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Optimizing the Delivery of Diabetes Management During Breast Cancer Care

优化乳腺癌护理期间糖尿病管理的实施

基本信息

批准号：
10262938
负责人：
Laura C Pinheiro
金额：
$ 17.23万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10262938
关键词：
2,4-Dinitrophenol Active Learning Acute Affect Attention Award Breast Breast Cancer Patient Breast Cancer Treatment Cancer Patient Caring Chemotherapy-Oncologic Procedure Chronic Disease Clinical Cluster randomized trial Development Plans Diabetes Mellitus Doctor of Philosophy Endocrinologist Ensure Evaluation Face Feeling Future Goals Grant Health Health Services High Prevalence Individual Internist Intervention Malignant Neoplasms Medicine Mentors Mentorship Modeling Non-Insulin-Dependent Diabetes Mellitus Nonmetastatic Nurse Practitioners Oncologist Oncology Oncology Nurse Outcome Patient Care Patient-Focused Outcomes Patients Phase Pilot Projects Primary Health Care Primary Nursing Care Provider Qualitative Research Reading Reporting Research Research Methodology Research Personnel Risk Scientific Inquiry Scientist Site Testing Training Uncertainty United States Dept. of Health and Human Services Woman Work Writing aggressive breast cancer blood glucose regulation cancer care cancer diagnosis cancer health disparity cancer therapy care outcomes care providers career development chemotherapeutic agent chemotherapy comorbidity design diabetes management effectiveness testing ethnic minority population glycemic control health care delivery health disparity health equity health training high risk implementation outcomes implementation science implementation trial improved improved outcome innovation interest malignant breast neoplasm mortality risk multidisciplinary non-diabetic racial and ethnic racial and ethnic disparities randomized trial skills success therapy design

项目摘要

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.

项目总结