Improving the prostate cancer survivorship care of veterans

描述(由申请人提供)： 退伍军人的前列腺癌负担很重，每年有20多万名幸存者和12,000例新诊断。大多数男性都患有这种常见疾病，而不是死于这种常见疾病，这使得前列腺癌的生存护理变得尤为重要。由于其在慢性病护理方面的领导地位和老年男性服务的比例，退伍军人健康管理局(VHA)处于有利地位，有望成为前列腺癌幸存者护理方面的全国领导者之一。然而，退伍军人前列腺癌生存护理的质量在很大程度上是未知的。此外，对于初级保健提供者或癌症专家是否应该对持续的癌症监测和治疗相关副作用(如大小便失禁、骨质疏松症)的管理负有主要责任，存在着很少的共识。最终，优化前列腺癌生存护理的工具的设计和实施取决于了解如何管理生存护理的责任以及良好生存护理的障碍。这项研究计划将提高我们对退伍军人前列腺癌生存护理的理解，并寻求使用最先进的实施科学方法来改进它。这项计划有三个目标。目的1：检验前列腺癌生存护理的两个关键质量指标的差异。使用全国VHA数据(2005-2011年)，我们将检查前列腺癌生存护理、癌症监测和骨密度检测的质量变化。目标2：评估提供高质量前列腺癌生存护理的障碍和促进者。在理论的指导下，我们将开展焦点小组，并与初级保健提供者和前列腺癌专家进行访谈，以更好地了解如何改善生存护理。目的3：开发、实施和试点以理论为基础的干预措施，以提高前列腺癌生存护理的质量。我们将利用我们的发现来试验一项干预措施，以解决AIM 1中发现的癌症监测和骨密度测试方面的质量差距，为随机试验做准备。由于老年前列腺癌幸存者的人数不断增加，优化他们的生存护理质量至关重要。我们的发现将为VHA的癌症生存护理模型提供参考，并指导未来提高癌症护理质量的实施努力。

DESCRIPTION (provided by applicant): The burden of prostate cancer among Veterans is substantial with over 200,000 survivors and 12,000 new diagnoses annually. Most men live with rather than die from this common disease making prostate cancer survivorship care especially important. Because of its leadership in chronic disease care and the proportion of older men served, the Veterans Health Administration (VHA) is well positioned to become one of the national leaders in prostate cancer survivorship care. However, the quality of Veteran prostate cancer survivorship care is largely unknown. In addition, there is poor consensus about whether primary care providers or cancer specialists should have primary responsibility for ongoing cancer surveillance and management of treatment-related side effects (e.g., incontinence, osteoporosis). Ultimately, the design and implementation of tools to optimize prostate cancer survivorship care rests upon understanding how responsibility for survivorship care is managed and the barriers to good survivorship care. This research program will improve our understanding of Veteran prostate cancer survivorship care and seek to improve it using state-of-the-art implementation science methods. This program has three aims. Aim 1: To examine variation in 2 key quality indicators of prostate cancer survivorship care. Using national VHA data (2005-2011), we will examine variation in the quality of prostate cancer survivorship care for cancer surveillance and bone density testing. Aim 2: To assess barriers and facilitators to delivering high quality prostate cancer survivorship care. Guided by theory, we will perform focus groups and interviews with primary care providers and prostate cancer specialists to better understand how to improve survivorship care. Aim 3: To develop, implement and pilot a theory-based intervention to improve the quality of prostate cancer survivorship care. We will use our findings to pilot an intervention that addresses quality gaps in cancer surveillance and bone density testing uncovered in Aim 1, in preparation for a randomized trial. Due to the expanding population of Veteran prostate cancer survivors, optimizing their quality of survivorship care is of the utmost importance. Our findings will inform models for cancer survivorship care across VHA and guide future implementation efforts to improve the quality of cancer care.