Developing and Piloting a Patient Navigation Program for Breast Cancer Survivors

描述(申请人提供)：尽管抗荷尔蒙药物、监视乳房X光检查和体检可以挽救生命，但许多乳腺癌幸存者并不遵守这些建议，由于癌症及其治疗的不利影响，他们的身体生活质量下降。研究还表明，与高加索妇女和社会经济地位较高的妇女相比，一些种族和少数民族妇女以及社会经济地位较低的妇女(以下称为服务不足)在乳腺癌治疗后获得最佳保健的可能性较小。患者导航是一种以障碍为重点的干预措施，旨在减少医疗保健差距，在提高对乳腺癌筛查和诊断服务的依从性方面已显示出一定程度的有效性。目前尚无研究集中于癌症存活期患者导航干预措施的开发和评估。因此，拟议项目的目标是开发和试行一项与文化相关的患者导航计划，重点是服务不足的乳腺癌幸存者开出的抗激素药物。预计护士患者导航干预可以改善激素受体阳性乳腺癌幸存者在完成手术、化疗和放射治疗后获得和坚持乳腺癌生存护理的机会和生活质量。拟议的项目将分两个阶段进行。在第一阶段，将利用现有的两个患者导航程序的结构，结合从通过深入访谈收集的定性数据获得的信息，开发患者导航干预。在第二阶段，患者导航干预将进行试点测试，以评估其可行性和潜力，通过将其与接受常规医疗护理以及国家癌症研究所题为《面向未来：癌症治疗后的生活》的小册子进行比较，评估其在改善未得到充分服务的乳腺癌幸存者遵守生存护理建议和生活质量方面的可行性和潜力。激素受体阳性的乳腺癌幸存者被随机分配到患者导航仪，将在8个月内接受患者导航员的服务。依从性和生活质量结果将在4个月和8个月的随访中进行评估。这项研究的具体目的是(1)评估服务不足的乳腺癌幸存者获得生存护理的促进因素(资源)和障碍；(2)利用定性研究的结果，开发患者导航干预措施，旨在改善服务不足的激素受体阳性乳腺癌幸存者对生存护理的坚持和生活质量；(3)通过评估患者导航干预措施对激素受体阳性乳腺癌幸存者坚持生存护理的坚持和生活质量的影响，对患者导航干预措施进行试点测试。拟议项目的实施与这一研究的长期目标是一致的：开发、评估和传播文化、识字和语言相关的干预措施，以提高服务不足的乳腺癌幸存者的生活质量和坚持推荐的医疗保健。

DESCRIPTION (provided by applicant): Despite life-saving benefits of anti-hormonal medications, surveillance mammography, and physical exams, many breast cancer survivors do not adhere to these recommendations and experience decreased physical quality of life due to the adverse effects of cancer and its treatment. Research also indicates that some racial and ethnic minority women and women of low socioeconomic status (hereafter described as underserved), are less likely to get optimal health care following treatment for breast cancer than Caucasian women and women of higher socioeconomic status. Patient navigation, a barrier-focused intervention designed to reduce health care disparities, has demonstrated some degree of efficacy in improving adherence to breast cancer screening and diagnostic services. No known research has focused on development and evaluation of patient navigation interventions during the cancer survivorship period. Therefore, the objectives of the proposed project are to develop and pilot test a culturally relevant patient navigation program focused on underserved breast cancer survivors prescribed anti-hormonal medications. It is expected that a nurse patient navigation intervention can improve access and adherence to breast cancer survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors who have completed surgery, chemotherapy, and radiation. The proposed project will be conducted in two phases. In Phase I, a patient navigation intervention will be developed using the structure of two existing patient navigation programs combined with information obtained from qualitative data collected through in-depth interviews. In Phase II, the patient navigation intervention will be pilot-tested to evaluate its feasibility and potential in improving adherence to survivorship care recommendations and quality of life for underserved breast cancer survivors by comparing it to receipt of usual medical care plus the National Cancer Institute's booklet entitled Facing Forward: Life After Cancer Treatment. Hormone receptor positive breast cancer survivors randomized to patient navigation will receive the services of a patient navigator for 8 months. Adherence and quality of life outcomes will be evaluated at 4 and 8 month follow ups. The specific aims of the study are to (1) evaluate underserved breast cancer survivors' facilitating factors (resources) and barriers related to obtaining survivorship care; and (2) develop a patient navigation intervention, infused with the results of qualitative research, designed to improve adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors; and (3) conduct a pilot test of the patient navigation intervention by evaluating its effect on adherence to survivorship care and quality of life in underserved hormone receptor positive breast cancer survivors. The implementation of the proposed project is consistent with the long-term objective of this line of research: to develop, evaluate, and disseminate culturally, literacy, and linguistically relevant interventions to improve quality of life and adherence to recommended health care in underserved breast cancer survivors.