Participation Restrictions in Young-Middle Adult Rural Breast Cancer Survivors

描述（由申请人提供）： 项目摘要：该项目将制定并初步评估一项干预措施，以帮助农村中、中年乳腺癌幸存者克服与癌症治疗有关的功能障碍。年轻的乳腺癌幸存者（60岁以下）有持续的家庭、社会和职业责任以及娱乐兴趣，并且在进行这些有价值的活动时出现长期困难的风险增加（参与限制）。农村癌症幸存者在医疗方面得不到充分的服务，而且由于距离和地理隔离，在获得传统康复服务方面面临重大障碍。迫切需要为这一群体采取其他康复办法。基于先前对癌症和其他医学人群的研究，设计了使用电话传递的行为激活和问题解决（BA/PS）干预的治疗手册的工作草案。在随机临床试验中测试干预措施之前，必须完成额外的工作。本研究的具体目标是A。完善BA/PS治疗手册，B.为BA/PS手册制定和应用治疗完整性措施，c.评估参与限制和相关结果，d.初步评价BA/PS的即刻效应和维持效应;基于我们的“自我调节”功能恢复模型，检查BA/PS效应的介质和调节剂。将在癌症治疗后3-6个月对188名中年乳腺癌幸存者进行持续参与限制筛查，40名持续参与限制的幸存者将通过电话接受BA/PS。将评估BA/PS参与者的治疗效果，并就他们在治疗期间的经历进行访谈，以提供完善手册的信息。这一研究方向的长期目标是为癌症的医疗和心理社会后果及其在医疗服务不足的癌症幸存者（例如，农村人口）。 公共卫生相关性： 乳腺癌治疗可能导致癌症幸存者在短期和长期内的功能干扰。这对生活质量和经济生产力产生了不利影响。医疗服务不足的人群迫切需要替代康复方法（例如，农村）。

DESCRIPTION (provided by applicant): Project Summary: This project will develop and preliminarily evaluate an intervention to assist young-middle adult rural breast cancer survivors to overcome functional impairments related to their cancer treatment. Younger breast cancer survivors (below age 60) have ongoing family, social and vocational responsibilities and recreational interests and are at increased risk of developing long-term difficulties performing these valued activities (participation restrictions). Rural cancer survivors are medically underserved and due to distance and geographic isolation face significant barriers to accessing traditional rehabilitation services. Alternative rehabilitation approaches are sorely needed for this population. Based on previous research with cancer and other medical populations a working draft of a treatment manual using a telephone-delivered Behavioral Activation and Problem Solving (BA/PS) intervention has been designed. Prior to testing the intervention in a randomized clinical trial, additional work must be completed. The specific aims of this study are to a. refine the BA/PS treatment manual, b. develop and apply treatment integrity measures for the BA/PS manual, c. assess participation restrictions and associated outcomes, d. preliminarily assess the immediate and maintenance effects of BA/PS, and e. examine mediators and moderators of BA/PS effects based on our "Self Regulation" model of functional recovery. 188 young-middle adult breast cancer survivors will be screened for persistent participation restrictions at 3-6 months following cancer treatment and 40 survivors with persistent participation restrictions will receive BA/PS delivered by phone. BA/PS participants will be assessed for treatment effectiveness and interviewed regarding their experiences during treatment to provide information for refining the manual. The long-term objective of this line of research is to develop effective and feasible treatments for the medical and psychosocial consequences of cancer and its treatment in medically underserved cancer survivors (e.g., rural populations). PUBLIC HEALTH RELEVANCE: Narrative Breast cancer treatment can lead to functional interference in cancer survivors over both the short and long-term. This adversely affects quality of life and economic productivity. Alternative rehabilitation approaches are sorely needed for medically underserved populations (e.g., rural).