Targeting the Teachable Moment: A Lifestyle Intervention for Breast Cancer Surviv

描述(申请人提供)：乳腺癌(BCA)是美国女性最常见的癌症。虽然大多数女性的寿命远远超过了癌症，但她们仍然面临着复发、二次原发癌症和许多其他疾病的高风险。饮食和锻炼的生活方式因素以及体重/成分的相关因素是BCA幸存者复发和死亡的重要决定因素，但大多数BCA幸存者没有达到推荐的健康饮食和锻炼水平。BCA的情感影响可能会通过增强改变健康生活方式的动机，为积极的改变创造一个潜在的“可教的时刻”，但似乎需要帮助大多数幸存者在癌症后改变或保持健康的生活方式。因此，促进健康生活方式改变的有效干预措施对于改善BCA幸存者的健康至关重要。最近关于改善BCA健康行为的干预研究表明，它们是有效的，但相当耗费时间和资源。此外，干预措施没有纳入癌症存活率的具体心理社会问题。这项研究将测试对BCA幸存者的第一次干预，这种干预明确地利用诊断后的“可教时刻”为健康饮食和运动行为改变提供动力。目标是确定在BCA治疗后的可教时刻，幸存者的担忧和心理社会因素可以在多大程度上通过有针对性的干预来引导，以促进适应性饮食和体力活动的改变。为此，我们开发了基于社会认知理论的定向可教时刻干预(TTMI)，重点关注生活方式改变的问题，解决BCA幸存者特有的促进者和障碍，并将生存问题转化为做出和保持积极生活改变的动机。试点数据表明，这是一种高度可接受且潜在有效的干预措施。这项拟议的研究是对195名最近完成初级治疗的BCA幸存者进行的随机临床试验。所有的学习交流将以邮件为基础。结果包括饮食(水果/蔬菜和脂肪摄入)、运动和BMI在干预结束(4个月)和随访(3个月后)的变化。这项研究的主要目的是测试新的干预措施(TTMI)与标准治疗方案(SLM和UC)在促进适应性生活方式改变方面的有效性，特别是在可教的时刻针对BCA幸存者，促进资源和应对技能，使女性能够在饮食、锻炼和体重管理方面做出积极改变。第二个目标是确定心理社会机制(即自我效能、意义、积极情感、应对技能、社会支持)在多大程度上中介和适度的干预效果，并检查随时间和跨群体改变的动机。 公共卫生相关性：鉴于乳腺癌幸存者的数量巨大且不断增加(美国已超过200万人)，以及他们对后续疾病的易感性增加，迫切需要有效的生活方式干预。这项研究的目的是检查生活方式干预的有效性是否通过明确关注生存问题而得到增强，这可能对为这一人群设计未来的干预措施具有重要意义。有效的生活方式改变干预措施不仅有望提高乳腺癌幸存者的心理健康和生活质量，而且还能提高他们的发病率和死亡率，从而对公共卫生产生重大的积极影响。

DESCRIPTION (provided by applicant): Breast cancer (BCa) is the most common cancer among US women. While most women live well beyond their cancer, they remain at heightened risk for recurrence, second primary cancers and many other diseases. Lifestyle factors of diet and exercise as well as the related factor of body weight/composition are strong determinants of recurrence and mortality in BCa survivors, yet most BCa survivors do not meet recommended levels of healthy diet and exercise. The emotional impact of BCa may create a potential "teachable moment" for positive change by heightening motivation for making healthy lifestyle changes, but assistance appears to be needed for most survivors to make or maintain healthy lifestyle changes following cancer. Thus, effective interventions for facilitating healthy lifestyle changes are critical for improving the health of BCa survivors. Recent research on interventions to improve BCa health behaviors has shown them to be effective but quite time and resource intensive. In addition, interventions have not incorporated the specific psychosocial issues of cancer survivorship. This study will test the first intervention for BCa survivors that explicitly capitalize on the "teachable moment" following diagnosis to provide motivation for healthy eating and exercise behavior change. The objective is to determine the extent to which, in the teachable moment following BCa treatment, survivor concerns and psychosocial factors can be channeled through a targeted intervention to facilitate adaptive diet and physical activity change. To this end, we developed the Targeted Teachable Moment Intervention (TTMI), based on social-cognitive theory, focusing on lifestyle changes issues, addressing facilitators and barriers specific to BCa survivors and channeling survivorship issues into motivation to make and maintain positive life changes. Pilot data suggest that this is a highly acceptable and potentially effective intervention. The proposed study is a randomized clinical trial of 195 BCa survivors who recently completed primary treatment. All study communications will be mail-based. Outcomes include changes in diet (fruit/vegetable and fat intake), exercise, and BMI at the end of the intervention (4 months) and follow-up (3 months later). The primary aim of the study is to test the effectiveness of the new intervention (TTMI) vis-`-vis standard treatment options (SLM and UC) in promoting adaptive lifestyle change specifically targeting BCa survivors at a teachable moment, facilitating resources and coping skills that enable the women to make positive changes in diet, exercise, and weight management. Secondary aims are to determine the extent to which psychosocial mechanisms (i.e., self-efficacy, meaning, positive affect, coping skills, social support) mediate and moderate intervention effects and to examine the motivation to change over time and across groups. PUBLIC HEALTH RELEVANCE: Given the large and increasing numbers of breast cancer survivors (already over 2 million in the US) and their heightened vulnerability to subsequent illness, effective lifestyle intervention is urgently needed. The goal of the present study, to examine whether effectiveness of a lifestyle intervention is enhanced by explicitly focusing on survivorship issues, could have important implications for the design of future interventions for this population. Effective lifestyle change interventions hold the promise for increasing not only the psychological wellbeing and quality of life of breast cancer survivors but also their morbidity and mortality, thus making a significant positive impact on public health.