Survivorship Care Planning and Communication for Rural Breast Cancer Survivors

描述(由申请人提供)：医学研究所和其他机构强烈建议退出积极治疗的幸存者接受一项全面的生存护理计划，该计划涉及监测、后遗症、心理社会需求和一般健康维持，并指明哪些提供者将处理该计划的哪些部分。尽管有这一建议，生存护理计划和沟通往往是不充分的，使幸存者对他们的护理感到困惑和不确定。此外，对与通信有关的生存护理障碍知之甚少，这可能是居住在农村的幸存者特别关注的问题，他们往往住在离他们的肿瘤学专家(S)有一段距离的地方，获得初级保健的机会有限。为了减少混乱和不确定性，并避免医疗工作的重复，我们设想了一个正式的规划和沟通过程，将患者的偏好与多个提供者的建议相结合，以生成一个全面的生存护理计划。[我们认为，这一过程的有效实施需要以临床为导向的个人，如护士、护士从业者、医生助理或医生，以促进和协调幸存者与他们的初级保健和肿瘤学专业提供者之间的沟通。]我们的目标是提供所需的信息，以创建和评估专门为满足农村幸存者的需要而设计的进程，同时也满足郊区和城市幸存者的需要。因此，我们的目标是：(1)描述乳腺癌幸存者对生存护理计划和沟通的知识、感知的重要性和障碍；(2)评估幸存者当前和优先与肿瘤专家和初级保健提供者就其生存护理计划进行沟通的情况；(3)探索当前幸存者和提供者之间的关系以及与幸存者的癌症相关不确定性和生活质量的沟通。所有数据将通过调查收集，主要依赖于从以前经过验证的工具中提取的问题，并通过硬拷贝邮件、在线或电话采访进行管理。我们的分析方法将包括描述性统计、相关性和回归建模。这一建议和由此产生的生存护理计划和沟通的临床模型的可测试干预将极大地促进我们对癌症生存护理的理解，特别是对居住在农村的乳腺癌幸存者。 与公共卫生相关：专家建议，通过制定和传达生存护理计划，缓解从积极治疗到癌症生存护理的往往困难的过渡。我们的研究将收集居住在农村、郊区和城市的癌症幸存者在生存护理规划和沟通方面的需求和偏好的信息。这些信息将帮助我们设计和评估专门为满足居住在农村的幸存者的需要而设计的护理规划进程，同时也满足居住在郊区和城市的幸存者的需要。

DESCRIPTION (provided by applicant): The Institute of Medicine and others have strongly recommended survivors exiting active treatment receive a comprehensive survivorship care plan addressing surveillance, late effects symptoms, psychosocial needs, and general health maintenance, as well as indicating which providers will handle which components of the plan. Despite this recommendation, survivorship care planning and communication are often inadequate, leaving survivors confused and uncertain about their care. In addition, little is known about communication- related barriers to survivorship care, which may be of particular concern for rural-residing survivors who often live at some distance from their oncology specialist(s) and have limited primary care access. To reduce confusion and uncertainty, and to avoid duplication of medical effort, we envision a formal planning and communication process that integrates patient preferences with recommendations from multiple providers to generate a comprehensive survivorship care plan. [We believe effective implementation of this process requires a clinically-oriented individual like a nurse, nurse practitioner, physician assistant, or physician to facilitate and coordinate communications between survivors and their primary care and oncology specialty providers.] Our goal is to generate information needed to create and evaluate a process designed specifically to accommodate the needs of rural-residing survivors while also meeting the needs of suburban and urban survivors. Thus we aim to: (1) describe breast cancer survivors' knowledge about, perceived importance of, and barriers to survivorship care planning and communication; (2) assess survivors' current and preferred communication with oncology specialists and primary care providers about their survivorship care plans; and (3) explore the relationship between current survivor and provider survivorship care planning and communication with survivors' cancer-related uncertainty and quality of life. All data will be collected via a survey relying heavily on questions drawn from previously validated instruments and administered via hard copy mail, on-line or telephone interview. Our analytic approach will include descriptive statistics, correlation, and regression modeling. Both this proposal and the resulting testable intervention of a clinical model of survivorship care planning and communication will substantially advance our understanding of cancer survivorship care, particularly for rural-residing breast cancer survivors. PUBLIC HEALTH RELEVANCE: Experts have recommended that the often difficult transition from active treatment to cancer survivorship care be eased by preparation and communication of a survivorship care plan. Our study will gather information about rural-, suburban- and urban-residing cancer survivors' needs and preferences for survivorship care planning and communication. This information will help us design and evaluate a care planning process designed specifically to accommodate the needs of rural-residing survivors while also meeting the needs of suburban- and urban-residing survivors.