Digital Self-Management and Peer Mentoring Intervention to Improve the Transition from Pediatric to Adult Health Care for Childhood Cancer Survivors

项目总结/摘要 儿童癌症需要根据其治疗暴露量进行基于风险的终身随访护理， 包括常规的医疗预约、晚期效应的监测和定期的癌症筛查。不幸的是， 儿童期癌症成年幸存者中不到五分之一获得这种基于风险的后续护理。的过渡 青少年和年轻人（AYA）幸存者的儿科到成人后续护理是一个关键时期，许多人 幸存者失访，特别是AYA幸存者谁确定为西班牙裔或自我效能低， 管理他们的照顾。虽然保健障碍的特点很清楚，但没有有效的干预措施， 帮助改善AYA儿童癌症幸存者的这种过渡。 为了解决这一差距，我们开发了管理您的健康，一个数字化的自我管理和同伴指导 改善生存护理自我管理的干预措施。它由六个1：1虚拟会话组成， 导师，另一个年轻的成年幸存者谁独立管理自己的照顾。每一届会议涉及 讨论一个补充性的基于网络的自我管理教育模块。同伴导师充当 支持性问责代理人，根据共同经验提供专门支持， 与模块的互动。我们初步的两组随机可行性试验表明，幸存者发现， 干预措施很有用，参与度很高，并报告自我管理有了显著改善。每 根据参与者的反馈，我们将基于网络的模块转换为移动的应用程序，以便于访问。目标 该项目的目的是评估管理您的健康（应用程序+同伴指导）的有效性， 在一项有300名儿童癌症幸存者的双臂随机试验中， 年龄18-25岁。我们将对那些认为自己是西班牙裔的AYA幸存者进行过度抽样， 疗效及随访观察。参与者将在基线、3个月、 和随机化后12个月，在12个月时提取用于指南一致性治疗的病历。 具体目标将评估干预对自我管理行为、生活质量和 遵循指南一致的后续护理，以及治疗效果的中介者和调节者。 拟议的研究与特别关注的通知“导航儿科， 成人保健：迷失在翻译中”，并寻求解决儿童长期保健方面的差距 癌症幸存者通过评估一种创新的基于理论的干预措施，以促进从儿科 to adult成人self-management自我管理of care护理.

Project Summary/Abstract Childhood cancers require lifelong risk-based follow-up care tailored to their treatment exposures, including routine medical appointments, monitoring for late effects, and regular cancer screenings. Unfortunately, less than 1 in 5 adult survivors of childhood cancer obtain such risk-based follow-up care. The transition from pediatric to adult follow-up care for adolescent and young adult (AYA) survivors is a critical period when many survivors are lost to follow-up, particularly AYA survivors who identify as Hispanic or have low self-efficacy to manage their care. While the barriers to care are well-characterized, there are no efficacious interventions to help improve this transition for AYA survivors of childhood cancer. To address this gap, we developed Managing Your Health, a digital self-management and peer mentoring intervention to improve survivorship care self-management. It consists of six 1:1 virtual sessions with a peer mentor, another young adult survivor who independently manages their own care. Each session involves discussion of a complementary web-based self-management educational module. Peer mentors act as supportive accountability agents, providing specialized support based on shared experience and facilitating engagement with the modules. Our preliminary two-arm randomized feasibility trial showed that survivors found the intervention useful, were highly engaged, and reported significant improvements in self-management. Per participant feedback, we translated the web-based modules into a mobile app for easier accessibility. The goal of this project is to evaluate the efficacy of Managing Your Health (app + peer mentoring) compared with educational control in a two-arm randomized trial with 300 young adult survivors of childhood cancer currently aged 18-25 years. We will oversample for AYA survivors who identify as Hispanic given evidence of low self- efficacy and follow-up care in this group. Participants will complete outcome measures at baseline, 3 months, and 12 months post-randomization, with medical record abstraction for guideline-concordant care at 12 months. Specific aims will evaluate the efficacy of the intervention on self-management behaviors, quality of life, and adherence to guideline-concordant follow-up care, as well as mediators and moderators of treatment effects. The proposed research aligns with priorities detailed in the notice of special interest “Navigating Pediatric to Adult Health Care: Lost in Translation,” and seeks to address gaps in the long-term health care of childhood cancer survivors by evaluating an innovative theory-based intervention to facilitate the transition from pediatric to adult self-management of care.