The Development and Evaluation of a Community-Based, Early Palliative Care Intervention for Black Women with Metastatic Breast Cancer

项目摘要/摘要 研究：晚期癌症患者的早期姑息治疗(PC)是一个研究不足的健康领域 公平。患有转移性乳腺癌(MBC)比例失调的黑人女性患有心理和 在这种严重的情况下生活对身体的影响。本研究的目的是开发和评估一种 社区参与、业馀导航员(LN)主导的早期个人电脑干预(Accept-PC)，针对遇险和 患有MBC的黑人女性的症状负担。具体目标是：1)组织焦点小组评估 早期个人计算机需求和首选内容、格式以及LN主导的基于社区的个人计算机干预；2) 反复开发和改进Accept-PC干预；3)进行试点随机对照试验 Accept-PC的(RCT)，以确定可行性，包括初步影响，为完全动力的 审判。为了实现这些目标，我们将采用循序渐进的嵌入、混合的方法，社区参与 设计。来自与患者和利益相关者的焦点小组的定性结果将指导 Accept-PC，将使用认知访谈进行迭代改进，并评估其可行性和 在试点RCT中的初步影响。应聘者：这个应用程序的主要目标是支持Melissa博士 Mazor的职业发展从一名指导研究员发展到一名独立的护士-调查员，专注于 改善未得到充分服务的晚期癌症妇女在个人电脑方面的差距。这个K08奖将为她提供 以下四个领域的高级培训：1)个人电脑干预开发；2)健康差距研究；3) 临床试验设计、领导和评估；以及4)R01授权撰写、领导和专业 发展。为了实现这些目标，她组建了一个多学科的指导团队。林博士，她 初级导师，是一位专注于乳腺癌自我管理的有成就的临床医生和调查员。Dr。 维斯尼夫斯基是她的联合小学导师，是一名差异卫生服务研究员，接受过正规的 生物统计学。史密斯博士是一位接受过个人电脑培训的肿瘤学家，他将提供社区参与研究和 个人电脑差异的社会决定因素。她的科学顾问包括卫生服务机构的戈尔茨坦博士 社区个人电脑领域的研究员和Dionne-Odon博士，一名护士研究员，将提供 癌症患者LN指导和临床试验方面的高级培训。环境：伊坎学派 西奈山的医学有着杰出的研究传统，是排名前20位的医学 美国国立卫生研究院资助的学校。普通内科是美国内科最大的内科。 并拥有完善的研究部门和卓越的研究基础设施。The Tisch 癌症研究所是美国国家癌症研究所指定的癌症中心，拥有完善的研究，并为 整个纽约市的不同患者群体。布鲁克代尔老年医学部 姑息医学是领先的姑息治疗机构之一，拥有无与伦比的研究支持。

PROJECT SUMMARY/ABSTRACT Research: Early palliative care (PC) for patients with advanced cancer is an understudied area of health equity. Black women with metastatic breast cancer (MBC) disproportionality suffer from the psychological and physical impacts of living with this serious condition. The purpose of this study is to develop and evaluate a community-engaged, lay-navigator (LN) led, early PC intervention (‘ACCEPT-PC’) that targets distress and symptom burden in Black women with MBC. The specific aims are to: 1) Conduct focus groups to assess the early PC needs and preferred content, format, and delivery of a LN led community-based PC intervention; 2) Iteratively develop and refine the ACCEPT-PC intervention; 3) Conduct a pilot randomized controlled trial (RCT) of ACCEPT-PC to determine feasibility, including preliminary impact, in preparation for a fully powered trial. To accomplish these aims, we will employ a sequential embedded, mixed method, community-engaged design. Qualitative findings from focus groups with patients and stakeholders will guide the development of ACCEPT-PC, which will be iteratively refined using cognitive interviews, and evaluated for feasibility and preliminary impact in a pilot RCT. Candidate: The primary objective of this application is to support Dr. Melissa Mazor’s career development from a mentored researcher to an independent nurse-investigator focused on improving disparities in PC for underserved women with advanced cancer. This K08 award will provide her with advanced training in the following four areas: 1) PC intervention development; 2) health disparities research; 3) clinical trial design, leadership and evaluation; and 4) R01 grant writing, leadership, and professional development. To achieve these goals, she has assembled a multidisciplinary mentoring team. Dr. Lin, her primary mentor, is an accomplished clinician-investigator focused on breast cancer self-management. Dr. Wisnivesky, her co-primary mentor, is a disparities health services researcher with formal training in biostatistics. Dr. Smith, an oncologist trained in PC, will provide expertise in community-engaged research and social determinants of PC disparities. Her scientific advisors include Dr. Goldstein, a health services researcher in the area of community-based PC and Dr. Dionne-Odom, a nurse researcher who will provide advanced training in LN coaching for cancer patients and clinical trials. Environment: The Icahn School of Medicine at Mount Sinai has a strong tradition of outstanding research and is one of the top 20 medical schools in NIH funding. The Division of General Internal Medicine is the largest division in the Department of Medicine and has a well-established section of research and exceptional research infrastructure. The Tisch Cancer Institute is an NCI-designated cancer center with well-established research and serves a large population of diverse patients throughout New York City. The Brookdale Department of Geriatrics and Palliative Medicine is one of the leading palliative care institutions with unparalleled research support.