Risk-stratified self-management care for colorectal cancer survivors: a new approach to increasing adherence to health behavior recommendations

项目总结/摘要 结直肠癌（CRC）的发病率和死亡率与可改变的生活方式因素密切相关，例如，物理 活动、酒精摄入和饮食。重要的是，CRC后坚持健康行为建议（HBR） 诊断改善身体功能，生活质量，并始终与更长的生存期相关。 然而，<10%的CRC幸存者在诊断后坚持健康行为建议（HBR）。 因此，解决CRC幸存者对HBR的低依从性是一项临床相关的未满足需求。低 坚持HBRs源于缺乏关于如何管理复杂健康的个性化指导 行为改变个性化的自我管理培训可以通过教授CRC幸存者 将健康行为建议融入其独特的生活环境所需的技能。非癌 如糖尿病和脊髓损伤，个性化的自我管理培训计划， 与健康行为建议的依从性增加相关， 标准化干预措施。到目前为止，个性化的生活方式自我管理方法还没有被 在癌症人群中进行测试。有强有力的证据表明，诊断后健康的生活方式因素可以改善患者的 结果，CRC是研究自我管理培训对HBR影响的重要人群 阿利克斯斯莱特博士的这项为期五年的指导研究计划旨在研究个性化自我的影响， 关于CRC幸存者摄取高溴联苯醚的管理培训方案。共120例I-III期CRC患者 12个月内确诊的患者将从Cedars-Sinai癌症中心招募，并使用 世界癌症研究基金会/美国癌症研究所（WCRF/AICR）健康 行为依从性量表。将入组WCRF/AICR评分表明HBR依从性低的患者 并随机分为：1）个性化的自我管理干预，重点是健康行为或2） 标准化健康行为教育计划。干预组的每一位患者都将收到 针对他们在WCRF/AIRC量表上HBR依从性较低的独特领域进行定制。我们的初步研究（n=30） 证明了个性化的自我管理训练干预是可行的，可以接受的， 癌症幸存者，并有可能影响遵守HBR。因此，我们期望一个更大的系统 对这种干预的评估将显示HBR依从性的显著和有临床意义的变化。 这项职业发展计划旨在扩展斯莱特博士在行为方面的技能 临床试验，2）生物统计学，和3）实施科学。培训计划包括讲习班和正式的 课程以及来自不同导师网络的指导。与支持性机构一起， 环境，这个指导研究计划将装备博士Sleight所需的技能， 开展针对HBR的个性化自我管理干预的大规模随机对照试验 坚持。

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) incidence and mortality are strongly linked to modifiable lifestyle factors, e.g., physical activity, alcohol intake, and diet. Importantly, adherence to health behavior recommendations (HBR) after CRC diagnosis improves physical function, quality of life, and is consistently associated with longer survival. However, <10% of CRC survivors adhere to health behavior recommendations (HBR) after diagnosis. Addressing low adherence to HBR in CRC survivors is therefore a clinically relevant unmet need. Low adherence to HBRs stems from a dearth of personally-tailored guidance about how to manage complex health behavior change. Personalized self-management training can remedy this issue by teaching CRC survivors the skills required to integrate health behavior recommendations into their unique life contexts. In non-cancer populations such as diabetes and spinal cord injury, personalized self-management training programs have been associated with increased adherence to health behavior recommendations when compared to standardized interventions. To date, a personalized approach to lifestyle self-management has not yet been tested in a cancer population. With strong evidence that post-diagnosis healthy lifestyle factors improve patient outcomes, CRC is an important population in which to study the impact of self-management training on HBR This five-year mentored research program for Dr. Alix Sleight aims to examine the effect of a personalized self- management training program on the uptake of HBRs in CRC survivors. A total of 120 stage I-III CRC patients diagnosed within 12 months will be recruited from the Cedars-Sinai Cancer Center and assessed using the standardized World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Health Behavior Adherence Scale. Patients with a WCRF/AICR score indicating low HBR adherence will be enrolled and randomized to: 1) a personalized self-management intervention with a focus on health behaviors or 2) a standardized health behavior education program. Each patient in the intervention group will receive content tailored to their unique areas of low HBR adherence on the WCRF/AIRC Scale. Our pilot study (n=30) demonstrated that a personalized self-management training intervention is feasible to implement, acceptable to cancer survivors, and has potential to impact adherence to HBR. We therefore expect that a larger systematic assessment of this intervention will show significant and clinically meaningful change in adherence to HBR. The proposed career development program was designed to expand Dr. Sleight’s skillset in 1) behavioral clinical trials, 2) biostatistics, and 3) implementation science. The training plan includes workshops and formal coursework alongside guidance from a network of diverse mentors. Together with a supportive institutional environment, this mentored research program will equip Dr. Sleight with the skills needed to develop and conduct large-scale randomized controlled trials of personalized self-management interventions for HBR adherence.