Partner Engagement & Receipt of Surveillance in Colorectal Cancer Survivors

 描述(申请人提供)：结直肠癌治愈后，有必要进行持续监测，以发现癌症复发。肝、肺和原发癌部位的有限复发可以通过外科手术切除，治愈率高达50%。然而，在美国每年120万结直肠癌幸存者中，近一半未能接受潜在的挽救生命的监测。理想护理和实际护理之间的这种差距代表着一个机会，可以确定以前未开发的支持来源，以提高一大批患者治愈的可能性。在一半的结直肠癌幸存者中，监测的使用不足，这要求我们考虑新的方法来改善护理。根据国家癌症研究所的说法，让患者的伴侣参与可能是改善癌症监测的一种方法，而患者的伴侣是生存体验的一部分。大多数结直肠癌患者是已婚或有伴侣的。合作伙伴是一个潜在的资源，提供者可以参与进来，以增加患者接受监测的机会。我们的初步研究表明，80%的结直肠癌患者希望伴侣参与治疗决策；85%的人报告说伴侣的支持程度很高。这项混合方法研究的目的是1)通过深入访谈，从结直肠癌幸存者及其伴侣的角度确定影响接受监测检测的因素；2)确定与伴侣在患者监测护理过程中的高水平参与度相关的伴侣特有因素。我们假设男性和/或黑人伴侣的敬业度最低；3)确定伴侣敬业度水平与患者接受监测之间的关系。我们假设，在伴侣参与监测护理过程最少的患者中，接受监测的人数最低。分析将考虑其他因素的作用，包括年龄、合并症、社会经济地位、种族、 [和灵性]在接受监视。目标2和3将通过调查一大批不同的结直肠癌幸存者及其伴侣来实现。拟议的项目不仅将提供数据，为未来针对夫妇(结直肠癌患者-伴侣二人组)的干预提供信息，它还将作为申请者发展为 卫生服务研究方面的独立研究员。申请者已经在结直肠癌护理质量的研究和结直肠癌的临床基础方面有很强的背景。通过精选课程，从国家卫生服务研究[和社会科学]专家那里获得指导，并完成一个精心设计的项目，将技能获得与研究目标联系起来，申请人将成为卫生服务研究的专家和独立调查员，因为它与癌症的生存有关。

 DESCRIPTION (provided by applicant): After curative treatment for colorectal cancer, ongoing surveillance is necessary to detect cancer recurrence. Limited recurrences in the liver, lung, and at the site of the primary cancer can be surgically resected with a cure rate as high as 50%. However, nearly half of the 1.2 million yearly survivors of colorectal cancer in the US fail to receive potentially life-saving surveillance. This gap between ideal care and actual care represents an opportunity to identify previously untapped sources of support to improve the likelihood of cure in a large group of patients. The under-use of surveillance in half of all colorectal cancer survivors requires that we consider novel methods to improve care. Engaging the partners of patients, who, according to the National Cancer Institute, is "part of the survivorship experience," may represent one approach to improving cancer surveillance. The majority of colorectal cancer patients are married or partnered. Partners serve as a potential resource that providers can engage to increase patients' receipt of surveillance. Our preliminary studies show that 80% of colorectal cancer patients want partners involved in treatment decisions; 85% report high levels of partner support. The aims of this mixed methods study are 1) To identify, through in-depth interviews, factors that influence the receipt of surveillance testing from the perspective of survivors of colorectal cancer and their partners; 2) To determine the partner-specific factors associated with a high level of partner engagement in the patient's surveillance care process. We hypothesize that engagement will be lowest among male and/or black partners; 3) to determine the relationship between level of partner engagement and patients' receipt of surveillance. We hypothesize that receipt of surveillance will be lowest among patients whose partners are least engaged in the surveillance care process. Analyses will account for the role of other factors, including age, comorbidity, socioeconomic status, race, [and spirituality] in receipt of surveillance. Aims 2 and 3 will be accomplished by surveying a large and diverse cohort of colorectal cancer survivors and their partners. Not only will the proposed project provide data to inform future interventions targeted at couples (colorectal cancer patient-partner dyads), it will also serve as a vehicle for the applicant's development into an independent researcher in health services research. The applicant already has a strong background in studies of the quality of colorectal cancer care and a clinical foundation in colorectal cancer. Through select coursework, mentorship from national experts in health services research [and social sciences], and completion of a carefully designed project linking skill acquisition to research aims, the applicant will emerge as an expert and independent investigator in health services research as it pertains to cancer survivorship.