Optimizing Veteran-Centered Prostate Cancer Survivorship Care

优化以退伍军人为中心的前列腺癌生存护理

• 批准号: 8597074
• 负责人: SARAH T HAWLEY
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8597074
• 关键词: Address; Adverse effects; Aftercare; Cancer Control; Cancer Survivor; Cancer Survivorship; Caring; Clinical; Clinical Services; Consent; Control Groups; Data; Data Sources; Development; Disease; Elements; Enrollment; Ensure; Erectile dysfunction; Evaluation; Fecal Incontinence; General Population; Goals; Health; Health Personnel; Health Services; Health Services Research; Healthcare Systems; Hormones; Incontinence; Intervention; Laboratories; Lead; Malignant Neoplasms; Malignant neoplasm of prostate; Measurable; Measures; Medical Records; Metabolic syndrome; Methods; Michigan; Monitor; Operative Surgical Procedures; Outcome; Patient Care; Patients; Pilot Projects; Population; Preparation; Primary Health Care; Printing; Process; Prostate; Quality of Care; Quality of life; Radiation therapy; Randomized; Randomized Controlled Trials; Recommendation; Relative (related person); Reporting; Research; Self Management; Services; Site; Survivors; Symptoms; System; Telephone; Translating; United States Department of Veterans Affairs; Urinary Incontinence; Veterans; Work; active method; experience; group intervention; improved; innovation; medical specialties; patient oriented; patient population; programs; psychosocial; randomized trial; service utilization; survivorship; symptom management; treatment as usual

DESCRIPTION (provided by applicant): Background: Although there are nearly 150,000 prostate cancer survivors in the VA, there has been little research to understand and improve survivorship care for this large population of Veterans. A substantial proportion of prostate cancer survivors in the general population have significant side effects from treatment (surgery or radiation therapy) that often persist for years including incontinence, erectile dysfunction, and metabolic syndrome, all of which can contribute to decreased quality of life. Our pilot data suggests that VA prostate cancer survivors experience similar or worse symptom burden to that of the general population of survivors. This is particularly unfortunate since many of these symptoms can be effectively self-managed. Furthermore, there is no program in the VA for assessing ongoing symptom burden in survivors and directing them to receive appropriate primary or specialty care if needed. Objectives: To address the need to improve patient-centered survivorship care management for Veterans with prostate cancer, we propose a 4 year study with two aims: 1) to conduct a randomized controlled trial to compare a personally tailored automated telephone symptom management intervention for improving symptoms and symptom self-management to usual care. We expect that those intervention group will have more confidence in symptom self-management and better symptom self-management and prostate cancer quality of life following the intervention, and that these outcomes will translate to more efficient use of services for these Veterans, and 2) to compare utilization of services among those in the intervention group to those in the control group. Methods: We will conduct a RCT of prostate cancer survivors at 3 VHA sites (Ann Arbor, Pittsburgh and St. Louis) who are 1-5 years post-treatment. Those with clinically meaningful symptom burden identified using an established measure of prostate cancer symptom burden will be invited to the study, consented and randomized to the automated telephone system or enhanced usual care (information about self-management). We will evaluate the impact of the intervention on confidence in symptom self-management as well as actual symptom burden and prostate cancer quality of life 6- and 12-months following enrollment. We will evaluate utilization of services 9-12 months post-enrollment using medical record/CPRS data sources. Finally, we will conduct a small process evaluation that will help us to better understand which elements of the intervention were effective, and will work with our primary care partners to make a recommendation for a broader deployment of an automated symptom self-management program in the VHA.

描述（由申请人提供）： 背景资料：虽然有近150，000前列腺癌幸存者在弗吉尼亚州，一直很少有研究来了解和改善生存护理这一庞大的退伍军人人口。在一般人群中，相当大比例的前列腺癌幸存者具有治疗（手术或放射治疗）的显著副作用，这些副作用通常持续多年，包括失禁，勃起功能障碍和代谢综合征，所有这些都可能导致生活质量下降。我们的试点数据表明，VA前列腺癌幸存者经历类似或更糟的症状负担的幸存者的一般人群。这是特别不幸的，因为许多这些症状可以有效地自我管理。此外，VA没有评估幸存者持续症状负担的计划，并指导他们在需要时接受适当的初级或专科护理。目的：为了解决改善以患者为中心的前列腺癌退伍军人生存护理管理的需要，我们提出了一项为期4年的研究，有两个目的：1）进行随机对照试验，比较个人定制的自动电话症状管理干预，以改善症状和症状自我管理，以常规护理。我们期望这些干预组在干预后对症状自我管理和更好的症状自我管理和前列腺癌生活质量更有信心，这些结果将转化为这些退伍军人更有效地使用服务，2）比较干预组与对照组中的服务利用率。方法：我们将在3个VHA中心（安阿伯、匹兹堡和圣路易斯）对治疗后1-5年的前列腺癌幸存者进行RCT。将邀请使用已确立的前列腺癌症状负担指标确定的具有临床意义的症状负担的受试者参加研究，获得知情同意并随机分配至自动电话系统或加强常规护理（关于自我管理的信息）。我们将评估干预措施对症状自我管理信心的影响，以及入组后6个月和12个月的实际症状负担和前列腺癌生活质量。我们将使用病历/CPRS数据源评估入组后9-12个月的服务利用率。最后，我们将进行一个小型的过程评估，这将有助于我们更好地了解干预措施的哪些要素是有效的，并将与我们的初级保健合作伙伴合作，为在VHA中更广泛地部署自动症状自我管理计划提出建议。