Mapping Breast Cancer Survivorship and the Survivor Institutional Interface

 描述（由申请人提供）：目前美国有超过250万乳腺癌幸存者。癌症生存率的主导范式集中在疾病的生物医学模型（机构视角）或心理社会措施（个人视角）上，但忽略了个人和机构之间的复杂相互作用（例如，卫生保健设施、工作场所），共同促进生存结果。迫切需要新的生存护理模式来适应老龄化人口不断变化的医疗保健需求，乳腺癌幸存者数量及其预期寿命的预期增加，以及医疗服务不足地区的医疗保健差异，这些地区受到医生和专家短缺的不成比例影响。拟议的跨学科研究相结合的理论框架，社会生态学与定性研究方法，调查乳腺癌的生存作为一个international过程之间的具体经验和制度的做法，在加州的内陆帝国，一个地区包括滨江和圣贝纳迪诺县。这项研究将对针对个人、机构和社区层面变化的医疗保健和政策干预措施的设计产生重大影响。 目的1：调查乳腺癌生存率的个体经验。采用纵向设计，将每年对内陆帝国乳腺癌幸存者进行一次深入的半结构化开放式访谈。招募将促进与内陆帝国乳腺癌组织的合作：粉红丝带的地方，米歇尔的地方，和南加州证人项目。 目标2：调查机构资源及其在定义生存护理中的作用。幸存者资源包括广泛的服务（即，运输援助，假肢安装）延伸到生存医疗护理之外，但却是生存医疗护理的组成部分。内陆帝国的机构资源将进行调查，一个特定的生存计划及其机构记录的深入案例研究。 目标3：绘制幸存者-机构界面图。利用目标1和2中收集的视觉和文本数据，映射允许对内陆帝国幸存者和机构在需求，资源和资源使用方面的观点之间的汇合点和分歧进行定性分析。 培训计划：申请人渴望成为一名独立的癌症生存研究人员。由癌症生存，社会生态学和组织研究的跨学科团队指导有助于实现这一目标。个性化的培训计划包括正式课程;应用技能培训;与赞助商和顾问的单独会议;每月小组辅导，师生阅读小组会议和妇女癌症治疗ConneXion疾病导向小组会议;参加组织研究中心的活动和一年一度的Chao Family Comprehensive Cancer Center科学务虚会，以及国家会议，如NCI两年一度的生存研究会议。

 DESCRIPTION (provided by applicant): There are currently over 2.5 million breast cancer survivors in the US. Dominant paradigms for cancer survivorship focus either on biomedical models of disease (institutional perspective) or psychosocial measures (individual perspective) but ignore the complex interactions between individuals and institutions (e.g., health care facilities, workplaces) that jointly contribute to survivorship outcomes. New models of survivorship care are urgently required to accommodate the changing healthcare needs of an aging population, anticipated in- creases in both the number of breast cancer survivors and their life expectancies, as well as healthcare dis- parities in medically underserved regions that are disproportionately affected by physician and specialist short- ages. The proposed interdisciplinary research combines the theoretical framework of social ecology with qualitative research methods to investigate breast cancer survivorship as an interactional process between embodied experience and institutional practices in California's Inland Empire, a region comprising Riverside and San Bernardino counties. This research will have significant implications for the design of healthcare and policy interventions that target change at the individual, institutional, and community levels. Aim 1: Investigate individual experiences of breast cancer survivorship. Using a longitudinal de- sign, in-depth semi-structured open-ended interviews will be conducted with Inland Empire breast cancer survivors at yearly intervals. Recruitment will be facilitated by collaborations with Inland Empire breast cancer organizations: The Pink Ribbon Place, Michelle's Place, and the Southern California Witness Project. Aim 2: Investigate institutional resources and their role in defining survivorship care. Survivor- ship resources comprising a broad range of services (i.e., transportation assistance, prosthesis fitting) extend beyond-but are integral to-survivorship medical care. Institutional resources in th Inland Empire will be surveyed, with an in-depth case study of one particular survivorship program and its institutional records. Aim 3: Map the survivor-institutional interface. Employing both visual and textual data collected in aims 1 and 2, mapping allows qualitative analysis of confluences and divergences between Inland Empire survivor and institutional perspectives regarding needs, resources, and resource use. Training program: The applicant aspires to become an independent cancer survivorship researcher. Mentoring by an interdisciplinary team in cancer survivorship, social ecology, and organizational studies con- tributes to accomplishment of this goal. The individualized training plan includes formal coursework; applied skills training; individual meetings with sponsors and advisers; monthly group mentoring, faculty-student reading group meetings, and Women's Cancer Cure ConneXion Disease Oriented Team meetings; participation in the Center for Organizational Research events and the annual Chao Family Comprehensive Cancer Center scientific retreat, as well as national conferences such as the NCI biennial survivorship research conference.