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癌症病例的增长率。大约 70% 的癌症幸存者患有共病，需要采取全面的医疗护理方法。然而，在所需的预防性护理和慢性病管理方面，癌症幸存者没有得到建议的适当水平的后续护理。幸存者可能会受益于心理社会工具和支持，以帮助他们应对护理过渡，适当监测他们的健康状况，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，目前缺乏专门设计来帮助幸存者主动管理从治疗终止到延长生存期的医疗保健的心理社会工具。为了填补这一空白，我们利用社交互动和健康沟通方面的社会和行为科学证据基础来开发和测试高度创新的自我管理干预措施：针对长期幸存者的扩展癌症教育 (EXCELS)。基于健康沟通最佳实践以及易于接触患者的智能技术，EXCELS 干预措施将包括 (1) 通过移动网络和智能手机应用程序提供的强化教育和决策支持材料以及 (2) 健康指导参与。干预开发计划包括三个步骤：首先，在形成阶段，我们将使用定性方法（即幸存者焦点小组、初级保健医疗团队成员深度访谈、用户测试）为 EXCELS 的设计和迭代开发提供信息。其次，我们将使用随机对照试验研究设计来试行干预措施。具体来说，我们将招募 480 名癌症幸存者（乳腺癌、前列腺癌、结直肠癌）至少 2 年前已完成积极的癌症治疗。全面的 EXCELS 干预措施包括持续 12 个月的干预措施，其中包括 (1) 通过移动网络/智能手机应用程序提供强化教育和自我护理支持材料，以及 (2) 健康辅导电话。 2X2 因子设计将用于测试“概念验证”或与常规护理相比完全实施的 EXCELS 干预措施的功效，以便测试组合干预措施以及每个单独的组成部分。主要结局是预防性卫生服务的使用以及跟踪癌症复发和晚期影响，并将患者的应对情况作为次要结局。将通过双盲研究人员的电话访谈和图表审核在基线以及第 6、12 和 18 个月时评估结果。最后，干预措施实施的过程评估以及本研究的试点数据将用于完善干预措施，以便在更大规模的实施和传播研究中进行测试。