Optimizing the Delivery of Diabetes Management During Breast Cancer Care

项目总结 20%的美国乳腺癌女性也患有糖尿病(DM)，面临的风险高出50% 与患有乳腺癌的非糖尿病妇女相比，癌症确诊后长达10年的死亡率更高。一个可能的 解释说，糖尿病在癌症治疗期间受到的关注较少，因为患者、肿瘤学家和 初级保健提供者(PCP)优先考虑癌症护理，而不是糖尿病管理。肿瘤学家可能会专注于癌症 护理(而不是DM管理)，患者可能在癌症诊断后的一段时间内看不到他们的初级保健医生，以及 在经常影响糖尿病的化疗方案的背景下，PCP可能会感到不舒服 血糖控制。考虑到这些问题，确定能够有效管理DM的提供商可能是一项 有吸引力的解决方案。执业护士(NPs)已成功融入许多肿瘤护理团队 以支持普通癌症护理。另外，NP已被证明成功地管理了各种非 癌症背景。然而，还没有研究确定肿瘤护理团队中的NP是否可以有效 在乳腺癌化疗期间管理DM。我假设一个受过糖尿病护理训练的NP 嵌入到肿瘤学团队中，可以在乳腺癌急性期护理期间有效地管理DM。 这项研究的目标是让利益相关者制定和实施由NP领导的干预措施，以 为因非转移性乳腺癌而接受化疗的妇女管理DM。要做到这一点， 我提出以下研究目标：1)收集患者、非政府组织、肿瘤学家和初级保健医生对以下问题的看法 NP在化疗期间管理DM的障碍和促进者，2)开发NP领导的干预以 在化疗期间管理糖尿病，以及3)进行试点研究，以实施干预和评估 实施成果(可达性、可接受性、适当性、可行性、忠诚度)。这次试行的结果 这项研究将为多地点随机试验测试这种NP领导的模型的有效性奠定基础。 作为一名受过博士培训的卫生服务研究员，专注于癌症结果和健康差距，我获得了 定量研究方面的专长。我现在寻求扩展我的研究技能，以包括实施试验。至 为了实现这一目标，我将在定性研究方法、医疗保健提供、 以及在现实世界环境中由利益相关者参与的干预设计、实施和评估。我会的 由两位全国公认的临床科学家Monika Safford博士和Lisa Kern博士指导。在一起，我们 为我设计了一份职业发展计划，通过课程学习和阅读获得技能，然后巩固这些技能 通过体验式学习来实现我的研究目的。这个奖项将使我能够朝着 我的长期目标是成为一名独立的卫生服务研究员，在 癌症护理、初级保健和健康公平，以改善患者结局和减少健康差距。

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.