Peer Coaching for Physical Activity Promotion among Breast Cancer Survivors: Adapting an Efficacious Intervention to Prepare for Implementation

促进癌症幸存者身体活动的干预措施改善了他们的功能，减少了疲劳， 在癌症康复和降低未来癌症风险方面提供其他益处。有必要采取干预措施 可以在比研究环境更广泛的范围内实施。我们为期12周的理论练习 研究人员通过电话进行的干预在改善健康方面是有效的， 增加乳腺癌、结直肠癌和子宫内膜癌患者的中度至剧烈体力活动（MVPA） 幸存者为了扩大干预的范围，我们在美国癌症协会的范围内培训了同伴教练 恢复计划提供相同的MVPA干预称为共同前进（MFT），以其他 乳腺癌幸存者在一项随机对照试验中，MFT显著增加MVPA， 这些幸存者的社会心理福利（平托，Stein & Dunsiger，2015）。现在，我们的目标是为更广泛的 通过自动化关键的资源密集型组件（如将幸存者与 通过使用基于网络的同行指导平台进行辅导，并收集关键指标，为大规模培训做好准备。 实施. InquistHealth的网络平台（Mentor 1 to 1 ™）已被证明是有效的同行 对慢性病管理的指导（例如，糖尿病）。我们将与InquisitHealth合作， 网络平台MFT。其目的是简化干预交付，确保保真度和提高幸存者 成果。这项为期4年的R 01申请将分为两个阶段：在第一阶段，我们将与6名同行合作 在之前的工作中已经提供MFT（我们最初的基于证据的MVPA干预）的教练。 使用迭代的以用户为中心的设计原则，我们将修改MFT的Web平台，创建webMFT。在 第二阶段，我们将进行一项随机对照试验，其中10-12名同伴教练将向56名 乳腺癌幸存者将随机接受webMFT或MVPA跟踪。我们将招募 并从三个癌症护理组织中通过同伴指导项目培训MFT新手教练。我们将 从教练那里收集webMFT的可行性和可接受性数据。我们将研究幸存者的结果 （客观测量MVPA和自我报告的疲劳，生活质量，身体功能和情绪）， 混合效应回归模型，以比较12周时的组。我们将获得幸存者的反馈， 使用WebMFT的经验基于RE-AIM框架和PRISM，我们将收集以下数据： 通过进行关键的多层次利益攸关方访谈，在组织一级制定执行指数。 使用更新的技术来增强干预交付、项目管理和自动化数据 收集具有促进有限的组织有效实施的令人兴奋的承诺 资源将基于证据的MFT调整到定制的网络平台并在多个级别收集数据 （教练，幸存者和组织）沿着成本将为强大的多站点提供坚实的基础 在更多的乳腺癌幸存者中增加MVPA（及其益处）。

Interventions promoting physical activity among cancer survivors improve their functioning, reduce fatigue and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider-scale than in research settings. Our 12-week theory-based exercise intervention that was delivered by research staff by telephone was efficacious in improving fitness, and increasing moderate-to-vigorous physical activity (MVPA) among breast, colorectal and endometrial cancer survivors. To widen the intervention’s reach, we trained peer coaches in the American Cancer Society’s Reach to Recovery program to deliver the same MVPA intervention called Moving Forward Together (MFT) to other breast cancer survivors. In a randomized controlled trial, MFT significantly increased MVPA and provided psychosocial benefits for these survivors (Pinto, Stein & Dunsiger, 2015). Now, our goal is to prepare for wider implementation of MFT by automating key resource-intensive components such as matching survivors with a coach by using a web-based peer mentoring platform and to collect key indices to prepare for large scale implementation. InquistHealth’s web platform (Mentor1to1™) has demonstrated to be effective in peer mentoring for chronic disease management (e.g., diabetes). We will partner with InquisitHealth to adapt their web platform for MFT. The aim is to streamline intervention delivery, assure fidelity and improve survivor outcomes. There will be two phases in this 4-year R01 application: in Phase 1, we will work with 6 peer coaches who have already delivered MFT (our original evidence-based MVPA intervention) in prior work. Using iterative user-centered design principles, we will modify the web platform for MFT, creating webMFT. In Phase 2, we will conduct a randomized controlled trial in which 10-12 peer coaches will deliver webMFT to 56 breast cancer survivors who will be randomized to receive either webMFT or MVPA Tracking. We will recruit and train coaches naïve to MFT from three cancer care organizations with peer mentoring programs. We will collect feasibility and acceptability data about webMFT from the coaches. We will examine survivor outcomes (objectively measured MVPA and self-reported fatigue, quality of life, physical functioning and mood) by using mixed effects regression models to compare groups at 12 weeks. We will obtain survivors’ feedback on their experience with webMFT. Based on the RE-AIM framework and PRISM, we will collect data on implementation indices at the organizational level by conducting key multi-level stakeholder interviews. Using newer technologies for enhanced intervention delivery, program management and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple-levels (coaches, survivors and organizations) along with costs will provide a strong foundation for a robust multi-site implementation trial to increase MVPA (and its benefits) among many more breast cancer survivors.