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，监测乳房X线检查和体检的救生效益，许多乳腺癌幸存者不遵守这些建议，并经历身体生活质量下降，由于癌症及其治疗的不良影响。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，一些少数种族和族裔妇女以及社会经济地位较低的妇女（以下称为服务不足妇女）在乳腺癌治疗后获得最佳保健的可能性较小。患者导航是一种旨在减少医疗保健差异的以障碍为中心的干预措施，在提高乳腺癌筛查和诊断服务的依从性方面表现出一定程度的疗效。目前还没有已知的研究关注癌症生存期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文化相关的患者导航计划，重点是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、化疗和放疗的激素受体阳性乳腺癌幸存者的乳腺癌生存护理和生活质量。拟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中获得的信息，开发患者导航干预。在第二阶段，患者导航干预将进行试点测试，以评估其可行性和潜力，通过将其与接受常规医疗护理加上国家癌症研究所的小册子“面向未来：癌症治疗后的生活”进行比较，提高对生存护理建议的依从性和服务不足的乳腺癌幸存者的生活质量。随机分配至患者导航组的激素受体阳性乳腺癌幸存者将接受患者导航员8个月的服务。将在4个月和8个月随访时评价依从性和生活质量结局。本研究的具体目的是（1）评估服务不足的乳腺癌幸存者的促进因素（2）制定患者导航干预措施，注入定性研究的结果，旨在改善对生存护理的依从性和激素受体阳性乳腺癌幸存者的生活质量;以及（3）通过评估患者导航干预对未得到充分服务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初步测试。拟议项目的实施符合这一研究方向的长期目标：开发、评估和传播文化、扫盲和语言相关干预措施，以改善服务不足的乳腺癌幸存者的生活质量，并坚持推荐的医疗保健。

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.