Mapping Breast Cancer Survivorship and the Survivor Institutional Interface

 描述(申请人提供)：目前美国有超过250万的乳腺癌幸存者。癌症生存的主流范式要么关注疾病的生物医学模型(机构视角)，要么关注心理社会措施(个体视角)，但忽视了个人与机构(如卫生保健设施、工作场所)之间的复杂相互作用，这些因素共同促进了生存结果。迫切需要新的生存护理模式，以适应老龄化人口不断变化的医疗保健需求，乳腺癌幸存者数量及其预期寿命的预期增加，以及医疗服务不足地区的医疗保健缺陷，这些地区受到医生和专科医生年龄不足的影响不成比例。拟议的跨学科研究结合了社会生态学的理论框架和定性研究方法，将乳腺癌存活率作为加州内陆帝国的具体经验和制度实践之间的互动过程进行调查，该地区包括河滨和圣贝纳迪诺县。这项研究将对以个人、机构和社区层面的变化为目标的医疗保健和政策干预的设计产生重大影响。目的1：探讨乳腺癌患者的个体生存经验。采用纵向设计，将每隔一年对内陆帝国乳腺癌幸存者进行深入的半结构化开放式访谈。招募工作将通过与内陆帝国乳腺癌组织的合作来促进，这些组织包括粉色丝带之地、米歇尔之家和南加州见证人项目。目标2：调查机构资源及其在确定生存护理方面的作用。生还船资源包括广泛的服务(即运输援助、假肢装配)，超出了生还医疗保健的范畴，但也是生还医疗服务的组成部分。将调查内陆帝国的机构资源，并对一个特定的生存计划及其机构记录进行深入的案例研究。目标3：绘制幸存者与机构之间的界面。利用目标1和目标2中收集的视觉和文本数据，绘图可以定性分析内陆帝国幸存者和机构在需求、资源和资源使用方面的汇合和分歧。培训计划：申请者立志成为一名独立的癌症生存研究人员。在癌症生存、社会生态和组织研究方面的跨学科团队的指导有助于实现这一目标。个别化培训计划包括正式课程；应用技能培训；与赞助商和顾问的个人会议；每月小组辅导、师生阅读小组会议和以女性癌症治疗疾病为导向的团队会议；参加组织研究中心活动和一年一度的潮家综合癌症中心科学务虚会，以及国家会议，如NCI两年一次的生存研究会议。

 DESCRIPTION (provided by applicant): There are currently over 2.5 million breast cancer survivors in the US. Dominant paradigms for cancer survivorship focus either on biomedical models of disease (institutional perspective) or psychosocial measures (individual perspective) but ignore the complex interactions between individuals and institutions (e.g., health care facilities, workplaces) that jointly contribute to survivorship outcomes. New models of survivorship care are urgently required to accommodate the changing healthcare needs of an aging population, anticipated in- creases in both the number of breast cancer survivors and their life expectancies, as well as healthcare dis- parities in medically underserved regions that are disproportionately affected by physician and specialist short- ages. The proposed interdisciplinary research combines the theoretical framework of social ecology with qualitative research methods to investigate breast cancer survivorship as an interactional process between embodied experience and institutional practices in California's Inland Empire, a region comprising Riverside and San Bernardino counties. This research will have significant implications for the design of healthcare and policy interventions that target change at the individual, institutional, and community levels. Aim 1: Investigate individual experiences of breast cancer survivorship. Using a longitudinal de- sign, in-depth semi-structured open-ended interviews will be conducted with Inland Empire breast cancer survivors at yearly intervals. Recruitment will be facilitated by collaborations with Inland Empire breast cancer organizations: The Pink Ribbon Place, Michelle's Place, and the Southern California Witness Project. Aim 2: Investigate institutional resources and their role in defining survivorship care. Survivor- ship resources comprising a broad range of services (i.e., transportation assistance, prosthesis fitting) extend beyond-but are integral to-survivorship medical care. Institutional resources in th Inland Empire will be surveyed, with an in-depth case study of one particular survivorship program and its institutional records. Aim 3: Map the survivor-institutional interface. Employing both visual and textual data collected in aims 1 and 2, mapping allows qualitative analysis of confluences and divergences between Inland Empire survivor and institutional perspectives regarding needs, resources, and resource use. Training program: The applicant aspires to become an independent cancer survivorship researcher. Mentoring by an interdisciplinary team in cancer survivorship, social ecology, and organizational studies con- tributes to accomplishment of this goal. The individualized training plan includes formal coursework; applied skills training; individual meetings with sponsors and advisers; monthly group mentoring, faculty-student reading group meetings, and Women's Cancer Cure ConneXion Disease Oriented Team meetings; participation in the Center for Organizational Research events and the annual Chao Family Comprehensive Cancer Center scientific retreat, as well as national conferences such as the NCI biennial survivorship research conference.