Research Project

西班牙裔/拉丁裔（HL）是美国人口最多、增长最快的少数族裔。即使考虑到年龄和分期分布的差异，HLs患者的大多数癌症存活率通常较低，这可能反映出患者获得及时、高质量治疗的机会较少。他们在护理质量和获得护理方面的差距也不成比例地大。癌症幸存者的经历往往以重大挑战为特征。尽管存在这些挑战和在高水平人群中观察到的显著差异，但对高水平人群中与生存相关的问题和优先事项的了解非常有限，特别是使用促进者/患者导航员（PN）将未满足社会心理需求的HL癌症幸存者与适当的社会心理服务联系起来的有效性。兰斯·阿姆斯特朗基金会（LAF） LIVESTRONG SurvivorCare （LSSC）项目现有的社区基础设施为评估其改善ls生活质量的有效性提供了一个极好的机会。这项拟议的为期5年的Redes En accident研究包括一种混合方法，分两个阶段在两个不同的HL群落中进行。第一阶段将采用基于社区的参与式研究（CBPR）方法，让为乳腺癌、结直肠癌和前列腺HL幸存者提供服务的社区合作伙伴参与进来。在这一阶段，我们将召集社区合作伙伴在每个站点召开以行动为导向的小组会议，介绍PN和LSSC联合计划（PN+LSSC）的组成部分和目标。通过这种CBPR方法产生有价值的社区反馈，我们将加强PN的作用，发展和扩展现有的合作关系，以促进参与者的招募，并根据拟议的随机对照试验（RCT）的有效性，为社区合作伙伴做好准备，以传播和实施PN+LSSC计划。II期将测试一项随机对照试验，以评估一种文化定制的PN+LSSC计划在改善乳腺癌、结直肠癌和前列腺HL幸存者的一般和疾病特异性生活质量（QOL）和治疗随访依从性方面的疗效。第二阶段还将评估这些结果的干预相关改善在多大程度上是由PN+LSSC计划的目标（例如，与患者的沟通）介导的

Hispanic/Latinos (HL) are the largest and fastest-growing minority population in the nation. HLs generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to fimely, high-quality treatment. They also experience disproportionately higher disparities in quality of care and access to care. The experience of cancer survivorship is often characterized by significant challenges. Despite these challenges and significant disparities observed among HLs, there is very limited knowledge of survivorship-related issues and priorifies among HLs, specifically the effectiveness of using promotores/patient navigators (PN) in linking HL cancer survivors with unmet psychosocial needs to appropriate psychosocial services. The existing community-based infrastructure of the Lance Armstrong Foundafion (LAF) LIVESTRONG SurvivorCare (LSSC) program provides an excellent opportunity to evaluate its efficacy in improving QOL among HLs. This proposed 5-year Redes En Accidn research study involves a mixed-methods approach that occurs in two phases across two disfinct and diverse HL communifies. Phase I will use a community-based participatory research (CBPR) approach to engage community-based partners that provide services to breast, colorectal and prostate HL cancer survivors. In this phase, we will gather community partners for action-oriented group meetings at each site to present components and targets of the combined PN and LSSC program (PN+LSSC). Through this CBPR approach to generate valuable community feedback, we will enhance the role of the PN, develop and extend existing cooperative relafionships to facilitate participant recruitment, and prepare community-based partners to disseminate and implement the PN+LSSC program upon the established efficacy of the proposed randomized controlled trial (RCT) of Phase II. Phase II will test a RCT to evaluate the efficacy of a culturally tailored PN+LSSC program on improving general and disease-specific quality of life (QOL) and treatment follow-up compliance among breast, colorectal and prostate HL cancer survivors. Phase II also will evaluate the extent to which intervention-associated improvements in these outcomes are mediated by targets of the PN+LSSC program (e.g., communication with medical team, meeting unmet needs and improving health behaviors). The RCT involves a 2 X 4 randomized repeated measures design with experimental condition (combined patient navigafion [PN] over 3 months with access to LSSC telephone-based counseling [PN+LSSC] vs. a usual care [UC] control condition) as the between-groups factor, and fime-point (baseline/pre-randomizafion [Tl]; post-PN [3-months post-TI; T2], and 6- [T3] and 12-months [T4] follow-up post-T2) as the within-groups factor. We will compare the effects ofthe PN+LSSC and UC condifions on QOL and treatment follow-up compliance in 300 (after attrition; n=150, South Florida and n=150, Texas' Lower Rio Grande Valley) breast, colorectal and prostate HL cancer survivors with no evidence of metastatic disease. To understand the mechanisms by which the PN+LSSC significantly impacts QOL and treatment compliance outcomes, we also will examine changes in unmet cancer needs, communicafion with the medical team and health behaviors as potential mediators of the intervention effects. Study findings will fill a significant gap in our understanding of the extent to which PN programs and existing community-based resources targefing survivors can improve the QOL of a growing number of HL cancer survivors who experience an unequal burden of unmet needs after cancer treatment. The efficacy of the proposed RCT will provide a conceptually sound and clinically relevant approach to address the needs of HL cancer survivors by integrating evidence-based practice into existing community resources and infrastructure, thus facilitating the dissemination and translafion of study findings through Phase I's CBPR process.