Optimizing Survivorship and Surveillance after Treatment for Colorectal Cancer

简介(申请人提供)：结直肠癌(CRC)是美国最常见的癌症之一，也是癌症死亡的主要原因。非裔美国人(AA)的结直肠癌死亡率显著高于欧洲裔美国人(EA)。治疗后(定义为手术后)监测对于筛查癌症复发和促进生活方式改变以降低复发风险至关重要。然而，大多数幸存者没有接受指南建议的监测。对遵守临床监测指南(即办公室就诊、癌胚抗原(CEA)检测、结肠镜检查)或遵守与生活方式有关的体重、锻炼、饮酒和吸烟监测指南的相关因素知之甚少。这项R21研究的目的是系统地调查多水平因素对结直肠癌幸存者参与以指南为基础的治疗后监测护理的作用。我们将调查个人因素(例如健康状况、知识、态度和人口统计)、提供者(例如医生与患者和专家与初级保健人员之间的沟通)以及实践层面因素(例如卫生保健使用、保险)对幸存者护理经验和结果的作用。在第一阶段，我们将对AA(n=20)和EA幸存者(n=20)治疗后1.5年的焦点小组(FGs)进行和分析，以评估他们的监测护理经验。另外两个FG(1个AAS和1个EAS，每个n=10)将与治疗后2-3个月的幸存者一起进行，以探讨他们对后续护理的期望和经验。我们还将对初级保健和专科医生(n=20)的访谈数据进行处理和分析，以评估与监测相关的做法，并对国家医生调查的修改进行预试。我们将开发幸存者调查和MD调查，系统地检查监测护理的障碍和促进者。在第二阶段，我们将使用认知访谈技术对16名CRC幸存者进行预测调查。然后，我们将评估幸存者调查(n=150名全州幸存者)的心理测量特性，并获得对结果衡量标准的估计，以指导随后的R01。我们将三角和综合研究结果，以开发多层次的干预措施，通过描绘最有可能影响患者、提供者和实践水平的促进者的具体战略，改善从癌症治疗到后续治疗的过渡。我们将使用干预映射方法来制定理论驱动的目标和干预策略和信息。拟议的工作至关重要，而且是及时的，具有科学和临床意义。此外，这项研究将在南卡罗来纳州由国家癌症研究所资助的两个医疗保健地点进行，这两个地点有不同的地理区域，有很大比例的再生障碍性贫血成年人，以及相关的健康差距。研究结果将导致未来的R01试验，在该试验中，将测试这项研究中制定的有针对性的干预策略和信息的理论指导建议，以提高依从性。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the U.S. and is a leading cause of cancer death. African Americans (AAs) have significantly higher CRC mortality rates than European Americans (EAs). Post-treatment (defined as post-surgical) surveillance is critical to screen for cancer recurrence and promote lifestyle changes to reduce risk of recurrence. However, most survivors do not receive guideline-recommended surveillance. Little is known about factors associated with adherence to clinical surveillance guidelines (i.e., office visits, carcionoembryonic antigen (CEA) tests, colonoscopy) or adherence to lifestyle-related surveillance guidelines for weight, exercise, alcohol and tobacco use. The purpose of this R21 study is to systematically investigate the role of multi-level factors on participation of CRC survivors in guideline-based post-treatment surveillance care. We will investigate the role of personal factors (e.g., health status, knowledge, attitudes and demographics), provider (e.g. physician-patient and specialist-primary care communication), and practice level factors (e.g., health care use, insurance) on survivor care experiences and outcomes. In Phase 1, we will conduct and analyze focus groups (FGs) of AA (n=20) and EA survivors (n=20) 1.5 years post-treatment to assess their surveillance care experiences. Two additional FGs (1 with AAs and 1 with EAs, each n=10) will be conducted with survivors who are 2-3 months post- treatment to explore their expectations about, and experiences with, follow-up care. We will also conduct and analyze data from interviews with primary care and specialist MDs (n=20) to assess practices related to surveillance and to pretest modifications to a national physician survey. We will develop a survivor survey and an MD survey to systematically examine barriers and facilitators of surveillance care. In Phase 2, we will use cognitive interviewing techniques with CRC survivors (n=16) to pretest the surveys. We will then evaluate the psychometric properties of the survivor survey (n=150 statewide survivors) and gain estimates of outcome measures to guide a subsequent R01. We will triangulate and synthesize findings to develop multi-level interventions to improve the transition from cancer treatment to follow-up by delineating specific strategies most likely to influence patient, provider and practice level enablers. We will use intervention mapping methods to develop theory-driven objectives and intervention strategies and messages. The proposed work is of vital importance and is timely with scientific and clinical relevance. Additionally, the study will be conducted at two National Cancer Institute-funded health care sites in SC, which have diverse geographic areas, a large proportion of AA adults and relevant health disparities. The study results will lead to a future R01 trial in which the theoretically guided recommendations for targeted intervention strategies and messages developed in this study will be tested to improve adherence.