Improving Adherence to Adjuvant Hormonal Therapy among Disadvantaged Breast Cancer Survivors

提高弱势乳腺癌幸存者对辅助激素治疗的依从性

• 批准号: 9767687
• 负责人: Tisha Felder
• 金额: $ 12.09万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9767687
• 关键词: Academic Medical Centers; Address; Adherence; Adjuvant; Affect; African American; Behavior; Behavior Therapy; Behavioral; Breast Cancer Risk Factor; Breast Cancer survivor; Cancer Center; Cancer Survivor; Caring; Cause of Death; Cessation of life; Clinical; Data Analytics; Death Rate; Development; Diagnosis; Disadvantaged; Disease; Documentation; Economically Deprived Population; Educational workshop; Ensure; Family; Foundations; Goals; Guidelines; Health; Health Communication; Health Professional; Healthcare Systems; Intervention; Intervention Studies; Interview; Knowledge; Medicaid; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Cancer Institute; Nature; Outcome; Outcomes and Health Services Research; Patients; Pharmacologic Substance; Population; Productivity; Qualitative Research; Recurrence; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Sampling; Schedule; Science; Scientific Advances and Accomplishments; South Carolina; Structure; Support System; Survivors; Testing; Time; Training; Underserved Population; United States; University resources; Woman; World Health Organization; adherence rate; administrative database; base; behavior test; cancer care; cancer health disparity; career; career development; design; disadvantaged population; disease natural history; ethnic disadvantage; evidence base; experience; fighting; hormone receptor-positive; hormone therapy; improved; innovation; intervention effect; malignant breast neoplasm; mortality; mortality disparity; patient-clinician communication; preference; public health relevance; racial and ethnic; racial disparity; research and development; skills; sociodemographics; socioeconomic disadvantage; socioeconomics; theories; therapy adherence; time interval

 DESCRIPTION (provided by applicant): My long-term career goal is to become a leader in our nation's fight to eliminate disparities and improve health outcomes among racial/ethnic and socioeconomically-disadvantaged cancer survivors. Specifically, I desire to become a nationally-recognized outcomes researcher who: 1) develops and disseminates effective strategies to improve adherence to evidence-based cancer care; and 2) leads collaborative and productive transdisciplinary science that advances the field of cancer disparities research. I have substantial training in health services/outcomes research using secondary data analytic approaches (e.g., large administrative database analyses) to investigate disparities in pharmaceutical treatment use among disadvantaged populations. Training facilitated by this National Cancer Institute (NCI) Mentored Research Scientist Development Award to Promote Diversity (K01) will provide me with the protected time to obtain the theoretical knowledge and methodological skills necessary to achieve my long-term career goal. My training goals for this proposed K01 are to: a) develop skills in qualitative research methods; b) develop skills in the development and testing of behavioral interventions, including multi-level approaches; c) expand my knowledge of health communication; and d) increase my scholarly productivity in cancer disparities research. My mentors and I have developed a three-pronged strategy to achieve my career goals and ensure that my research training needs are addressed: 1) a strong, interdisciplinary team of mentors and collaborators who will guide my research and career development; 2) an innovative research project integrated with my training goals that is both scientifically relevant and rigorous in its design and methods; and 3) a schedule of didactic coursework, workshops, seminars and professional interactions that build upon the existing resources of the University of South Carolina and South Carolina's only NCI-designated cancer center-the Hollings Cancer Center of the Medical University of South Carolina. My proposed research plan seeks to address the paucity of existing intervention research focused on improving adherence to adjuvant hormonal therapy (AHT), particularly among racial and socioeconomically disadvantaged groups who experience excess rates of breast cancer mortality. Current clinical guidelines recommend hormone-receptor positive breast cancer survivors take AHT for at least 5 years. However, less than half of patients are adherent to guidelines and suboptimal AHT adherence is associated with increased risk of breast cancer mortality. Research has extensively documented socio-demographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors that can be modified (e.g., knowledge, patient-provider communication) and targeted by interventions. Identifying these modifiable intervention targets is critical to the development of efficacious strategies to improve adherence. Therefore, the overall goal of this study is to develop and test a theory-based, multi-level intervention to improve adherence to AHT among breast cancer survivors from racial and socioeconomically-disadvantaged backgrounds. The specific aims of this study are to: 1) explore multi- level (e.g., patient, healthcare system) factrs that influence adherence to AHT; 2) develop a theory-based, multi-level intervention to improve adherence to AHT; and 3) pilot and evaluate a theory-based, multi-level intervention. The proposed studies will provide training, mentorship, and research experience that will provide the foundation for my career as an independent investigator committed to improving health outcomes and eliminating disparities among the growing cancer survivor population.

 描述（由申请人提供）：我的长期职业目标是成为我们国家消除种族/民族和社会经济弱势癌症幸存者之间的差距和改善健康结果的领导者。具体来说，我希望成为一个国家认可的结果研究员谁：1）开发和传播有效的策略，以提高遵守循证癌症护理;和2）导致合作和生产性的跨学科科学，推进癌症差异研究领域。我在使用二级数据分析方法进行卫生服务/结果研究方面接受过大量培训（例如，大型行政数据库分析），以调查弱势群体中药物治疗使用的差异。由这个国家癌症研究所（NCI）指导研究科学家发展奖促进多样性（K 01）促进的培训将为我提供受保护的时间，以获得实现我的长期职业目标所需的理论知识和方法技能。我的培训目标是：a）发展定性研究方法的技能; B）发展行为干预措施的开发和测试技能，包括多层次方法; c）扩大我的健康传播知识; d）提高我在癌症差异研究中的学术生产力。我的导师和我已经制定了一个三管齐下的战略，以实现我的职业目标，并确保我的研究培训需求得到解决：1）一个强大的，跨学科的导师和合作者团队，他们将指导我的研究和职业发展; 2）一个创新的研究项目，与我的培训目标相结合，既科学相关，又严格的设计和方法;以及3）建立在南卡罗来纳州大学和南卡罗来纳州唯一的NCI指定的癌症中心--南卡罗来纳州医科大学霍林斯癌症中心现有资源基础上的教学课程、讲习班、研讨会和专业互动的时间表。我提出的研究计划旨在解决现有干预研究的不足，重点是提高辅助激素治疗（AHT）的依从性，特别是在经历乳腺癌死亡率过高的种族和社会经济弱势群体中。目前的临床指南建议受体阳性乳腺癌幸存者服用AHT至少5年。然而，只有不到一半的患者遵守指南，并且次优的AHT依从性与乳腺癌死亡率风险增加相关。研究已经广泛记录了与坚持AHT相关的社会人口统计学和疾病特异性因素，但很少有证据表明可以改变行为因素（例如，知识，患者-提供者沟通）和干预措施的目标。确定这些可修改的干预目标对于制定有效的策略以提高依从性至关重要。因此，本研究的总体目标是开发和测试一种基于理论的多层次干预措施，以提高来自种族和社会经济弱势背景的乳腺癌幸存者对AHT的依从性。本研究的具体目的是：1）探索多层次（如，患者、医疗保健系统）影响AHT依从性的因素; 2）开发基于理论的多层次干预措施，以提高AHT依从性; 3）试验和评估基于理论的多层次干预措施。拟议的研究将提供培训，指导和研究经验，这将为我的职业生涯提供基础，作为一名独立的研究人员，致力于改善健康状况，消除不断增长的癌症幸存者人口之间的差距。

项目成果

Expectations and reality: perceptions of support among African American breast cancer survivors.

• DOI: 10.1080/13557858.2017.1373072
• 发表时间: 2019-10
• 期刊: Ethnicity & health
• 影响因子: 3.1
• 作者: Felder TM;Estrada RD;Quinn JC;Phelps KW;Parker PD;Heiney SP
• 通讯作者: Heiney SP

Increasing Human Papillomavirus Vaccination and Cervical Cancer Screening in Nigeria: An Assessment of Community-Based Educational Interventions.

尼日利亚增加人乳头瘤病毒疫苗接种和宫颈癌筛查：基于社区的教育干预措施评估。

• DOI: 10.1177/0272684x20916611
• 发表时间: 2020
• 期刊: International quarterly of community health education
• 影响因子: 1.3
• 作者: Nkwonta,ChigozieAnastacia;HilfingerMessias,DeAnneK;Felder,Tisha;Luchok,Kathryn
• 通讯作者: Luchok,Kathryn

Intervention to Reduce Stigma and Improve Knowledge of HPV and Cervical Cancer in Nigeria: A Community-Based Assessment.

尼日利亚减少耻辱感并提高对 HPV 和宫颈癌了解的干预措施：基于社区的评估。

• DOI: 10.1097/fch.0000000000000309
• 发表时间: 2021
• 期刊: Family & community health
• 影响因子: 2.3
• 作者: Nkwonta,ChigozieAnastacia;HilfingerMessias,DeAnneK;Felder,Tisha;Luchok,Kathryn
• 通讯作者: Luchok,Kathryn

Evaluation of a Computer-Based Decision Aid for Promoting Informed Prostate Cancer Screening Decisions Among African American Men: iDecide.

对基于计算机的决策辅助工具的评估，以促进非裔美国男性知情的前列腺癌筛查决策：iDecide。

• DOI: 10.1177/0890117118786866
• 发表时间: 2019
• 期刊: American journal of health promotion : AJHP
• 作者: Owens,OtisL;Felder,Tisha;Tavakoli,AbbasS;Revels,AsaA;Friedman,DanielaB;Hughes-Halbert,Chanita;Hébert,JamesR
• 通讯作者: Hébert,JamesR

Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic.

• DOI: 10.1097/nnr.0000000000000493
• 发表时间: 2021-05-01
• 期刊: Nursing research
• 影响因子: 2.5
• 作者: Abshire DA;McDonnell KK;Donevant SB;Corbett CF;Tavakoli AS;Felder TM;Pinto BM
• 通讯作者: Pinto BM