A web-based intervention to promote follow-up care communication and functional status of Chinese immigrant breast cancer survivors

基于网络的干预措施促进中国移民乳腺癌幸存者的后续护理沟通和功能状态

• 批准号: 9316194
• 负责人: Judy Huei-yu Wang
• 金额: $ 22.34万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9316194
• 关键词: Address; Adherence; Adverse effects; American; Asians; Breast Cancer Patient; Breast Cancer survivor; Breast Cancer survivorship; Cancer Survivor; Cancer Survivorship; Caring; Chinese American; Chinese People; Clinical; Communication; Communication Programs; Communities; Comorbidity; Competence; Data; Diagnosis; Distal; Distress; Emotional; Enrollment; Focus Groups; Generations; Guidelines; Health; Health Personnel; Healthcare; Home environment; Immigrant; Incidence; Individual; Information Systems; Institute of Medicine (U.S.); Instruction; Internet; Intervention; Interview; Limited English Proficiency; Linguistics; Los Angeles; Mainstreaming; Malignant Neoplasms; Measurement; Mediating; Medical; Not Hispanic or Latino; Online Systems; Outcome; Participant; Patient Education; Patient Outcomes Assessments; Patient Rights; Patients; Phase; Physical Function; Population; Productivity; Provider; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Research; Resources; Role; Running; Self Efficacy; Self Management; Stress; Subgroup; Survivors; Symptoms; Telephone Interviews; Testing; United States; Visit; Woman; Work; aged; arm; authority; bilingualism; cancer care; clinical practice; community based participatory research; cultural values; design; efficacy testing; ethnic difference; experience; follow-up; functional status; health care quality; health disparity; improved; improved outcome; interactive tool; intervention program; malignant breast neoplasm; neoplasm registry; novel strategies; persistent symptom; physical symptom; programs; prospective; psychologic; randomized trial; research study; response; skills; social; social cognitive theory; socioeconomics; symptom management; symptomatic improvement; therapy design; tool; treatment as usual; usability; web site

PROJECT SUMMARY/ABSTRACT Communication with doctors is essential for cancer survivors to manage treatment-related side effects and promote their functioning. However, Chinese immigrant cancer survivors consistently report poorer communication with doctors than non-Hispanic White (NHW) survivors. This is likely related to the Chinese cultural value of complying with authorities to maintain social harmony which goes against the American cultural value of patient autonomy; thus, Chinese are less likely to express their concerns and needs to doctors, increasing challenges in treating their cancer-related symptoms. Our data showed that Chinese immigrant breast cancer survivors (BCS) had more physical problems and poorer physical functioning than NHW BCS. Chinese Americans' breast cancer incidence rates are steadily increasing and over 90% of breast cancer patients survive over 5 years. Yet, there are no interventions designed to improve Chinese immigrant survivors' follow-up care communication with doctors about symptom management. About 76% of Chinese Americans are foreign-born, the fastest growing immigrant group in the US. We propose a two-phase research study to develop and evaluate a culturally appropriate, web-based intervention program called E-Talkcare to enhance Chinese immigrant BCS' communication competence and functional status. Guided by communication and social cognitive theories, we will use community-based participatory research principles to develop E-Talkcare to educate Chinese immigrant BCS on how to seek, provide, and verify information with doctors and provide a platform for them to build English-Chinese symptom reports and question prompt lists (QPL)for medical visits. For phase I, we will convene a community advisory board and run two focus groups with at least 16 Chinese immigrant BCS, and individual interviews with 5-7 Chinese BCS to test the usability of E-Talkcare. In phase II, we will conduct a randomized controlled trial to pilot test the efficacy of E-Talkcare in enhancing Chinese BCS' communication, perceived control, and self-efficacy (intermediate outcomes), as well as symptom distress, adherence to breast cancer survivorship care guidelines, and quality of life (distal outcomes) by using the Chinese patient-reported outcomes measurement information system (PROMIS®) short forms. Using Los Angeles (LA) cancer registry cases, we will enroll 118 Chinese immigrant BCS with stage 0-III breast cancer, aged 18 or older, and within 1-3 years post-diagnosis. They will be randomized to either the E-Talkcare intervention or usual care control arms. The full intervention can be completed in ~30 minutes. Participants will be telephone interviewed at baseline, and 3-months and 6-months post-randomization. E-talkcare is the first culturally relevant e-communication program for Chinese BCS. The use of bilingual PROMIS® symptom reports and QPL is a novel approach for the target group. This study is prospective in identifying culturally efficacious tools to assist clinical practice to reach and care for this underserved but growing immigrant population.

项目摘要/摘要 与医生的沟通对于管理与治疗相关的副作用和 促进他们的功能。但是，中国移民癌的存活始终报告较差 与非西班牙裔白人（NHW）的沟通相比，与医生的沟通。这可能与中国人有关 遵守当局维持社会和谐的文化价值 患者自主权的文化价值；因此，中国人不太可能向医生表达他们的担忧和需求， 在治疗与癌症相关的症状方面面临的挑战越来越大。我们的数据表明中国移民 乳腺癌幸存者（BCS）比NHW BC有更多的身体问题和身体功能较差。 中国美国人的乳腺癌发病率正在稳步增加，超过90％的乳腺癌 患者存活5年。然而，没有旨在改善中国移民幸存者的干预措施 与医生有关症状管理的后续护理沟通。大约76％的华裔美国人 是外国出生的，是美国增长最快的移民群体。我们提出了一项两阶段研究 制定和评估一个名为电子通讯的文化适当，基于网络的干预计划，以增强 中国移民BC的沟通能力和功能状况。通过沟通和 社会认知理论，我们将使用基于社区的参与研究原则来开发电子传播。 向中国移民教育如何寻求，提供和验证医生的信息，并提供 为他们建立英语 - 中国症状报告和问题提示清单（QPL）的平台。 对于第一阶段，我们将召开一个社区顾问委员会，并与两个焦点小组一起，至少有16个中文 BC的移民和对5-7个中国BC的个人访谈来测试电子传说的可用性。在第二阶段， 我们将进行一项随机对照试验，以测试E-TalkCare在增强中国BCS方面的效率 沟通，感知控制和自我有效（中级结果）以及症状困扰， 遵守乳腺癌生存护理指南和生活质量（远端结果） 中国患者报告的结果测量信息系统（PROMIS®）简短表格。使用los Angeles（LA）癌症注册案例，我们将招募118个患有0-III期乳腺癌的中国移民BC， 年龄在18岁或以上，并在诊断后1-3岁之内。他们将被随机分配到e-talkcare 干预或通常的护理控制臂。整个干预措施可以在约30分钟内完成。参与者会 在基线时进行电话采访，三个月后三个月和6个月。 e-talkcare是第一个 中文BCS与文化相关的电子通信计划。使用双语Promis®符号报告 QPL是目标组的新方法。这项研究是指确定具有文化效率的 帮助临床实践的工具，以达到和照顾这一服务不足但日益增长的移民人口。