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.

项目概要/摘要 结直肠癌 (CRC) 的发病率和死亡率与可改变的生活方式因素密切相关，例如身体状况 重要的是，CRC 后遵守健康行为建议 (HBR)。 诊断可以改善身体机能、生活质量，并且始终与更长的生存期相关。 然而，<10% 的 CRC 幸存者在诊断后坚持健康行为建议 (HBR)。 因此，解决 CRC 幸存者对 HBR 依从性低的问题是一个临床相关的未满足需求。 坚持 HBR 源于缺乏关于如何管理复杂健康的个人定制指导 个性化的自我管理培训可以通过向结直肠癌幸存者传授以下知识来解决这个问题。 将健康行为建议融入其独特的非癌症生活环境所需的技能。 糖尿病和脊髓损伤等人群，个性化的自我管理培训计划已 与相比，与增加遵守健康行为建议有关 迄今为止，尚未形成个性化的生活方式自我管理方法。 在癌症人群中进行了测试，有强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的健康状况。 结果显示，CRC 是研究自我管理培训对 HBR 影响的重要人群 Alix Sleight 博士的这项为期五年的指导研究项目旨在检验个性化自我认知的效果。 关于 CRC 幸存者摄取 HBR 的管理培训计划 总共 120 名 I-III 期 CRC 患者。 将从 Cedars-Sinai 癌症中心招募 12 个月内确诊的患者，并使用 标准化世界癌症研究基金会/美国癌症研究所 (WCRF/AICR) 健康 行为依从量表。WCRF/AICR 评分表明 HBR 依从性较低的患者将被纳入。 并随机分为：1）以健康行为为重点的个性化自我管理干预措施或 2） 干预组中的每位患者都会收到标准化的健康行为教育计划内容。 针对 WCRF/AIRC 量表中 HBR 依从性较低的独特领域进行定制（n=30）。 个性化的自我管理培训干预是可行的、可接受的 癌症幸存者，并有可能影响 HBR 的依从性，因此我们预计会有更大的系统性。 对该干预措施的评估将显示 HBR 依从性发生重大且具有临床意义的变化。 拟议的职业发展计划旨在扩展 Sleight 博士在 1) 行为方面的技能 临床试验，2) 生物统计学，3) 实施科学 培训计划包括研讨会和正式培训。 课程作业以及来自多元化导师网络和支持机构的指导。 环境中，这个指导性的研究项目将使 Sleight 博士具备开发和 开展针对 HBR 的个性化自我管理干预措施的大规模随机对照试验 坚持。