will be evaluated at 4 and 8 month follow ups. The specific aims of the study are to (1) evaluate underserved breast cancer survivors' facilitating factors (resources) and barriers related to obtaining survivorship care; and (2) develop a patient navigation intervention, infused with the results of qualitative research, designed to improve adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors; and (3) conduct a pilot test of the patient navigation intervention by evaluating its effect on adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors. The implementation of the proposed project is consistent with the long-term objective of this line of research: to develop, evaluate, and disseminate culturally, literacy, and linguistically relevant interventions to improve quality of life and adherence to recommended health care in underserved breast cancer survivors. PUBLIC HEALTH RELEVANCE: Research has shown that adherence to life saving recommendations for breast cancer survivorship, including anti-hormonal medications, surveillance mammography, and physical exams, is low among some breast cancer survivors. The proposed study is the first to develop and pilot test a patient navigator program that focuses specifically on underserved breast cancer survivors who are prescribed anti-hormonal medicines. An intervention that increases adherence to recommendations for breast cancer survivorship care meets national priorities for providing quality care to cancer survivors and has the potential to reduce breast cancer mortality.

描述（由申请人提供）：尽管抗激素药物、监测乳房X光检查和体检可以挽救生命，但许多乳腺癌幸存者并未遵守这些建议，并且由于癌症及其治疗的不利影响而导致身体生活质量下降。研究还表明，与白人妇女和社会经济地位较高的妇女相比，一些种族和族裔少数妇女以及社会经济地位较低的妇女（以下称为服务不足）在乳腺癌治疗后获得最佳医疗保健的可能性较小。患者导航是一种以障碍为重点的干预措施，旨在减少医疗保健差异，已证明在提高乳腺癌筛查和诊断服务的依从性方面具有一定的功效。没有已知的研究关注癌症生存期间患者导航干预措施的开发和评估。因此，拟议项目的目标是开发和试点测试一个与文化相关的患者导航计划，重点关注服务不足的乳腺癌幸存者处方抗激素药物。预计护士患者导航干预可以改善已完成手术、化疗和放疗、激素受体阳性乳腺癌幸存者服务不足的乳腺癌幸存者护理的获取和依从性以及生活质量。拟议项目将分两个阶段进行。在第一阶段，将利用两个现有患者导航程序的结构，结合通过深入访谈收集的定性数据获得的信息来开发患者导航干预措施。在第二阶段，患者导航干预将进行试点测试，通过将其与接受的常规医疗护理以及国家癌症研究所题为《面向未来：癌症治疗后的生活》的小册子进行比较，评估其在提高对生存护理建议的依从性和提高服务不足的乳腺癌幸存者的生活质量方面的可行性和潜力。随机接受患者导航的激素受体阳性乳腺癌幸存者将接受患者导航员为期 8 个月的服务。将在 4 个月和 8 个月的随访中评估依从性和生活质量结果。该研究的具体目的是（1）评估服务不足的乳腺癌幸存者在获得幸存者护理方面的促进因素（资源）和障碍； (2) 制定患者导航干预措施，融入定性研究结果，旨在提高激素受体阳性乳腺癌幸存者对生存护理的依从性和生活质量； (3) 通过评估患者导航干预对服务不足的激素受体阳性乳腺癌幸存者的生存护理依从性和生活质量的影响，对患者导航干预进行试点测试。拟议项目的实施与该研究方向的长期目标是一致的：开发、评估和传播文化、读写能力和语言相关的干预措施，以改善服务不足的乳腺癌幸存者的生活质量和对建议的医疗保健的依从性。 公共健康相关性：研究表明，一些乳腺癌幸存者对乳腺癌生存挽救生命建议（包括抗激素药物、监测乳房 X 光检查和体检）的遵守率较低。这项拟议的研究是第一个开发和试点测试患者导航程序的项目，该项目专门针对服务不足、接受抗激素药物治疗的乳腺癌幸存者。提高对乳腺癌幸存者护理建议的遵守率的干预措施符合国家为癌症幸存者提供优质护理的优先事项，并有可能降低乳腺癌死亡率。