Research Project

西班牙裔/拉丁裔（HL）是美国最大和增长最快的少数民族人口。即使考虑到年龄和分期分布的差异，HL对大多数癌症的存活率通常也较低，这可能反映了获得高质量治疗的机会较少。他们在护理质量和获得护理方面也经历了不成比例的更大差距。癌症生存的经验往往具有重大挑战的特点。尽管在HL中观察到这些挑战和显著差异，但对生存相关问题的了解非常有限，并优先考虑HL，特别是使用promotores/patient navigators（PN）将具有未满足的心理社会需求的HL癌症幸存者与适当的心理社会服务联系起来的有效性。Lance Armstrong Foundation（LAF）LIVESTRONG SurvivorCare（LSSC）计划的现有社区基础设施为评估其在改善HL生活质量方面的有效性提供了绝佳的机会。这项拟议的为期5年的Redes En Accidn研究涉及一种混合方法，该方法分两个阶段进行，跨越两个不同的HL公报。第一阶段将采用基于社区的参与性研究（CBPR）方法，吸引为乳腺癌、结直肠癌和前列腺癌HL幸存者提供服务的社区合作伙伴。在这一阶段，我们将召集社区合作伙伴在每个地点举行面向行动的小组会议，介绍PN和LSSC联合计划（PN+LSSC）的组成部分和目标。通过这种CBPR方法来产生有价值的社区反馈，我们将加强PN的作用，发展和扩大现有的合作关系以促进参与者招募，并准备社区合作伙伴在拟议的II期随机对照试验（RCT）的既定疗效基础上传播和实施PN+LSSC计划。II期将测试一项RCT，以评价文化定制的PN+LSSC项目在改善乳腺癌、结直肠癌和前列腺癌HL幸存者的一般和疾病特异性生活质量（QOL）以及治疗随访依从性方面的疗效。第二阶段还将评估PN+LSSC计划的目标（例如，连通 医疗团队，满足未满足的需求和改善健康行为）。RCT采用2 × 4随机重复测量设计，（将3个月内的患者导航[PN]与LSSC电话咨询[PN+LSSC]相结合，对比常规护理[UC]对照条件）作为组间因素，（基线/随机化前[T1]; PN后[T1后3个月; T2]，以及T2后6个月[T3]和12个月[T4]随访）作为组内因素。我们将比较 PN+LSSC和UC条件对300例（脱落后; n=150，南佛罗里达和n=150，德克萨斯州下格兰德河谷）乳腺癌、结直肠癌和前列腺癌HL幸存者的QOL和治疗随访依从性的影响，无转移性疾病的证据。为了了解PN+LSSC显著影响QOL和治疗依从性结局的机制，我们还将检查未满足的癌症需求、与医疗团队的沟通和健康行为的变化，作为干预效果的潜在介质。 研究结果将填补我们对PN计划和针对幸存者的现有社区资源在多大程度上可以改善越来越多的HL癌症幸存者的生活质量的理解中的一个重大空白，这些幸存者在癌症治疗后经历了不平等的未满足需求负担。拟议RCT的有效性将提供一种概念合理且临床相关的方法，通过将循证实践整合到现有社区资源和基础设施中来满足HL癌症幸存者的需求，从而促进研究结果在I期CBPR过程中的传播和确认。

Hispanic/Latinos (HL) are the largest and fastest-growing minority population in the nation. HLs generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to fimely, high-quality treatment. They also experience disproportionately higher disparities in quality of care and access to care. The experience of cancer survivorship is often characterized by significant challenges. Despite these challenges and significant disparities observed among HLs, there is very limited knowledge of survivorship-related issues and priorifies among HLs, specifically the effectiveness of using promotores/patient navigators (PN) in linking HL cancer survivors with unmet psychosocial needs to appropriate psychosocial services. The existing community-based infrastructure of the Lance Armstrong Foundafion (LAF) LIVESTRONG SurvivorCare (LSSC) program provides an excellent opportunity to evaluate its efficacy in improving QOL among HLs. This proposed 5-year Redes En Accidn research study involves a mixed-methods approach that occurs in two phases across two disfinct and diverse HL communifies. Phase I will use a community-based participatory research (CBPR) approach to engage community-based partners that provide services to breast, colorectal and prostate HL cancer survivors. In this phase, we will gather community partners for action-oriented group meetings at each site to present components and targets of the combined PN and LSSC program (PN+LSSC). Through this CBPR approach to generate valuable community feedback, we will enhance the role of the PN, develop and extend existing cooperative relafionships to facilitate participant recruitment, and prepare community-based partners to disseminate and implement the PN+LSSC program upon the established efficacy of the proposed randomized controlled trial (RCT) of Phase II. Phase II will test a RCT to evaluate the efficacy of a culturally tailored PN+LSSC program on improving general and disease-specific quality of life (QOL) and treatment follow-up compliance among breast, colorectal and prostate HL cancer survivors. Phase II also will evaluate the extent to which intervention-associated improvements in these outcomes are mediated by targets of the PN+LSSC program (e.g., communication with medical team, meeting unmet needs and improving health behaviors). The RCT involves a 2 X 4 randomized repeated measures design with experimental condition (combined patient navigafion [PN] over 3 months with access to LSSC telephone-based counseling [PN+LSSC] vs. a usual care [UC] control condition) as the between-groups factor, and fime-point (baseline/pre-randomizafion [Tl]; post-PN [3-months post-TI; T2], and 6- [T3] and 12-months [T4] follow-up post-T2) as the within-groups factor. We will compare the effects ofthe PN+LSSC and UC condifions on QOL and treatment follow-up compliance in 300 (after attrition; n=150, South Florida and n=150, Texas' Lower Rio Grande Valley) breast, colorectal and prostate HL cancer survivors with no evidence of metastatic disease. To understand the mechanisms by which the PN+LSSC significantly impacts QOL and treatment compliance outcomes, we also will examine changes in unmet cancer needs, communicafion with the medical team and health behaviors as potential mediators of the intervention effects. Study findings will fill a significant gap in our understanding of the extent to which PN programs and existing community-based resources targefing survivors can improve the QOL of a growing number of HL cancer survivors who experience an unequal burden of unmet needs after cancer treatment. The efficacy of the proposed RCT will provide a conceptually sound and clinically relevant approach to address the needs of HL cancer survivors by integrating evidence-based practice into existing community resources and infrastructure, thus facilitating the dissemination and translafion of study findings through Phase I's CBPR process.