Improving Adherence to Adjuvant Hormonal Therapy among Disadvantaged Breast Cancer Survivors

提高弱势乳腺癌幸存者对辅助激素治疗的依从性

• 批准号: 9337382
• 负责人: Tisha Felder
• 金额: $ 12.75万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-11 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9337382
• 关键词: Academic Medical Centers; Address; Adherence; Adjuvant; Affect; African American; Behavior; Behavior Therapy; Behavioral; Breast Cancer survivor; Cancer Center; Cancer Survivor; Caring; Cause of Death; Cessation of life; Clinical; Communication; Data Analytics; Death Rate; Development; Diagnosis; Disadvantaged; Disease; Documentation; Educational workshop; Ensure; Family; Foundations; Goals; Guidelines; Health; Health Communication; Health Professional; Healthcare Systems; Hormone Receptor; Intervention; Intervention Studies; Interview; Knowledge; Medicaid; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; National Cancer Institute; Nature; Outcome; Outcomes and Health Services Research; Patients; Pharmacologic Substance; Population; Productivity; Provider; Qualitative Research; Recurrence; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Research Training; Resources; Risk; Sampling; Schedule; Science; Scientific Advances and Accomplishments; South Carolina; Support System; Survivors; Testing; Time; Training; Underserved Population; United States; University resources; Woman; World Health Organization; administrative database; base; behavior test; cancer care; cancer health disparity; career; career development; design; disadvantaged population; disease natural history; evidence base; experience; fighting; hormone therapy; improved; innovation; intervention effect; malignant breast neoplasm; mortality; mortality disparity; preference; public health relevance; racial and ethnic; racial disparity; research and development; skills; socioeconomic disadvantage; theories; therapy adherence; time interval

 DESCRIPTION (provided by applicant): My long-term career goal is to become a leader in our nation's fight to eliminate disparities and improve health outcomes among racial/ethnic and socioeconomically-disadvantaged cancer survivors. Specifically, I desire to become a nationally-recognized outcomes researcher who: 1) develops and disseminates effective strategies to improve adherence to evidence-based cancer care; and 2) leads collaborative and productive transdisciplinary science that advances the field of cancer disparities research. I have substantial training in health services/outcomes research using secondary data analytic approaches (e.g., large administrative database analyses) to investigate disparities in pharmaceutical treatment use among disadvantaged populations. Training facilitated by this National Cancer Institute (NCI) Mentored Research Scientist Development Award to Promote Diversity (K01) will provide me with the protected time to obtain the theoretical knowledge and methodological skills necessary to achieve my long-term career goal. My training goals for this proposed K01 are to: a) develop skills in qualitative research methods; b) develop skills in the development and testing of behavioral interventions, including multi-level approaches; c) expand my knowledge of health communication; and d) increase my scholarly productivity in cancer disparities research. My mentors and I have developed a three-pronged strategy to achieve my career goals and ensure that my research training needs are addressed: 1) a strong, interdisciplinary team of mentors and collaborators who will guide my research and career development; 2) an innovative research project integrated with my training goals that is both scientifically relevant and rigorous in its design and methods; and 3) a schedule of didactic coursework, workshops, seminars and professional interactions that build upon the existing resources of the University of South Carolina and South Carolina's only NCI-designated cancer center-the Hollings Cancer Center of the Medical University of South Carolina. My proposed research plan seeks to address the paucity of existing intervention research focused on improving adherence to adjuvant hormonal therapy (AHT), particularly among racial and socioeconomically disadvantaged groups who experience excess rates of breast cancer mortality. Current clinical guidelines recommend hormone-receptor positive breast cancer survivors take AHT for at least 5 years. However, less than half of patients are adherent to guidelines and suboptimal AHT adherence is associated with increased risk of breast cancer mortality. Research has extensively documented socio-demographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors that can be modified (e.g., knowledge, patient-provider communication) and targeted by interventions. Identifying these modifiable intervention targets is critical to the development of efficacious strategies to improve adherence. Therefore, the overall goal of this study is to develop and test a theory-based, multi-level intervention to improve adherence to AHT among breast cancer survivors from racial and socioeconomically-disadvantaged backgrounds. The specific aims of this study are to: 1) explore multi- level (e.g., patient, healthcare system) factrs that influence adherence to AHT; 2) develop a theory-based, multi-level intervention to improve adherence to AHT; and 3) pilot and evaluate a theory-based, multi-level intervention. The proposed studies will provide training, mentorship, and research experience that will provide the foundation for my career as an independent investigator committed to improving health outcomes and eliminating disparities among the growing cancer survivor population.

 描述（由适用提供）：我的长期职业目标是成为我们国家消除差距并改善种族/种族和社会经济占据待遇的癌症生存的领导者的领导者。具体而言，我希望成为一个全国认可的结果研究人员：1）制定并传播有效的策略，以提高遵守循证癌症护理； 2）领导着癌症差异研究领域的合作和产品跨学科科学。我使用二级数据分析方法（例如，大型行政数据库分析）在卫生服务/结果研究中进行了大量培训，以调查灾害人群中药物治疗使用中的分布。该国家癌症研究所（NCI）为促进多样性的研究科学家发展奖（K01）准备的培训将为我提供受保护的时间，以获得实现我长期职业目标所需的理论知识和方法论技巧。我针对此提议的K01的培训目标是：a）发展定性研究方法的技能； b）发展行为干预措施的发展和测试，包括多层次方法； c）扩大我对健康沟通的了解； d）提高我在癌症差异研究中的科学生产力。我和我的导师已经制定了一项三管齐下的战略，以实现我的职业目标并确保我的研究培训需求得到满足：1）一个强大的，跨学科的导师和合作者团队，将指导我的研究和职业发展； 2）与我的培训目标相结合的创新研究项目，其设计和方法既具有科学相关又严格； 3）基于南卡罗来纳大学和南卡罗来纳州唯一的NCI指定的癌症中心 - 南卡罗来纳州医科大学的霍林斯癌症中心的现有资源的教学课程，讲习班，半手和专业互动的时间表。我提出的研究计划旨在解决现有干预研究的匮乏，重点是改善依从性以调整激素疗法（AHT），尤其是在经历超过乳腺癌死亡率的种族和社会经济困扰群体中。当前的临床指南建议马酮受体阳性乳腺癌存活至少5年。但是，不到一半的患者遵守指南，次优的AHT依从性与乳腺癌死亡率的增加有关。研究已广泛记录了与遵守AHT相关的社会人口统计学和疾病特异性因素，但是对可以修改的行为因素的证据很少（例如，知识，患者提供的沟通），并以干预为目标。确定这些可修改的干预目标对于发展有效策略以提高依从性至关重要。因此，这项研究的总体目标是开发和测试一种基于理论的多层次干预措施，以提高乳腺癌生存中AHT的依从性，这些乳腺癌存活中的种族和社会经济占据占领背景。这项研究的具体目的是：1）探索影响遵守AHT的多层次（例如患者，医疗保健系统）事实； 2）开发一种基于理论的多层次干预措施，以提高对AHT的依从性； 3）试点和评估基于理论的多层次干预。拟议的研究将提供培训，指导和研究经验，这将为我作为致力于改善健康结果并消除癌症生存人数差异的独立研究人员的职业奠定基础。