Optimizing Survivorship and Surveillance after Treatment for Colorectal Cancer

描述（由申请人提供）：结直肠癌（CRC）是美国最常诊断的癌症之一，是癌症死亡的主要原因。非裔美国人（AAs）的CRC死亡率明显高于欧洲裔美国人（EAs）。治疗后（定义为手术后）监测对于筛查癌症复发和促进生活方式改变以降低复发风险至关重要。然而，大多数幸存者没有接受指南建议的监测。对与遵守临床监测指南相关的因素知之甚少（即，门诊、癌胚抗原（CEA）检测、结肠镜检查）或遵守生活方式相关的体重、运动、酒精和烟草使用监测指南。 这项R21研究的目的是系统地研究多水平因素对CRC幸存者参与基于指南的治疗后监测护理的作用。我们将研究个人因素的作用（例如，健康状况、知识、态度和人口统计学）、提供者（例如，医生-患者和专家-初级保健沟通）和实践水平因素（例如，医疗保健使用、保险）对幸存者护理经验和结果的影响。在第1阶段，我们将对治疗后1.5年的AA（n=20）和EA幸存者（n=20）进行焦点组（FG）分析，以评估他们的监测护理经验。将对治疗后2-3个月的幸存者进行另外两次FG（1次AA和1次EA，各n=10），以探索他们对随访护理的期望和经验。我们还将对初级保健和专科医学博士（n=20）的访谈数据进行分析，以评估与监测相关的实践，并对全国医生调查进行预测试修改。我们将开展一项幸存者调查和一项MD调查，以系统地研究监视护理的障碍和促进因素。在第2阶段，我们将使用认知访谈技术与CRC幸存者（n=16）进行预测试的调查。然后，我们将评估幸存者调查（n=150全州幸存者）的心理测量特性，并获得结果措施的估计，以指导随后的R 01。我们将对研究结果进行三角分析和综合，以制定多层次的干预措施，通过制定最有可能影响患者、提供者和实践层面推动者的具体策略，改善从癌症治疗到随访的过渡。我们将使用干预映射方法来制定理论驱动的目标和干预策略和信息。 拟议的工作是至关重要的，是及时的科学和临床相关性。此外，该研究将在SC的两个国家癌症研究所资助的医疗保健中心进行，这些中心具有不同的地理区域，大部分AA成年人和相关的健康差异。研究结果将导致未来的R 01试验，在该试验中，将测试本研究中开发的针对性干预策略和信息的理论指导建议，以提高依从性。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the U.S. and is a leading cause of cancer death. African Americans (AAs) have significantly higher CRC mortality rates than European Americans (EAs). Post-treatment (defined as post-surgical) surveillance is critical to screen for cancer recurrence and promote lifestyle changes to reduce risk of recurrence. However, most survivors do not receive guideline-recommended surveillance. Little is known about factors associated with adherence to clinical surveillance guidelines (i.e., office visits, carcionoembryonic antigen (CEA) tests, colonoscopy) or adherence to lifestyle-related surveillance guidelines for weight, exercise, alcohol and tobacco use. The purpose of this R21 study is to systematically investigate the role of multi-level factors on participation of CRC survivors in guideline-based post-treatment surveillance care. We will investigate the role of personal factors (e.g., health status, knowledge, attitudes and demographics), provider (e.g. physician-patient and specialist-primary care communication), and practice level factors (e.g., health care use, insurance) on survivor care experiences and outcomes. In Phase 1, we will conduct and analyze focus groups (FGs) of AA (n=20) and EA survivors (n=20) 1.5 years post-treatment to assess their surveillance care experiences. Two additional FGs (1 with AAs and 1 with EAs, each n=10) will be conducted with survivors who are 2-3 months post- treatment to explore their expectations about, and experiences with, follow-up care. We will also conduct and analyze data from interviews with primary care and specialist MDs (n=20) to assess practices related to surveillance and to pretest modifications to a national physician survey. We will develop a survivor survey and an MD survey to systematically examine barriers and facilitators of surveillance care. In Phase 2, we will use cognitive interviewing techniques with CRC survivors (n=16) to pretest the surveys. We will then evaluate the psychometric properties of the survivor survey (n=150 statewide survivors) and gain estimates of outcome measures to guide a subsequent R01. We will triangulate and synthesize findings to develop multi-level interventions to improve the transition from cancer treatment to follow-up by delineating specific strategies most likely to influence patient, provider and practice level enablers. We will use intervention mapping methods to develop theory-driven objectives and intervention strategies and messages. The proposed work is of vital importance and is timely with scientific and clinical relevance. Additionally, the study will be conducted at two National Cancer Institute-funded health care sites in SC, which have diverse geographic areas, a large proportion of AA adults and relevant health disparities. The study results will lead to a future R01 trial in which the theoretically guided recommendations for targeted intervention strategies and messages developed in this study will be tested to improve adherence.