Developing and Piloting a Patient Navigation Program for Breast Cancer Survivors

描述（由申请人提供）：尽管抗激素药物、乳房x光检查和身体检查对挽救生命有好处，但许多乳腺癌幸存者没有遵守这些建议，由于癌症及其治疗的不良影响，生活质量下降。研究还表明，与高加索妇女和社会经济地位较高的妇女相比，一些种族和少数民族妇女和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保健的可能性较小。“病人导航”是一项以障碍为重点的干预措施，旨在减少医疗保健方面的差距，在提高乳腺癌筛查和诊断服务的依从性方面已显示出一定程度的功效。没有已知的研究集中于癌症生存期患者导航干预的开发和评估。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程序，重点关注服务不足的乳腺癌幸存者处方抗激素药物。预期护士-患者导航干预可以改善那些完成手术、化疗和放疗的激素受体阳性乳腺癌幸存者获得和坚持乳腺癌生存护理的机会和生活质量。建议项目将分两个阶段进行。在第一阶段，将使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，开发患者导航干预。在第二阶段，将对患者导航干预进行试点测试，通过将其与接受常规医疗护理和国家癌症研究所题为“向前看：癌症治疗后的生活”的小册子进行比较，评估其在提高对幸存者护理建议的依从性和改善服务不足的乳腺癌幸存者生活质量方面的可行性和潜力。随机分配到患者导航组的激素受体阳性乳腺癌幸存者将接受8个月的患者导航服务。依从性和生活质量结果将在4个月和8个月随访时进行评估。该研究的具体目的是：(1)评估服务不足的乳腺癌幸存者获得生存护理的促进因素（资源）和障碍；(2)结合定性研究的结果，开发一种患者导航干预，旨在提高服务不足的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。拟议项目的实施符合这一研究领域的长期目标：制定、评估和传播与文化、扫盲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所建议的保健服务的依从性。

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.