Optimizing the Delivery of Diabetes Management During Breast Cancer Care

项目摘要 20%的美国乳腺癌女性同时患有糖尿病（DM）， 与患有乳腺癌的非糖尿病女性相比，癌症诊断后10年内的死亡率。一个可能 一种解释是，DM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DM管理。肿瘤学家可能会关注癌症 护理（而不是DM管理），患者在癌症诊断后可能看不到他们的PCP， PCP在化疗方案的背景下管理DM可能会感到不舒服， 血糖控制考虑到这些问题，确定一个可以有效管理DM的提供商可能是一个 有吸引力的解决方案执业护士（NP）已成功地融入许多肿瘤护理团队 来支持一般癌症护理。另外，NP已被证明在各种非糖尿病患者中成功管理DM。 癌症设置。然而，没有研究确定肿瘤护理团队中的NP是否可以有效地 在乳腺癌化疗期间管理DM。我假设一个受过糖尿病护理培训的护士， 在乳腺癌治疗的这个急性期，嵌入肿瘤团队的医生可以有效地管理DM。 本研究的目的是让利益攸关方参与制定和实施以国家方案为主导的干预措施， 管理因非转移性乳腺癌而接受化疗的女性的DM。为了实现这一点， 我提出以下研究目标：1）引出患者，NPs，肿瘤学家和PCP的观点， 化疗期间NP管理DM的障碍和促进因素，2）开发NP主导的干预措施， 在化疗期间管理DM，3）进行试点研究，以实施干预并评估 实施结果（范围、可接受性、适当性、可行性、忠实性）。该试点的结果 这项研究将为多中心随机试验奠定基础，以测试这种NP主导模式的有效性。 作为一名博士培训的卫生服务研究人员，专注于癌症结果和健康差异，我获得了 定量研究的专业知识。我现在寻求扩大我的研究技能，包括实施试验。到 为了实现这一目标，我将在定性研究方法，医疗服务， 以及在现实世界中参与干预设计，实施和评估。我将 由两名全国公认的临床科学家Monika Safford博士和丽莎克恩博士指导。一起我们 我为我设计了一个职业发展计划，通过课程和阅读来获得技能，然后巩固 通过实践我的研究目标，这个奖项将使我能够前进， 我的长期目标是成为一名独立的卫生服务研究人员， 癌症护理，初级保健和健康公平，以改善患者的结果和减少健康差距。

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.