The Breast Cancer and the Workforce Communication App: A randomized controlled trial of an English/Spanish intervention to promote long-term job retention

摘要 在与乳腺癌诊断相关的众多压力源中，失业是迄今影响最大的因素之一 未得到充分研究。长期的财务后果可能包括难以支付账单、积累债务以及 破产了。重要的是，癌症幸存者的破产与治疗依从性的降低有关。 并增加了死亡率。有权获得工作住宿的女性，如工作时间灵活性，更多 可能在化疗期间工作，并长期保留他们的工作。同样，女性拥有足够的 病假可以选择休假，同时保持工作稳定。然而，低收入少数族裔的人数较少 很可能有这样的通融，导致更高的失业率和财务困境。为了这些 对于患者来说，找到一种在治疗期间继续工作的方法是至关重要的。在乳腺癌和劳动力市场 这项研究的重点是移民和少数民族妇女、症状负担和缺乏工作住宿 都与失业有关。只有57%的诊断前受雇的低收入女性在确诊后保住了工作 治疗完成率，相比之下，高收入女性的这一比例为93%。在没有工作的人中，84%的人将 缺乏就业到癌症症状或治疗。低收入女性的可能性不到 收入较高的女性拥有通融的雇主，而保住工作的可能性只有四分之一。 然而，随着时间的推移，对要求工作住宿的信心有所改善的患者超过 保住工作的可能性是那些信心没有改善的人的五倍。有一个令人信服的 需要有效的干预措施来支持低收入移民和少数民族在治疗期间工作 以提高乳腺癌患者的长期工作保留率和经济稳定性。的目标是 拟议的研究是评估为促进工作而开发的移动应用程序(APP)的有效性 在辅助(治愈性)乳腺癌化疗期间。这款应用有一个双管齐下的方法：它将有所帮助 女性与临床医生沟通以优化症状控制，这将帮助她们与 雇主就住宿事宜进行谈判。我们的研究是基于有证据表明交流行为 可以教授不同英语水平的患者，从而提高对患者的反应能力 需要。此外，患者与医生之间的沟通策略可以在工作环境中使用。 我们的应用程序将这些原则应用到工作场所和诊所。使用应用程序来交付 鉴于我们的目标人群在获得支持和高收入方面面临的障碍，干预是有吸引力的 智能手机使用的普遍性。我们将随机分配说英语和西班牙语的女性 接受I-III期乳腺癌化疗的患者将收到APP或信息手册(对照)。 参与者将在基线和化疗期间完成调查，以评估症状负担和工作 住宿。治疗后4个月、1年和2年的调查将衡量长期工作保留率。

ABSTRACT Of the many stressors associated with a breast cancer diagnosis, job loss is one of the most impactful yet understudied. Long-term financial consequences can include difficulty paying bills, accumulation of debt, and bankruptcy. Importantly, bankruptcy in cancer survivors has been linked to decreased treatment adherence and increased mortality. Women with access to work accommodations, such as schedule flexibility, are more likely to work during chemotherapy and to retain their jobs in the long term. Similarly, women with adequate sick leave may choose to take time off while maintaining job security. However, low-income minorities are less likely to have such accommodations, leading to higher rates of job loss and financial distress. For these patients, finding a way to continue to work during treatment is critical. In the Breast Cancer and the Workforce study, which focuses on immigrant and minority women, symptom burden and lack of work accommodations were both linked to job loss. Only 57% of pre-diagnosis employed low-income women retained their jobs after treatment completion, compared to 93% of higher-income women. Of those not working, 84% attributed their lack of employment to cancer symptoms or treatment. Low-income women were less than half as likely as higher-income women to have accommodating employers and only one-fourth as likely to retain their jobs. However, patients whose confidence in asking for work accommodations improved over time were more than five times as likely to retain their jobs than those whose confidence did not improve. There is a compelling need for an effective intervention to support working during treatment in low-income immigrant and minority breast cancer patients in order to improve long-term job retention and financial stability. The goal of the proposed study is to evaluate the effectiveness of a mobile application (app) developed to promote working during adjuvant (curative) breast cancer chemotherapy. The app has a two-pronged approach: it will help women communicate with clinicians to optimize symptom control, and it will help them communicate with employers to negotiate for accommodations. Our study is grounded in evidence that communication behaviors can be taught to patients of varying English proficiency, resulting in improved responsiveness to patients' needs. Furthermore, patient-physician communication strategies can be adapted for use in the work setting. Our app applies these principles to the workplace as well as the clinic. The use of an app to deliver the intervention is appealing in light of barriers our target population faces in accessing support and the high prevalence of smartphone use. We will randomly assign English- and Spanish-speaking women who are about to undergo chemotherapy for stage I-III breast cancer to receive the app or an informational booklet (control). Participants will complete surveys at baseline and during chemotherapy to assess symptom burden and work accommodations. Surveys 4 months and 1 and 2 years post-treatment will measure long-term job retention.