Ostomy Telehealth Self-management Training for Cancer Survivors

造口的癌症幸存者，最常见的是直肠癌和膀胱癌，面临着复杂的适应问题。 通常情况下，术后护理不足以让癌症幸存者做好造口自我管理的准备， 行为改变、心理支持或健康生活，这是确保最佳健康相关的必要条件 生活质量(HRQOL)。我们开发了造口护士和同行主导的造口治疗后慢性护理- 基于Ostomy自我管理远程医疗计划(OSMT)。这一计划是一种教育和支持 在小组环境中为癌症幸存者和他们的照顾者/支持人员提供课程。我们 获得了积极的试点可行性结果，但在患者到达 参与计划的集中地点。因此，我们正在利用远程医疗作为一种交付方法来 提高癌症幸存者的参与能力。在这项研究中，我们将针对生活在农村和其他地区的患者 非大都市区。 该提案是对远程医疗提供的自我管理计划进行的一项随机对照研究 与注意力控制条件(ACC)组的干预进行比较。我们预计OSMT科目将有所改善 患者活动性、自我效能、HRQOL和知识，通过：1)自我管理的技术处理 挫折、疲劳、疼痛、孤立、装备、社交场合；2)克服适当锻炼的障碍； 3)沟通技巧；4)营养、菜单策划、用餐时间安排。此外，我们希望显示成本效益，以 该计划，以及社区报销的证据。 目标1：使用我们增强的远程医疗技术，确定患者的激活度(PA)、自我效能、造口- 与OSMT和注意力控制相比，相关知识和HRQOL随着时间的推移而得到改善和保持 农村人口中的条件(ACC)群体。 目标2：确定远程医疗服务的第三方报销是否与 用于面对面访问，并足以支持我们在农村地区的OSMT干预。

Cancer survivors with ostomies, most commonly rectal and bladder cancers, face complex adjustment issues. Typically, post-operative care does not adequately prepare cancer survivors for ostomy self-management, behavior change, psychological support or healthy living, which is requisite to assure optimal Health-Related Quality of Life (HRQOL). We developed an ostomy nurse and peer ostomate-led post-treatment chronic care- based Ostomy Self-Management Telehealth program (OSMT). This program is an education and support curriculum delivered in the group setting for both cancer survivors and their caregiver/support person. We received positive pilot feasibility results, but encountered major access barriers in patients getting to a centralized location to participate in the program. Therefore, we are utilizing telehealth as a delivery method to improve cancer survivor ability to participate. For this study, we will target patients living in rural and other nonmetro areas. The proposal is a randomized controlled study of our self-management program delivered by telehealth intervention compared to an Attention Control Condition (ACC) group. We expect OSMT subjects will improve patient activation, self-efficacy, HRQOL and knowledge via: 1) techniques for self-management to handle frustration, fatigue, pain, isolation, equipment, social situations; 2) overcoming barriers to appropriate exercise; 3) communication skills; 4) nutrition, menu planning, meal timing. In addition, we hope to show a cost benefit to the program, and evidence of reimbursement in the community. Aim 1: Using our enhanced telehealth techniques, determine if patient activation (PA), self-efficacy, ostomy- related knowledge, and HRQOL are improved and sustained over time, comparing OSMT and attention control condition (ACC) groups in rural populations. Aim 2: Determine whether third-party reimbursement for telehealth care encounters are comparable to those for in-person visits and adequate for supporting our OSMT intervention in rural areas.