Optimizing the Delivery of Diabetes Management During Breast Cancer Care

优化乳腺癌护理期间糖尿病管理的实施

基本信息

批准号：
10262938
负责人：
Laura C Pinheiro
金额：
$ 17.23万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10262938
关键词：
2,4-Dinitrophenol Active Learning Acute Affect Attention Award Breast Breast Cancer Patient Breast Cancer Treatment Cancer Patient Caring Chemotherapy-Oncologic Procedure Chronic Disease Clinical Cluster randomized trial Development Plans Diabetes Mellitus Doctor of Philosophy Endocrinologist Ensure Evaluation Face Feeling Future Goals Grant Health Health Services High Prevalence Individual Internist Intervention Malignant Neoplasms Medicine Mentors Mentorship Modeling Non-Insulin-Dependent Diabetes Mellitus Nonmetastatic Nurse Practitioners Oncologist Oncology Oncology Nurse Outcome Patient Care Patient-Focused Outcomes Patients Phase Pilot Projects Primary Health Care Primary Nursing Care Provider Qualitative Research Reading Reporting Research Research Methodology Research Personnel Risk Scientific Inquiry Scientist Site Testing Training Uncertainty United States Dept. of Health and Human Services Woman Work Writing aggressive breast cancer blood glucose regulation cancer care cancer diagnosis cancer health disparity cancer therapy care outcomes care providers career development chemotherapeutic agent chemotherapy comorbidity design diabetes management effectiveness testing ethnic minority population glycemic control health care delivery health disparity health equity health training high risk implementation outcomes implementation science implementation trial improved improved outcome innovation interest malignant breast neoplasm mortality risk multidisciplinary non-diabetic racial and ethnic racial and ethnic disparities randomized trial skills success therapy design

项目摘要

PROJECT SUMMARY Twenty percent of US women with breast cancer also have diabetes mellitus (DM) and face a 50% higher risk of death up to 10 years after cancer diagnosis compared to non-diabetic women with breast cancer. A possible explanation is that DM receives less attention during cancer treatments because patients, oncologists, and primary care providers (PCPs) prioritize cancer care over DM management. Oncologists may focus on cancer care (rather than DM management), patients may not see their PCPs in the period after cancer diagnosis, and PCPs may not feel comfortable managing DM in the context of chemotherapy regimens that frequently affect glucose control. Given these concerns, identifying a provider who could effectively manage DM may be an attractive solution. Nurse practitioners (NPs) have been successfully integrated into many oncology care teams to support general cancer care. Separately, NPs have been shown to successfully manage DM in various non- cancer settings. However, no study has determined whether a NP on the oncology care team can effectively manage DM during chemotherapy for breast cancer. I hypothesize that a NP trained in DM care and embedded in the oncology team can effectively manage DM during this acute phase of breast cancer care. The objective of this study is to engage stakeholders to develop and implement a NP-led intervention to manage DM for women receiving chemotherapy for incident non-metastatic breast cancer. To accomplish this, I propose the following research aims: 1) elicit the perspectives of patients, NPs, oncologists, and PCPs about barriers to and facilitators for a NP managing DM during chemotherapy, 2) develop a NP-led intervention to manage DM during chemotherapy, and 3) conduct a pilot study to implement the intervention and assess implementation outcomes (reach, acceptability, appropriateness, feasibility, fidelity). Findings from this pilot study will lay the groundwork for a multi-site, randomized trial testing the effectiveness of this NP-led model. As a PhD-trained health services researcher focused on cancer outcomes and health disparities, I have gained quantitative research expertise. I now seek to expand my research skills to include implementation trials. To accomplish this goal, I will pursue mentorship and training in qualitative research methods, healthcare delivery, and in stakeholder-engaged intervention design, implementation, and evaluation in real-world settings. I will be mentored by two nationally-recognized clinician scientists, Dr. Monika Safford and Dr. Lisa Kern. Together, we designed a career development plan for me to gain skills through coursework and reading that is then solidified through experiential learning by carrying out my research aims. This Award will enable me to advance toward my long-term goal of becoming an independent health services researcher working at the intersection of cancer care, primary care, and health equity to improve patient outcomes and reduce health disparities.

项目摘要美国乳腺癌二十％的女性也患有糖尿病（DM），面临高50％的风险与乳腺癌的非糖尿病女性相比，癌症诊断后长达10年的死亡。可能解释是，由于患者，肿瘤学家和初级保健提供者（PCP）优先考虑癌症护理而不是DM管理。肿瘤学家可能会专注于癌症护理（而不是DM管理），患者可能在癌症诊断后的一段时间内看不到PCP，并且在经常影响的化学疗法方案的背景下，PCP可能不舒服地管理DM 葡萄糖控制。考虑到这些问题，确定可以有效管理DM的提供商可能是有吸引力的解决方案。护士从业人员（NP）已成功整合到许多肿瘤学护理团队中支持一般癌症护理。另外，已显示NP在各种非 - 癌症环境。但是，尚无研究确定肿瘤学护理团队的NP是否可以有效在化学疗法治疗乳腺癌期间管理DM。我假设一个接受了DM护理培训的NP和嵌入在肿瘤学团队中可以在乳腺癌护理的这一急性阶段有效地管理DM。这项研究的目的是让利益相关者开发和实施由NP领导的干预措施管理接受化疗的女性DM，以用于非转移性乳腺癌。为此，我提出以下研究的目的：1）引起患者，NP，肿瘤学家和PCP的观点在化学疗法期间管理DM的NP的障碍和促进因子，2）开发NP主导的干预措施在化学疗法期间管理DM，3）进行试点研究以实施干预并评估实施成果（覆盖范围，可接受性，适当性，可行性，保真度）。该飞行员的发现研究将为多站点，随机试验测试该NP LED模型的有效性奠定基础。作为一名受过博士培训的卫生服务研究人员，专注于癌症成果和健康差异，我已经获得了定量研究专业知识。我现在寻求扩大研究技能，以包括实施试验。到实现这一目标，我将在定性研究方法，医疗保健交付中进行指导和培训在利益相关者参与的干预设计，实施和评估中，在现实世界中。我会的由两位全国认可的临床医生Monika Safford博士和Lisa Kern博士指导。在一起，我们为我设计了一项职业发展计划，以通过课程和阅读获得技能，然后巩固通过进行经验学习，通过进行我的研究目的。这个奖项将使我能够迈向我成为一名独立卫生服务研究人员的长期目标癌症护理，初级保健和健康公平性，以改善患者结局并减少健康差异。