Cancer treatment retraumatization in sexual abuse survivors

描述(由申请人提供)：性虐待(SA)的统计数据令人震惊：1/4的女性和1/6的男性在18岁之前经历过性侵。医疗保健程序，即使是那些看起来很轻微或例行公事的程序，也与儿童期性虐待有相似之处(例如，将物体插入身体、暴露、脆弱、疼痛、无能为力)。由于这些相似之处，SA幸存者可能会因为医疗保健程序而感到再次受到创伤。毫不奇怪，为了避免这种再创伤，SA幸存者可能会避免医疗保健(例如，推迟或取消治疗)。尽管癌症治疗通常涉及侵入性/私密性的医疗程序，以及避免癌症治疗的严重后果，但迄今为止还没有关于性虐待癌症(SACA)患者的癌症治疗再创伤与避免癌症治疗之间的关系的实证研究。目的：该项目的总体目标是更好地了解SACA患者的癌症治疗经验，这种痛苦与逃避治疗的关系，以及哪些SACA患者面临癌症治疗再创伤和逃避的风险最大。具体目标是：1)检验SACA患者癌症治疗再创伤增加将与癌症治疗回避增加相关的假设；2)测试癌症治疗再创伤增加和逃避癌症治疗将与：a)SA严重程度(例如，持续时间、武力)、b)暴露于其他类型的儿童期虐待以及c)相关的假设 暴露于癌前创伤性生活事件；3)探讨性别和癌症特征对研究结果的影响。研究方法：本研究以医疗再创伤避免(HRA)模型为指导。目标1-3将通过对从SA幸存者支持网站、癌症支持网站和众包网站(Amazon Machine Turk)招募的600名SACA患者(300名男性，300名女性)进行在线调查来实现。在线方法将通过提供匿名来改善患者体验，并将通过允许在全国范围内招聘来提高项目的普及性。通径分析将用于研究分析。长期目标：拟议的研究是改善接受癌症治疗的SACA患者的护理质量和生活质量的关键第一步。该项目将促进科学知识，并将帮助癌症护理社区了解SACA患者在癌症治疗过程中所经历的困难。研究结果将作为一项研究计划的基础，包括开发干预措施和评估工具，以减少这一脆弱群体的癌症治疗、再创伤和回避。与NIH/NCI使命的联系：该项目与健康人2020年的目标是一致的，即改善癌症患者和幸存者的生活质量。

DESCRIPTION (provided by applicant): The statistics on sexual abuse (SA) are staggering: 1 in 4 women and 1 in 6 men have experienced abusive sexual experiences before the age of 18. Healthcare procedures, even those that may seem minor or routine, share similarities with childhood sexual abuse (e.g., insertion of objects into the body, exposure, vulnerability, pain, powerlessness). Due to these similarities, SA survivors can feel retraumatized by healthcare procedures. Not surprisingly, to avoid this retraumatization, SA survivors may avoid healthcare (e.g., delay or cancel treatment). Despite the often invasive/intimate medical procedures involved in cancer treatment, and the serious consequences of cancer treatment avoidance, there has been no empirical study to date of the relationship between cancer treatment retraumatization and cancer treatment avoidance in sexually abused cancer (SACA) patients. Objectives: The overall goal of the project is to develop a greater understanding of SACA patients experiences of cancer treatment, how this suffering relates to treatment avoidance, and which SACA patients are most at risk for cancer treatment retraumatization and avoidance. Specific Aims are to: 1) test the hypothesis that increased cancer treatment retraumatization will be associated with increased cancer treatment avoidance in SACA individuals; 2) test the hypotheses that increased cancer treatment retraumatization and avoidance will be associated with: a) SA severity (e.g., duration, force), b) exposure to other types of childhood abuse, and c) exposure to pre-cancer traumatic life events; and, 3) explore the influence of gender and cancer characteristics on study outcomes. Methodology: The study is guided by the Healthcare Retraumatization Avoidance (HRA) model. Aims 1-3 will be accomplished through an online survey administered to 600 SACA patients (300 men, 300 women) recruited from SA survivor support websites, a cancer support website, and a crowdsourcing website (Amazon Mechanical Turk). The online approach will improve patient experience by providing anonymity, and will improve the generalizability of the project by allowing for nationwide recruitment. Path analysis will be used for study analyses. Long-term goals: The proposed study is a critical first step toward improving quality of care and quality of life of SACA patients undergoing cancer treatment. The project will advance scientific knowledge and will aid the cancer care community in understanding the difficulties SACA patients experience during cancer treatment. Results will serve as a foundation for a program of research including the development of interventions and assessment tools to reduce cancer treatment retraumatization and avoidance in this vulnerable population. Connection to NIH/NCI mission: This project is consistent with the Healthy People 2020 goal of improving quality of life of cancer patients and survivors.