Life After Cancer: Examining Survivor Transitions From Specialist to Primary Care

描述(申请人提供)：这份职业发展申请的总体目标是使哈德森博士成为癌症生存和初级保健研究的独立研究员。癌症幸存者的数量正在迅速增加。乳腺癌和前列腺癌的存活率超过75%。已经被诊断出癌症的人中，超过一半的人预计可以存活5年以上。每三次癌症护理办公室就诊中，就有一次是初级保健提供者。初级保健的重点是护理、协调和连续性，这对于实现更好的幸存者护理是必要的。然而，关于初级保健提供者对幸存者结局的影响的研究还相当不发达。两项新的研究表明，同时看肿瘤学家和初级保健医生的幸存者比看其中之一的患者更有可能接受推荐的后续护理。然而，没有研究调查患者如何看待这些护理选项、他们的决策过程或这些因素对接受后续护理的影响。通过访谈和调查研究方法的结合，建议的研究相互促进：(1)探索早期乳腺癌和前列腺癌幸存者对后续癌症筛查的初级保健的态度；(2)开发和验证将在一项研究中实施的调查工具，该研究描述初级保健的使用情况，并评估影响幸存者如何使用专家和初级保健医生进行后续保健的认知-情感、患者支持和人口因素。拟议的培训计划通过在健康心理学、风险感知、决策、癌症生物学和流行病学方面提供必要的高级指导和课程来支持这项研究。这将使PI能够有效地进行拟议的研究，并为以后开发可测试的干预措施提供强有力的循证基础，帮助幸存者更有效地与初级保健提供者合作，进行后续的癌症护理。这一培训和研究计划将对确定幸存者面临的常见和重要的生活质量问题以及确定这些问题背后的机制和风险因素至关重要。最重要的是，从这些研究中获得的知识对于开发和测试理论指导的干预措施至关重要，这些干预措施的重点是提供新的战略，以更有效地解决初级保健环境中的幸存者护理问题。

DESCRIPTION (provided by applicant): The overall goal of this career development application is to enable Dr. Hudson to become an independent researcher in cancer survivorship and primary care research. The numbers of cancer survivors are rapidly increasing. Breast and prostate cancer survival exceeds 75%. More than half of individuals already diagnosed with cancer are expected to survive for more than 5 years. Primary care providers are seen for one out of three cancer care office visits. Primary care foci of care coordination and continuity are necessary for achieving better survivor care. However, research on primary care providers' impact on survivor outcomes is fairly underdeveloped. Two new studies suggest that survivors who see both oncologists and primary care physicians are more likely to receive recommended follow-up care than patients who see one or the other. However, there is no research that examines how patients think about these options for care, their decision making processes or the impact of these factors on receiving follow-up care. Using a combination of interviewing and survey research methodologies, the proposed studies build on each other to (1) explore early stage breast and prostate cancer survivors' attitudes toward primary care for follow-up cancer screening and (2) develop and validate a survey instrument to be implemented in a study that describes primary care usage and assesses cognitive-affective, patient support and demographic factors that affect how survivors use specialists and primary care physicians for follow-up care. The training plan proposed supports this research by providing necessary advanced mentoring and coursework in health psychology, risk perception, decision making, cancer biology and epidemiology. This will enable the PI to effectively conduct the proposed studies and provide a strong, evidence based foundation for later development of a testable intervention that helps survivors more effectively work with primary care providers around their follow-up cancer care. This program of training and research will be critical to identifying common and important quality of life problems faced by survivors and identifying mechanisms and risk factors underlying these problems. Most importantly, the knowledge gained from these studies is essential for development and testing of theory guided interventions that focus on providing new strategies to more effectively address survivor care in the primary care setting.