Extended Cancer Education for Longer-term Survivors (EXCELS) In Primary Care

初级保健中长期幸存者的扩展癌症教育 (EXCELS)

• 批准号: 9326812
• 负责人: SHAWNA V. HUDSON
• 金额: $ 66.27万
• 依托单位: RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9326812
• 关键词: Address; Aftercare; Behavioral Sciences; Blinded; Breast; Cancer Control Research; Cancer Patient; Cancer Survivor; Cancer Survivorship; Caring; Case Manager; Cellular Phone; Chronic Disease; Chronically Ill; Collaborations; Colorectal; Complex; Computer software; Control Groups; Data; Development; Disease Management; Education; Enrollment; Ensure; Ethnography; Evaluation; Focus Groups; Goals; Growth; Health; Health Communication; Health Personnel; Health behavior; Healthcare; Individual; Institute of Medicine (U.S.); Interdisciplinary Study; Internet; Intervention; Interview; Late Effects; Malignant Neoplasms; Mediator of activation protein; Medical; Medical Care Team; Monitor; Monitoring for Recurrence; Multimedia; New Jersey; Online Systems; Outcome; Participant; Patient Care; Patients; Phase; Physicians; Population; Premature aging syndrome; Preventive; Preventive Health Services; Preventive care; Preventive healthcare; Preventive service; Primary Health Care; Process; Program Appropriateness; Prostate; Provider; Qualitative Methods; Randomized Controlled Trials; Recruitment Activity; Recurrence; Regimen; Reporting; Research; Research Design; Research Personnel; Risk; Screening for cancer; Self Care; Self Management; Social Interaction; Social Sciences; Survivors; Technology; Telephone Interviews; Testing; Translations; United States; Work; active method; base; behavioral/social science; cancer care; cancer education; cancer prevention; cancer recurrence; cancer therapy; coping; design; disorder prevention; dissemination research; evidence base; experience; follow-up; group intervention; implementation research; improved; innovation; member; mobile computing; novel; oncology; primary care setting; primary outcome; programs; psychosocial; research study; secondary outcome; social; survivorship; theories; therapy development; tool; treatment as usual; uptake; usability

There are 13.7 million cancer survivors in the United States. By 2050 the rate of growth for cancer survivors is expected to outpace the rate of growth for incident cancer cases. Approximately 70 percent of cancer survivors have co-morbid conditions that require a comprehensive approach to their medical care. Yet, cancer survivors do not receive recommended follow-up care at appropriate levels, with regard to both needed preventive care and chronic disease management. Survivors may benefit from psychosocial tools and support to help them cope with care transitions, to appropriately monitor their health, and to help them manage their interactions with members of the healthcare provider team. Unfortunately, there is currently a lack of psychosocial tools designed specifically to help survivors proactively manage their healthcare from the termination of treatment into extended survivorship. To fill this void, we draw on the social and behavioral science evidence base in social interaction and health communication to develop and test a highly innovative, self-management intervention: Extended Cancer Education for Longer-term Survivors (EXCELS). Based on health communication best practices, as well as on smart technology for ready access to patients, the EXCELS intervention will consist of (1) enhanced education and decision support materials delivered via mobile web and smart phone application and (2) health coaching engagement. The plan for intervention development involves three steps: first, during the formative phase, we will use qualitative methods (i.e., focus groups with survivors, depth interviews with primary care healthcare team members, user testing) to inform the design and iterative development of EXCELS. Second, we will pilot the intervention using a randomized controlled trial study design. Specifically, we will enroll 480 cancer survivors (breast, prostate, colorectal) who have completed active cancer treatment at least 2 years ago. The comprehensive EXCELS intervention consists of an ongoing 12 month intervention that entails (1) enhanced education and self-care support materials delivered via mobile web/smart phone application and (2) health coaching calls. A 2X2 factorial design will be used to test "proof of concept" or efficacy for the fully implemented EXCELS intervention compared with usual care so that the combined intervention - as well as each individual component - will be tested. The primary outcomes are use of preventive health services and tracking of cancer recurrence and late effects with patient coping as a secondary outcome. Outcomes will be assessed at baseline and at 6, 12, and 18 months by telephone interviews and chart audit by blinded research staff. Finally, a process evaluation of intervention implementation, as well as pilot data from this study, will be used to refine the intervention for testing in a larger implementation and dissemination research study.

美国有1370万癌症幸存者。到2050年，癌症幸存者的增长率预计将超过癌症病例的增长率。大约70%的癌症幸存者患有共病，需要全面的医疗护理。然而，癌症幸存者在所需的预防性护理和慢性病管理方面没有得到适当水平的建议后续护理。幸存者可以从心理社会工具和支持中受益，以帮助他们科普护理过渡，适当监测他们的健康状况，并帮助他们管理与医疗保健提供者团队成员的互动。不幸的是，目前缺乏专门设计的心理社会工具，以帮助幸存者积极管理他们的医疗保健，从治疗终止到延长生存期。为了填补这一空白，我们利用社会互动和健康沟通中的社会和行为科学证据库，开发和测试一种高度创新的自我管理干预措施：长期生存者的扩展癌症教育（EXCELS）。基于健康传播最佳实践以及方便患者访问的智能技术，EXCELS干预措施将包括（1）通过移动的网络和智能手机应用程序提供的强化教育和决策支持材料，以及（2）健康指导参与。干预发展计划包括三个步骤：首先，在形成阶段，我们将使用定性方法（即，与幸存者的焦点小组，与初级保健医疗团队成员的深度访谈，用户测试），以告知设计和迭代开发的EXCEL。第二，我们将采用随机对照试验研究设计进行干预试验。具体来说，我们将招募480名癌症幸存者（乳腺癌，前列腺癌， 结直肠），至少2年前完成了积极的癌症治疗。EXCELS综合干预包括持续12个月的干预，包括（1）通过移动的网络/智能手机应用程序提供强化教育和自我护理支持材料，以及（2）健康指导电话。将使用2X2析因设计来测试“概念验证”或与常规护理相比完全实施的EXCELS干预的有效性，以便测试组合干预以及每个单独的组分。主要结果是使用预防性卫生服务和跟踪癌症复发和晚期效应，患者应对作为次要结果。将在基线和6、12和18个月时通过电话访谈和由设盲研究人员进行的图表稽查评估结局。最后，干预措施实施的过程评价以及本研究的试点数据将用于完善干预措施，以便在更大的实施和传播研究中进行测试。