Extended Cancer Education for Longer-term Survivors (EXCELS) In Primary Care

初级保健中长期幸存者的扩展癌症教育 (EXCELS)

基本信息

批准号：
8743195
负责人：
SHAWNA V. HUDSON
金额：
$ 62.67万
依托单位：
RBHS-ROBERT WOOD JOHNSON MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8743195
关键词：
Address Aftercare Behavior monitoring Behavioral Sciences Blinded Breast Cancer Control Research Cancer Patient Cancer Survivor Cancer Survivorship Caring Case Manager Chronic Disease Chronically Ill Collaborations Colorectal Complex Computer software Control Groups Data Development Disease Management Education Enrollment Ensure Ethnography Evaluation Focus Groups Goals Growth Health Health Communication Health Personnel Health behavior Healthcare Individual Institute of Medicine (U.S.)Interdisciplinary Study Internet Intervention Interview Late Effects Long-Term Survivors Malignant Neoplasms Mediator of activation protein Medical Medical Care Team Monitor Monitoring for Recurrence Multimedia New Jersey Online Systems Outcome Participant Patient Care Patients Phase Physicians Population Premature aging syndrome Preventive Preventive Health Services Primary Health Care Printing Process Prostate Provider Qualitative Methods Randomized Controlled Trials Recruitment Activity Recurrence Regimen Reporting Research Research Design Research Personnel Risk Screening for cancer Self Care Self Management Services Social Interaction Social Sciences Staging Survivors Technology Telephone Telephone Interviews Testing Translations United States Work active method base behavioral/social science cancer education cancer prevention cancer recurrence cancer therapy computerized data processing coping design disorder prevention dissemination research evidence base experience follow-up group intervention implementation research improved innovation iterative design member novel oncology primary care setting primary outcome programs psychosocial research study secondary outcome survivorship theories therapy development tool treatment as usual uptake usability

项目摘要

There are 13.7 million cancer survivors in the United States. By 2050 the rate of growth for cancer survivors is expected to outpace the rate of growth for incident cancer cases. Approximately 70 percent of cancer survivors have co-morbid conditions that require a comprehensive approach to their medical care. Yet, cancer survivors do not receive recommended follow-up care at appropriate levels, with regard to both needed preventive care and chronic disease management. Survivors may benefit from psychosocial tools and support to help them cope with care transitions, to appropriately monitor their health, and to help them manage their interactions with members of the healthcare provider team. Unfortunately, there is currently a lack of psychosocial tools designed specifically to help survivors proactively manage their healthcare from the termination of treatment into extended survivorship. To fill this void, we draw on the social and behavioral science evidence base in social interaction and health communication to develop and test a highly innovative, self-management intervention: Extended Cancer Education for Longer-term Survivors (EXCELS). Based on health communication best practices, as well as on smart technology for ready access to patients, the EXCELS intervention will consist of (1) enhanced education and decision support materials delivered via mobile web and smart phone application and (2) health coaching engagement. The plan for intervention development involves three steps: first, during the formative phase, we will use qualitative methods (i.e., focus groups with survivors, depth interviews with primary care healthcare team members, user testing) to inform the design and iterative development of EXCELS. Second, we will pilot the intervention using a randomized controlled trial study design. Specifically, we will enroll 480 cancer survivors (breast, prostate, colorectal) who have completed active cancer treatment at least 2 years ago. The comprehensive EXCELS intervention consists of an ongoing 12 month intervention that entails (1) enhanced education and self-care support materials delivered via mobile web/smart phone application and (2) health coaching calls. A 2X2 factorial design will be used to test "proof of concept" or efficacy for the fully implemented EXCELS intervention compared with usual care so that the combined intervention - as well as each individual component - will be tested. The primary outcomes are use of preventive health services and tracking of cancer recurrence and late effects with patient coping as a secondary outcome. Outcomes will be assessed at baseline and at 6, 12, and 18 months by telephone interviews and chart audit by blinded research staff. Finally, a process evaluation of intervention implementation, as well as pilot data from this study, will be used to refine the intervention for testing in a larger implementation and dissemination research study.

美国有1370万癌症幸存者。到2050年，癌症幸存者的增长率预计将超过事件癌病例的增长率。大约70％的癌症幸存者的合并状况需要全面的医疗方法。然而，就需要的预防性护理和慢性疾病管理而言，癌症幸存者没有在适当水平上获得适当水平的建议后续护理。幸存者可能会受益于社会心理工具和支持，以帮助他们应对护理过渡，适当监控其健康，并帮助他们管理与医疗保健提供者团队成员的互动。不幸的是，目前缺乏专门设计的社会心理工具，以帮助幸存者从终止治疗中积极管理其医疗保健，从而扩展生存。为了填补这一空白，我们借鉴了社会互动和健康沟通中的社会和行为科学证据基础，以发展和测试高度创新的自我管理干预：长期幸存者的癌症教育扩展（Excels）。根据健康沟通的最佳实践以及智能技术，可以随时可以使用患者，excels干预措施将包括（1）通过移动网络和智能电话应用程序提供的增强教育和决策支持材料以及（2）健康教练参与。干预开发计划涉及三个步骤：首先，在形成阶段，我们将使用定性方法（即与幸存者的焦点小组，与初级保健医疗团队成员的深度访谈，用户测试）来告知Excels的设计和迭代开发。其次，我们将使用随机对照试验设计设计进行干预。具体而言，我们将招募480个癌症幸存者（乳房，前列腺，结直肠癌）至少两年前已经完成了主动癌症治疗。综合性干预措施包括一个正在进行的12个月干预措施，该干预需要（1）通过移动网络/智能电话应用程序和（2）健康教练电话提供的增强教育和自我保健支持材料。与通常的护理相比，将使用2x2阶乘设计来测试完全实施的“概念验证”或功效，以符合干预措施，以便将测试合并的干预措施以及每个组件。主要结果是使用预防性保健服务以及跟踪癌症复发和患者应对作为次要结果的后期影响。结果将在基线和6、12和18个月的电话访谈和盲目研究人员进行图表审核中评估。最后，将对干预实施的过程评估以及本研究的试验数据，将用于完善在更大的实施和传播研究中进行测试的干预措施。