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Optimizing the Delivery of Diabetes Management During Breast Cancer Care

优化乳腺癌护理期间糖尿病管理的实施

基本信息

批准号：
10682524
负责人：
Laura C Pinheiro
金额：
$ 17.23万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10682524
关键词：
2,4-Dinitrophenol Active Learning Acute Affect Attention Award Breast Breast Cancer Patient Breast Cancer Treatment Breast Cancer therapy Cancer Patient Care given by nurses Caring Chemotherapy-Oncologic Procedure Chronic Disease Clinical Cluster randomized trial Communities Development Plans Diabetes Mellitus Disparity Doctor of Philosophy Endocrinologist Ensure Evaluation Face Feeling Future Goals Grant Health Health Services High Prevalence Hospitalization Individual Infection Inpatients Internist Intervention Malignant Neoplasms Medicine Mentors Mentorship Modeling Non-Insulin-Dependent Diabetes Mellitus Nonmetastatic Nurse Practitioners Oncologist Oncology Oncology Nurse Outcome Patient Care Patient-Focused Outcomes Patients Phase Pilot Projects Primary Care Primary Nursing Care Provider Qualitative Research Reading Reduce health disparities Reporting Research Research Methodology Research Personnel Risk Scientific Inquiry Scientist Site Testing Training Uncertainty United States Dept. of Health and Human Services Woman Work Writing aggressive breast cancer blood glucose regulation cancer care cancer diagnosis cancer health disparity cancer therapy career development chemotherapeutic agent chemotherapy comorbidity design diabetes management effectiveness testing ethnic disparity ethnic minority glycemic control health care delivery health disparity health equity health training high risk implementation evaluation implementation outcomes implementation science implementation trial improved improved outcome innovation interest malignant breast neoplasm mortality mortality risk multidisciplinary non-diabetic outcome disparities pilot test primary care provider racial disparity racial minority randomized trial skills success therapy design

项目摘要

PROJECT SUMMARY Twenty percent of US women with breast cancer also have diabetes mellitus (DM) and face a 50% higher risk of death up to 10 years after cancer diagnosis compared to non-diabetic women with breast cancer. A possible explanation is that DM receives less attention during cancer treatments because patients, oncologists, and primary care providers (PCPs) prioritize cancer care over DM management. Oncologists may focus on cancer care (rather than DM management), patients may not see their PCPs in the period after cancer diagnosis, and PCPs may not feel comfortable managing DM in the context of chemotherapy regimens that frequently affect glucose control. Given these concerns, identifying a provider who could effectively manage DM may be an attractive solution. Nurse practitioners (NPs) have been successfully integrated into many oncology care teams to support general cancer care. Separately, NPs have been shown to successfully manage DM in various non- cancer settings. However, no study has determined whether a NP on the oncology care team can effectively manage DM during chemotherapy for breast cancer. I hypothesize that a NP trained in DM care and embedded in the oncology team can effectively manage DM during this acute phase of breast cancer care. The objective of this study is to engage stakeholders to develop and implement a NP-led intervention to manage DM for women receiving chemotherapy for incident non-metastatic breast cancer. To accomplish this, I propose the following research aims: 1) elicit the perspectives of patients, NPs, oncologists, and PCPs about barriers to and facilitators for a NP managing DM during chemotherapy, 2) develop a NP-led intervention to manage DM during chemotherapy, and 3) conduct a pilot study to implement the intervention and assess implementation outcomes (reach, acceptability, appropriateness, feasibility, fidelity). Findings from this pilot study will lay the groundwork for a multi-site, randomized trial testing the effectiveness of this NP-led model. As a PhD-trained health services researcher focused on cancer outcomes and health disparities, I have gained quantitative research expertise. I now seek to expand my research skills to include implementation trials. To accomplish this goal, I will pursue mentorship and training in qualitative research methods, healthcare delivery, and in stakeholder-engaged intervention design, implementation, and evaluation in real-world settings. I will be mentored by two nationally-recognized clinician scientists, Dr. Monika Safford and Dr. Lisa Kern. Together, we designed a career development plan for me to gain skills through coursework and reading that is then solidified through experiential learning by carrying out my research aims. This Award will enable me to advance toward my long-term goal of becoming an independent health services researcher working at the intersection of cancer care, primary care, and health equity to improve patient outcomes and reduce health disparities.

项目总结 20%的美国乳腺癌女性也患有糖尿病(DM)，面临的风险高出50% 与患有乳腺癌的非糖尿病妇女相比，癌症确诊后长达10年的死亡率更高。一个可能的解释说，糖尿病在癌症治疗期间受到的关注较少，因为患者、肿瘤学家和初级保健提供者(PCP)优先考虑癌症护理，而不是糖尿病管理。肿瘤学家可能会专注于癌症护理(而不是DM管理)，患者可能在癌症诊断后的一段时间内看不到他们的初级保健医生，以及在经常影响糖尿病的化疗方案的背景下，PCP可能会感到不舒服血糖控制。考虑到这些问题，确定能够有效管理DM的提供商可能是一项有吸引力的解决方案。执业护士(NPs)已成功融入许多肿瘤护理团队以支持普通癌症护理。另外，NP已被证明成功地管理了各种非癌症背景。然而，还没有研究确定肿瘤护理团队中的NP是否可以有效在乳腺癌化疗期间管理DM。我假设一个受过糖尿病护理训练的NP 嵌入到肿瘤学团队中，可以在乳腺癌急性期护理期间有效地管理DM。这项研究的目标是让利益相关者制定和实施由NP领导的干预措施，以为因非转移性乳腺癌而接受化疗的妇女管理DM。要做到这一点，我提出以下研究目标：1)收集患者、非政府组织、肿瘤学家和初级保健医生对以下问题的看法 NP在化疗期间管理DM的障碍和促进者，2)开发NP领导的干预以在化疗期间管理糖尿病，以及3)进行试点研究，以实施干预和评估实施成果(可达性、可接受性、适当性、可行性、忠诚度)。这次试行的结果这项研究将为多地点随机试验测试这种NP领导的模型的有效性奠定基础。作为一名受过博士培训的卫生服务研究员，专注于癌症结果和健康差距，我获得了定量研究方面的专长。我现在寻求扩展我的研究技能，以包括实施试验。至为了实现这一目标，我将在定性研究方法、医疗保健提供、以及在现实世界环境中由利益相关者参与的干预设计、实施和评估。我会的由两位全国公认的临床科学家Monika Safford博士和Lisa Kern博士指导。在一起，我们为我设计了一份职业发展计划，通过课程学习和阅读获得技能，然后巩固这些技能通过体验式学习来实现我的研究目的。这个奖项将使我能够朝着我的长期目标是成为一名独立的卫生服务研究员，在癌症护理、初级保健和健康公平，以改善患者结局和减少健康差距。

项目成果

期刊论文数量（11）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Racial disparities in diabetes care among incident breast, prostate, and colorectal cancer survivors: a SEER Medicare study.

事件乳房，前列腺和结直肠癌幸存者中糖尿病护理的种族差异：一项Seer Medicare研究。

DOI：
10.1007/s11764-021-01003-z
发表时间：
2022-03
期刊：
JOURNAL OF CANCER SURVIVORSHIP
影响因子：
3.7
作者：
Pinheiro, Laura C.;Soroka, Orysya;Kern, Lisa M.;Higgason, Noel;Leonard, John P.;Safford, Monika M.
通讯作者：
Safford, Monika M.

Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators.

DOI：
10.1007/s00520-022-07112-4
发表时间：
2022-08
期刊：
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
影响因子：
0
作者：
通讯作者：

Diabetes and Cancer Co-management Education: Leveraging the Patient Activated Learning System (PALS) for Patients with Breast Cancer.

DOI：
10.1007/s13187-023-02298-5
发表时间：
2023-10
期刊：
JOURNAL OF CANCER EDUCATION
影响因子：
1.6
作者：
Rothman, Julia;Roudik, Michael;Zeng, Caroline;Ssebyala, Shakirah;Pinheiro, Laura C. C.
通讯作者：
Pinheiro, Laura C. C.

Eliciting primary care and oncology provider perspectives on diabetes management during active cancer treatment.

DOI：
10.1007/s00520-021-06264-z
发表时间：
2021-11
期刊：
SUPPORTIVE CARE IN CANCER
影响因子：
3.1
作者：
Cho, Jacklyn;Nilo, Daniela;Sterling, Madeline R.;Kern, Lisa M.;Safford, Monika M.;Pinheiro, Laura C.
通讯作者：
Pinheiro, Laura C.

Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors.

癌症幸存者中糖尿病相关急诊就诊和住院治疗的种族差异。