Optimizing Veteran-Centered Prostate Cancer Survivorship Care

描述(由申请人提供)： 背景：尽管退伍军人中有近150,000名前列腺癌幸存者，但很少有研究了解和改善这一庞大退伍军人的生存护理。在普通人群中，相当大比例的前列腺癌幸存者在治疗(手术或放射治疗)中有显著的副作用，这些副作用通常持续多年，包括大小便失禁、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的症状负担与普通幸存者相似或更严重。这是特别不幸的，因为这些症状中的许多都可以有效地自我管理。此外，退伍军人管理局没有计划评估幸存者持续的症状负担，并指导他们在需要时接受适当的初级或专科护理。目的：为了满足改善前列腺癌退伍军人以患者为中心的生存护理管理的需要，我们提出了一项为期4年的研究，目的有两个：1)进行随机对照试验，比较个人定制的自动化电话症状管理干预改善症状和症状自我管理与常规护理的效果。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利用服务，2)比较干预组和对照组之间的服务利用情况。方法：我们将在3个VHA地点(安娜堡、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随机对照试验。那些使用已建立的前列腺癌症状负担衡量标准确定具有临床意义的症状负担的人将被邀请参加这项研究，并同意并随机进入自动电话系统或增强型日常护理(关于自我管理的信息)。我们将评估干预对症状自我管理的信心以及登记后6个月和12个月的实际症状负担和前列腺癌生活质量的影响。我们将在注册后9-12个月使用病历/CPRS数据源评估服务的利用率。最后，我们将进行一项小型流程评估，帮助我们更好地了解干预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更广泛地部署自动化症状自我管理计划提出建议。

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.