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

乳腺癌和劳动力沟通应用程序：一项针对促进长期工作保留的英语/西班牙语干预措施的随机对照试验

• 批准号: 10333219
• 负责人: Victoria S Blinder
• 金额: $ 55.55万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10333219
• 关键词: Adjuvant; Adjuvant Therapy; Aftercare; Bankruptcy; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer therapy; Cancer Patient; Cancer Survivor; Cellular Phone; Characteristics; Charge; Chemotherapy-Oncologic Procedure; Clinic; Common Terminology Criteria for Adverse Events; Communication; Communities; Diagnosis; Employment; Ethnic Origin; Face; Financial Hardship; Foundations; Goals; High Prevalence; Immigrant; Income; Intervention; Job loss; Language; Light; Link; Low income; Malignant Neoplasms; Measures; Mediation; Minority; Minority Women; Mobile Health Application; Occupations; Oncology; Pamphlets; Participant; Patient Outcomes Assessments; Patient Self-Report; Patients; Physicians; Provider; Race; Randomized; Randomized Controlled Trials; Reporting; Risk; Savings; Schedule; Security; Sick Leave; Surveys; Survivors; Symptoms; System; Target Populations; Time; Woman; Work; Working Women; Workplace; base; breast cancer diagnosis; chemotherapy; communication behavior; design; effective intervention; effectiveness evaluation; effectiveness testing; efficacy testing; flexibility; follow-up; improved; malignant breast neoplasm; mobile application; mobile computing; mortality; mortality risk; novel; skills; stressor; tool; treatment adherence; treatment duration; trial comparing

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.

抽象的 在与乳腺癌诊断相关的众多压力源中，失业是影响最大的压力源之一 待研究。长期的财务后果可能包括支付账单困难、债务积累和 破产。重要的是，癌症幸存者的破产与治疗依从性下降有关 并增加死亡率。能够获得工作便利（例如日程安排灵活性）的女性更容易 可能在化疗期间工作并长期保住工作。同样，拥有足够能力的女性 病假可以选择请假，同时保持工作保障。但低收入少数群体的比例较低 可能会有这样的住宿条件，从而导致更高的失业率和财务困境。对于这些 对于患者来说，找到在治疗期间继续工作的方法至关重要。在乳腺癌和劳动力中 研究重点关注移民和少数民族妇女、症状负担和缺乏工作安排 两者都与失业有关。诊断前就业的低收入女性中只有 57% 在诊断后保住了工作 相比之下，高收入女性的治疗完成率为 93%。在那些没有工作的人中，84％的人将其归因于 缺乏就业机会来治疗癌症症状或治疗。低收入女性的可能性不到一半 高收入女性拥有包容的雇主，但保住工作的可能性只有四分之一。 然而，随着时间的推移，对要求工作安排的信心有所提高的患者超过 保住工作的可能性是那些信心没有改善的人的五倍。有一个引人注目的 需要有效的干预措施来支持低收入移民和少数族裔治疗期间的工作 乳腺癌患者，以提高长期工作保留和财务稳定性。的目标 拟议的研究旨在评估为促进工作而开发的移动应用程序（应用程序）的有效性 在辅助（治疗性）乳腺癌化疗期间。该应用程序有一个双管齐下的方法：它会有所帮助 女性与临床医生沟通以优化症状控制，这将有助于她们与 与雇主协商住宿事宜。我们的研究基于以下证据：沟通行为 可以教授不同英语水平的患者，从而提高对患者的反应 需要。此外，医患沟通策略可以适应工作环境。 我们的应用程序将这些原则应用于工作场所和诊所。使用应用程序来交付 鉴于我们的目标人群在获得支持方面面临障碍以及高风险，干预措施很有吸引力 智能手机使用的普及。我们将随机分配讲英语和西班牙语的女性，她们大约 接受 I-III 期乳腺癌化疗以接收应用程序或信息手册（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情况。