Risk-stratified self-management care for colorectal cancer survivors: a new approach to increasing adherence to health behavior recommendations

结直肠癌幸存者的风险分层自我管理护理：提高遵守健康行为建议的新方法

• 批准号: 10740693
• 负责人: Alix G. Sleight
• 金额: $ 12.95万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740693
• 关键词: Address; Adherence; Aftercare; Alcohol consumption; American; Area; Behavior; Behavior Therapy; Behavioral Sciences; Biometry; Cancer Center; Cancer Survivor; Clinical; Colorectal Cancer; Complex; Controlled Clinical Trials; Diabetes Mellitus; Diagnosis; Diet; Dose; Education; Educational Intervention; Educational process of instructing; Educational workshop; Enrollment; Environment; Funding; Goals; Habits; Health; Health behavior; Health behavior change; Incidence; Institution; Intervention; Interview; Life; Life Style; Link; Malignant Neoplasms; Managed Care; Measurement; Measures; Mediating; Mediator; Mentors; Outcome; Participant; Patient-Focused Outcomes; Patients; Philosophy; Physical Function; Physical activity; Pilot Projects; Population; Precision Health; Procedures; Process; Program Development; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Recurrence; Research; Self Efficacy; Self Management; Spinal cord injury; Standardization; Survival Rate; Testing; Training; Training Programs; Treatment Efficacy; Triage; United States; Work; anticancer research; arm; behavioral adherence; behavioral clinical trial; cancer diagnosis; career development; clinically relevant; colon cancer patients; design; efficacy evaluation; group intervention; health assessment; healthy lifestyle; implementation science; improved; intervention delivery; lifestyle factors; modifiable lifestyle factors; mortality; novel strategies; personalized approach; process evaluation; programs; prospective; recruit; reduce symptoms; risk stratification; secondary outcome; self-management program; skills; stem; therapy design; tool; treatment effect; uptake

PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) incidence and mortality are strongly linked to modifiable lifestyle factors, e.g., physical activity, alcohol intake, and diet. Importantly, adherence to health behavior recommendations (HBR) after CRC diagnosis improves physical function, quality of life, and is consistently associated with longer survival. However, <10% of CRC survivors adhere to health behavior recommendations (HBR) after diagnosis. Addressing low adherence to HBR in CRC survivors is therefore a clinically relevant unmet need. Low adherence to HBRs stems from a dearth of personally-tailored guidance about how to manage complex health behavior change. Personalized self-management training can remedy this issue by teaching CRC survivors the skills required to integrate health behavior recommendations into their unique life contexts. In non-cancer populations such as diabetes and spinal cord injury, personalized self-management training programs have been associated with increased adherence to health behavior recommendations when compared to standardized interventions. To date, a personalized approach to lifestyle self-management has not yet been tested in a cancer population. With strong evidence that post-diagnosis healthy lifestyle factors improve patient outcomes, CRC is an important population in which to study the impact of self-management training on HBR This five-year mentored research program for Dr. Alix Sleight aims to examine the effect of a personalized self- management training program on the uptake of HBRs in CRC survivors. A total of 120 stage I-III CRC patients diagnosed within 12 months will be recruited from the Cedars-Sinai Cancer Center and assessed using the standardized World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Health Behavior Adherence Scale. Patients with a WCRF/AICR score indicating low HBR adherence will be enrolled and randomized to: 1) a personalized self-management intervention with a focus on health behaviors or 2) a standardized health behavior education program. Each patient in the intervention group will receive content tailored to their unique areas of low HBR adherence on the WCRF/AIRC Scale. Our pilot study (n=30) demonstrated that a personalized self-management training intervention is feasible to implement, acceptable to cancer survivors, and has potential to impact adherence to HBR. We therefore expect that a larger systematic assessment of this intervention will show significant and clinically meaningful change in adherence to HBR. The proposed career development program was designed to expand Dr. Sleight’s skillset in 1) behavioral clinical trials, 2) biostatistics, and 3) implementation science. The training plan includes workshops and formal coursework alongside guidance from a network of diverse mentors. Together with a supportive institutional environment, this mentored research program will equip Dr. Sleight with the skills needed to develop and conduct large-scale randomized controlled trials of personalized self-management interventions for HBR adherence.

项目摘要/摘要 结直肠癌（CRC）的发病率和死亡率与可修改的生活方式因素密切相关，例如物理 活动，酒精摄入和饮食。重要的是，CRC之后遵守健康行为建议（HBR） 诊断可改善身体机能，生活质量，并始终与更长的生存有关。 但是，诊断后<10％的CRC幸存者遵守健康行为建议（HBR）。 因此，解决CRC存活中HBR的依从性较低是临床上相关的未满足需求。低的 遵守HBRS植物的人身管理如何管理复杂健康 行为改变。个性化的自我管理培训可以通过教授CRC的生存来记住这个问题 将健康行为建议纳入其独特的生活环境所需的技能。在非癌症中 糖尿病和脊髓损伤等人群，个性化的自我管理培训计划 与与健康行为建议的依从性增加有关 标准化干预措施。迄今为止，一种个性化的生活方式自我管理方法尚未 在癌症人群中进行了测试。有力的证据表明诊断后健康的生活方式因素可以改善患者 结果，CRC是研究自我管理培训对HBR的影响的重要人群 这项为阿里克斯·莱克（Alix Sleight）博士的五年改装研究计划旨在研究个性化的自我 有关CRC存活中HBR的吸收的管理培训计划。共有120阶段I-III CRC患者 在12个月内被诊断出来将从雪松赛壁癌中心招募，并使用 标准化世界癌症研究基金/美国癌症研究所（WCRF/AICR）健康 行为依从性量表。 WCRF/AICR评分的患者将招募低HBR依从性 并随机分解为：1）一个个性化的自我管理干预措施，专注于健康行为或2） 标准化的健康行为教育计划。干预组中的每个患者都会收到内容 根据其在WCRF/AIRC量表上具有低HBR依从性的独特区域量身定制。我们的试点研究（n = 30） 证明实施个性化的自我管理培训干预是可行的，可以接受 癌症存活，并且有可能影响遵守HBR。因此，我们期望更大的系统 对这项干预的评估将显示出对HBR的依从性的重大和临床有意义的变化。 拟议的职业发展计划旨在扩大Sleight博士的技能1）行为 临床试验，2）生物统计学和3）实施科学。培训计划包括研讨会和正式 课程以及多样性导师网络的指导。与支持机构一起 环境，该修改的研究计划将使Sleight博士配备开发和发展所需的技能 对HBR进行个性化自我管理干预措施的大规模随机对照试验 坚持。