Improving Adherence to Adjuvant Hormonal Therapy among Disadvantaged Breast Cancer Survivors

 描述(由申请人提供)：我的长期职业目标是成为我国消除种族/民族和社会经济不利的癌症幸存者之间的差异和改善健康结果的斗争的领导者。具体地说，我希望成为一名国家认可的成果研究人员：1)开发和传播有效的战略，以提高对循证癌症护理的遵守；2)领导协作和富有成效的跨学科科学，推动癌症差异研究领域的发展。我在卫生服务/结果研究方面接受了大量培训，使用次级数据分析方法(例如，大型行政数据库分析)来调查弱势人群在药物治疗使用方面的差异。由国家癌症研究所(NCI)指导的促进多样性研究科学家发展奖(K01)提供的培训将为我提供有保障的时间，以获得实现我长期职业目标所需的理论知识和方法技能。我建议的K01的培训目标是：a)培养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)扩展我的健康传播知识；d)提高我在癌症差异研究方面的学术生产力。我和我的导师们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满足：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，在设计和方法上既科学相关，又严格；以及3)在南卡罗来纳大学和南卡罗来纳大学唯一由NCI指定的癌症中心-南卡罗来纳医科大学霍林斯癌症中心-的现有资源基础上，制定教学课程、研讨会、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匮乏，重点是提高对辅助激素治疗(AHT)的依从性，特别是在经历过高乳腺癌死亡率的种族和社会经济弱势群体中。目前的临床指南建议激素受体阳性的乳腺癌幸存者至少服用AHT 5年。然而，只有不到一半的患者遵守指南，AHT依从性不佳与乳腺癌死亡风险增加有关。研究已经广泛地记录了与坚持AHT相关的社会人口学和疾病特定因素，但很少有证据表明可以修改(例如，知识、患者-提供者沟通)并通过干预针对的行为因素。确定这些可修改的干预目标对于制定有效的战略以提高依从性至关重要。因此，这项研究的总体目标是开发和测试一种基于理论的、多层次的干预措施，以提高来自种族和社会经济不利背景的乳腺癌幸存者对AHT的依从性。这项研究的具体目标是：1)探索影响AHT依从性的多层次(例如，患者、医疗系统)因素；2)开发基于理论的多层次干预以提高对AHT的依从性；以及3)试验和评估基于理论的多层次干预。拟议的研究将提供培训、指导和研究经验，为我作为一名独立调查员的职业生涯奠定基础，致力于改善健康结果，消除不断增长的癌症幸存者人口之间的差异。

 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.