To enhance breast cancer survivorship of Asian Americans

 尽管很少有关于亚裔美国人乳腺癌幸存者的研究，但众所周知，这些女性承担着不必要的乳腺癌负担，因为他们很少抱怨症状或疼痛，延迟寻求帮助，并且由于他们的文化价值观和信仰以及语言障碍，很少要求或获得支持。这表明这一特定人群确实需要支助。然而，由于缺乏工作人员的时间和保险报销，越来越多的癌症中心制定的生存计划在提供信息和指导/支持方面存在严重障碍。此外，快节奏的临床患者-提供者互动的压力使得卫生保健提供者几乎没有时间根据这些妇女的文化态度为她们提供最新的信息和指导或支持。所有这些情况都需要一种创新和创造性的信息和辅导/支持提供方法。使用计算机和移动的设备（智能手机和平板电脑）的基于技术的方法有望以高度的灵活性和可访问性满足这一需求，并最大限度地降低在忙碌和昂贵的医疗保健环境中的干预成本。此外，不涉及面对面互动的基于技术的干预可能对许多来自乳腺癌仍然是一种耻辱经历的文化的妇女更有效。因此，基于初步研究（PS），研究团队开发并试点测试了一个理论驱动的基于技术的信息和辅导/支持计划，该计划使用多种功能为亚裔美国人乳腺癌幸存者量身定制。拟议的随机干预研究的目的是测试亚裔美国人乳腺癌幸存者（TICAA）基于技术的信息和指导/支持计划在提高女性乳腺癌生存经验方面的有效性。具体目标是：a）确定从基线（测试前）到时间点1（1个月后）和时间点2（3个月后），干预组在主要结局（帮助需求、身心症状和生活质量）方面是否比对照组有显著更大的改善; B）确定基于理论的变量（态度、自我效能、感知障碍和相关的社会影响） 乳腺癌生存率），其介导TICAA对主要结果的干预作用;以及c）确定TICAA对主要结果的影响是否由背景特征和疾病因素调节。拟议的研究将以班杜拉的行为改变理论为指导。本研究采用随机重复测量的前测/后测对照组设计，在330名亚裔美国乳腺癌幸存者。长期目标是：（a）在各种保健环境中实施该方案;（B）确定TICAA是否会导致长期改善健康结果;（c）从根本上加强针对少数族裔乳腺癌幸存者群体的文化定制技术干预措施的方法/范例。

 DESCRIPTION (provided by applicant): To Enhance Breast Cancer Survivorship of Asian Americans Despite few studies on Asian American breast cancer survivors, it is well known that these women shoulder unnecessary burden of breast cancer because they rarely complain about symptoms or pain, delay seeking help, and rarely ask or get support due to their cultural values and beliefs and language barriers. This demonstrates a definite need for support in this specific population. However, survivorship programs that are increasingly instituted at cancer centers have serious impediments to providing information and coaching/support because of the lack of staff time and insurance reimbursement. Furthermore, the pressure of fast-paced clinical patient-provider interactions leaves little time for health care providers to provide up-to-date information and coaching or support for these women based on their cultural attitudes. All these circumstances necessitate an innovative and creative delivery method of information and coaching/support. A technology- based approach using computers and mobile devices (smart phones and tablets) promises to meet this necessity with high flexibility and accessibility, and minimizes the cost of the intervention in busy and costly health care settings. Also, a technology-based intervention that does not involve face-to-face interactions could work better for many women from cultures where breast cancer is still a stigmatizing experience. Therefore, based on Preliminary Studies (PSs), the research team has developed and pilot-tested a theory-driven technology-based information and coaching/support program that is culturally tailored to Asian American breast cancer survivors using multiple features. The purpose of the proposed randomized intervention study is to test the efficacy of the technology-based information and coaching/support program for Asian American breast cancer survivors (TICAA) in enhancing the women's breast cancer survivorship experience. The specific aims are to: a) determine whether the intervention group will show significantly greater improvements than the control group in primary outcomes (needs for help, physical and psychological symptoms, and quality of life) from baseline (pre-test) to Time Points 1 (post 1-month) and 2 (post 3-months); b) identify theory-based variables (attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) that mediate the intervention effects of the TICAA on the primary outcomes; and c) determine whether the effects of the TICAA on the primary outcomes are moderated by background characteristics and disease factors. The proposed study will be guided by the Bandura's Theory of Behavioral Change. This study adopts a randomized repeated measures pretest/posttest control group design in 330 Asian American breast cancer survivors. The long-term goals are to: (a) implement the program into various health care settings; (b) determine if the TICAA will lead to long-term improved health outcomes; and (c) fundamentally enhance the methodology/paradigm of culturally tailored technology-based interventions for ethnic minority groups of breast cancer survivors.