Disseminating PAL

描述(申请人提供)：目前有超过240万乳腺癌(BRCA)幸存者生活在美国。作为BRCA治疗的一种常见和病态的影响，淋巴水肿是长期存活者的主要担忧。淋巴水肿导致四肢肿胀和不适，严重损害手臂功能。虽然发病率通常在20%-30%之间，但淋巴水肿会对所有BRCA幸存者产生负面影响，因为危险因素定义不清，而且这种情况是慢性的、进行性的和不可治愈的。长期以来，临床医生一直建议乳腺癌幸存者避免用受影响的手臂抬起，以避免淋巴水肿的发生或恶化。最近完成的体力活动和淋巴水肿试验(PAL)的结果提供了令人信服的证据，证明这种避免提举的善意规避风险的建议是错误的。在一项大样本量的研究中，PAL试验证实了举重训练干预对预防淋巴水肿发作的有效性。举重训练干预还改善了肌肉力量以及对力量和健康、外表和性的自我感觉。媒体关注和形成性评估工作表明，乳腺癌患者和临床医生社区对广泛传播这一创新干预措施感兴趣，如果它能安全进行的话。下一步是开发和评估通信渠道和基础设施，以修订PAL干预交付方法，该方法可广泛传播，强调安全，并且仍然有效。这项探索性研究将试行修订后的干预交付方法，明确告知临床医生和幸存者对安全性的担忧。在肿瘤随访期间，在Rena Rowan乳房中心就诊的幸存者将得到肿瘤临床医生的转介，以进行手臂和肩膀问题的标准化物理治疗评估(如果需要的话，还可以进行治疗)，包括但不限于淋巴水肿。在获得理疗师的批准后，120名幸存者将参加四个小组理疗课程。在这些课程中，幸存者将学习安全和有效地执行PAL重量训练方案的基本要素。在此之后，每个妇女将被提供选择参加PAL举重计划在自己的家里或在社区基督教青年会。物理治疗评估、治疗(如果需要)和学习PAL举重计划的小组会议的费用都将由参与者的保险支付。由于这不是他们治疗的一部分(例如，这是可选的)，预计一些幸存者将选择不参与部分或全部提供的干预。将收集数据，以帮助解释拟议方法的哪些要素促进或阻止更广泛地传播和采用这一方法，以提供PAL干预。对干预措施的评估将由有助于解释传播成功的创新模型结构的传播指导，包括相对优势、兼容性、复杂性、可试验性和观察到的结果。这项先导研究的结果将被用来进一步修订PAL干预提供方法，以开发更大的传播试验。 公共卫生相关性：最近完成的体力活动和淋巴水肿(PAL)试验的令人兴奋的结果受到了乳腺癌临床治疗和生存界的热烈欢迎。然而，对于如何最好地为乳腺癌幸存者提供这种成功、安全和有效的基于基督教青年会的举重干预仍存在疑问。这项拟议的探索性研究旨在测试一种干预交付系统，该系统将接触到许多幸存者，强调患者安全，并仍将幸存者与她所在的社区基督教青年会联系起来，以长期支持举重活动。

DESCRIPTION (provided by applicant): There are more than 2.4 million breast cancer (BrCa) survivors living in the U.S. today. As a common and morbid effect of BrCa treatment, lymphedema ranks principal among concerns of long-term survivors. Lymphedema causes limb swelling and discomfort, significantly impairing arm function. Though incidence is commonly quoted to be between 20-30%, lymphedema negatively affects all BrCa survivors because risk factors are ill-defined and the condition is chronic, progressive, and incurable. Breast cancer survivors have long been advised by clinicians to avoid lifting with the affected arm to avoid onset or worsening of lymphedema. The results of the recently completed Physical Activity and Lymphedema Trial (PAL) provide compelling evidence that this well-meaning risk-averse advice to avoid lifting was in error. The PAL Trial established the effectiveness of a weight-training intervention to prevent lymphedema flare-ups in a study with a large sample size. The weight-training intervention also improved muscle strength and self perception of strength and health, appearance and sexuality. Media attention and formative assessment work indicate that the breast cancer patient and clinician communities are interested in broad dissemination of this innovative intervention if it can be done safely. The next step is to develop and assess communication channels and infrastructure for a revised method of PAL intervention delivery that is broadly disseminable, emphasizes safety and is still effective. This exploratory study will pilot test a revised intervention delivery approach specifically informed by clinician and survivor concerns for safety. During an oncology follow-up visit, survivors seen at the Rena Rowan Breast Center will receive a referral from an oncology clinician for a standardized physical therapy evaluation (and treatment, if needed) of arm and shoulder problems, including but not limited to lymphedema. After clearance from a physical therapist, 120 survivors will participate in four group physical therapy sessions. During these sessions, survivors will learn essential elements of safe and effective performance of the PAL weight-training protocol. After this, each woman will be provided options to participate in the PAL weight-lifting program in their home or at a community YMCA. The cost of the physical therapy evaluation, treatment (if needed), and group sessions to learn the PAL weight-lifting program will all be paid for by the participant's insurance. As this is not a part of their curative therapy (e.g., it is optional), it is anticipated that some survivors will choose not to participate in some or all of this offered intervention. Data will be collected to help explain what elements of the proposed approach facilitate or prevent broader dissemination and uptake of this approach to delivering the PAL intervention. Evaluation of the intervention will be guided by Dissemination of Innovation Model constructs that help explain dissemination success, including relative advantage, compatibility, complexity, trialability, and observed results. Results of this pilot study will be used to further revise the PAL intervention delivery approach to develop a larger dissemination trial. PUBLIC HEALTH RELEVANCE: The exciting results of the recently completed Physical Activity and Lymphedema (PAL) trial have been received enthusiastically by the breast cancer clinical treatment and survivorship communities. However, there are questions as to how best to deliver this successful, safe, and effective YMCA based weight-lifting intervention for breast cancer survivors. The proposed exploratory study is intended to test an intervention delivery system that will reach many survivors, emphasizes patient safety, and still links the survivor back to her community YMCA for long-term support of weight-lifting activities.