Peer Coaching for Physical Activity Promotion among Breast Cancer Survivors: Adapting an Efficacious Intervention to Prepare for Implementation

促进癌症幸存者体力活动的干预措施改善了他们的功能，减少了疲劳和 在癌症康复和降低未来癌症风险方面提供其他好处。有必要进行干预 这可以在比研究环境更广泛的范围内实施。我们为期12周的基于理论的练习 研究人员通过电话进行的干预在改善健康方面是有效的，并且 乳腺癌、结直肠癌和子宫内膜癌患者增加中等到剧烈的体力活动(MVPA) 幸存者。为了扩大干预的范围，我们对美国癌症协会的同行教练进行了培训 到恢复计划，以提供相同的MVPA干预，称为一起前进(MFT)到其他 乳腺癌幸存者。在一项随机对照试验中，MFT显著增加了MVPA并提供了 为这些幸存者提供心理社会福利(Pinto，Stein&Dunsiger，2015)。现在，我们的目标是为更广泛的 通过自动化关键的资源密集型组件实施MFT，例如将幸存者与 一位教练利用基于网络的同行辅导平台，收集关键指标，为大规模开展做准备 实施。InquistHealth的网络平台(Mentor1to1™)已经证明在同行中是有效的 指导慢性病管理(如糖尿病)。我们将与InquisitHealth合作，使他们的 MFT的Web平台。目的是简化介入治疗的交付，确保保真度并提高存活率 结果。这个为期4年的R01应用程序将分为两个阶段：在第一阶段，我们将与6个Peer合作 在之前的工作中已经提供了MFT(我们最初的基于证据的MVPA干预)的教练。 利用迭代的以用户为中心的设计原则，我们将修改MFT的网络平台，创建WebMFT。在……里面 第二阶段，我们将进行随机对照试验，在该试验中，10-12名同行教练将向56名 乳腺癌幸存者将被随机接受WebMFT或MVPA跟踪。我们将招募 并通过同伴指导计划，从三个癌症护理组织培训天真到MFT的教练。我们会 从教练那里收集有关WebMFT的可行性和可接受性数据。我们将检查幸存者的结果 (客观测量MVPA和自我报告的疲劳、生活质量、身体功能和情绪)通过使用 建立混合效应回归模型，比较12周时的组间比较。我们将收集幸存者对他们的反馈 使用WebMFT的经验。基于RE-AIM框架和PRISM，我们将收集以下数据 通过进行关键的多层次利益攸关方访谈，在组织一级制定执行指数。 使用更新的技术增强干预交付、计划管理和自动化数据 集合具有令人兴奋的承诺，可以促进有限组织的有效实施 资源。使循证MFT适应定制的网络平台，并在多个层面收集数据 (教练、幸存者和组织)以及成本将为强大的多站点提供坚实的基础 在更多的乳腺癌幸存者中增加MVPA(及其好处)的实施试验。

Interventions promoting physical activity among cancer survivors improve their functioning, reduce fatigue and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider-scale than in research settings. Our 12-week theory-based exercise intervention that was delivered by research staff by telephone was efficacious in improving fitness, and increasing moderate-to-vigorous physical activity (MVPA) among breast, colorectal and endometrial cancer survivors. To widen the intervention’s reach, we trained peer coaches in the American Cancer Society’s Reach to Recovery program to deliver the same MVPA intervention called Moving Forward Together (MFT) to other breast cancer survivors. In a randomized controlled trial, MFT significantly increased MVPA and provided psychosocial benefits for these survivors (Pinto, Stein & Dunsiger, 2015). Now, our goal is to prepare for wider implementation of MFT by automating key resource-intensive components such as matching survivors with a coach by using a web-based peer mentoring platform and to collect key indices to prepare for large scale implementation. InquistHealth’s web platform (Mentor1to1™) has demonstrated to be effective in peer mentoring for chronic disease management (e.g., diabetes). We will partner with InquisitHealth to adapt their web platform for MFT. The aim is to streamline intervention delivery, assure fidelity and improve survivor outcomes. There will be two phases in this 4-year R01 application: in Phase 1, we will work with 6 peer coaches who have already delivered MFT (our original evidence-based MVPA intervention) in prior work. Using iterative user-centered design principles, we will modify the web platform for MFT, creating webMFT. In Phase 2, we will conduct a randomized controlled trial in which 10-12 peer coaches will deliver webMFT to 56 breast cancer survivors who will be randomized to receive either webMFT or MVPA Tracking. We will recruit and train coaches naïve to MFT from three cancer care organizations with peer mentoring programs. We will collect feasibility and acceptability data about webMFT from the coaches. We will examine survivor outcomes (objectively measured MVPA and self-reported fatigue, quality of life, physical functioning and mood) by using mixed effects regression models to compare groups at 12 weeks. We will obtain survivors’ feedback on their experience with webMFT. Based on the RE-AIM framework and PRISM, we will collect data on implementation indices at the organizational level by conducting key multi-level stakeholder interviews. Using newer technologies for enhanced intervention delivery, program management and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple-levels (coaches, survivors and organizations) along with costs will provide a strong foundation for a robust multi-site implementation trial to increase MVPA (and its benefits) among many more breast cancer survivors.