Addressing Psychosocial Disparities in Rural Hispanic Cancer Survivors

解决农村西班牙裔癌症幸存者的心理社会差异

• 批准号: 8189575
• 负责人: Rachel M. Ceballos
• 金额: $ 14万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-12 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189575
• 关键词: Address; Affect; Aftercare; Applications Grants; Behavioral; Biological; Biological Factors; Biological Markers; Biomedical Research; Breast; C-reactive protein; Cancer Control; Cancer Survivor; Cancer Survivorship; Cardiovascular Diseases; Cervical; Chronic; Clinical; Communities; Comorbidity; Control Groups; Coupled; Development; Development Plans; Diabetes Mellitus; Distress; Education; Educational workshop; Elements; Emotional; Environment; Ethical Issues; Evaluation; Family; Fatigue; Female; Focus Groups; Fred Hutchinson Cancer Research Center; Fright; Future; Goals; Health; Hispanics; Hormones; Hydrocortisone; Income; Inflammatory; Institute of Medicine (U.S.); Interdisciplinary Study; Intervention; Interview; Investigation; Language; Life; Life Experience; Linguistics; Link; Literature; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of ovary; Manuscripts; Measures; Medical; Mentors; Mentorship; National Research Council; Not Hispanic or Latino; Occupations; Outcome; Ovarian; Pain; Pancreas; Participant; Pathway interactions; Perception; Personal Satisfaction; Phase; Physiological; Population; Program Development; Program Evaluation; Program Sustainability; Proteins; Protocols documentation; Psychoneuroendocrinology; Public Health; Qualitative Methods; Qualitative Research; Quality of life; Randomized; Randomized Controlled Trials; Readability; Recurrence; Research; Research Methodology; Research Personnel; Research Technics; Resources; Risk; Rural; Rural Community; Salivary; Sampling; Scientist; Senior Scientist; Series; Serum; Social status; Social support; Staging; Strategic Planning; Survival Rate; Survivors; Testing; Training; Training Programs; United States National Institutes of Health; Universities; Uterine Cancer; Washington; Woman; anticancer research; authority; base; biobehavior; biopsychosocial; cancer health disparity; cancer prevention; cancer recurrence; cancer risk; career; career development; community based participatory research; design; direct application; empowered; experience; health disparity; health related quality of life; improved; interest; malignant breast neoplasm; member; phase 1 study; phase 2 study; prognostic indicator; programs; psychosocial; reproductive; responsible research conduct; social; social cognitive theory; survivorship; symposium; tool; uptake

DESCRIPTION (provided by applicant): Candidate. Dr. Ceballos is a motivated young investigator with the goal of becoming an independent investigator in the field of cancer health disparities. As a biobehavioral health scientist, she is interested in applying her training in psychoneuroendocrinology (PNE) to the development and evaluation of culturally- appropriate behavioral and psychosocial cancer survivorship interventions. While Dr. Ceballos has substantial training and experience in biobehavioral cancer research, the primary objective of this career development plan is to build on Dr. Ceballos's experience with mentored training in qualitative methods, cultural competency, and program development, providing to provide her with the tools needed to achieve her goal of becoming an independent investigator conducting research to address cancer health disparities. To help her achieve the above stated goals her career development plan will consist of didactic training (coursework, seminars, and workshops), participation in scientific conferences, manuscript development, submission of NIH grant applications, and direct mentorship by senior scientists. Dr. Ceballos will receive guidance from her primary mentor, Dr. Beti Thompson, and co-mentors, Dr. Karen Syrjala and Dr. Anne McTiernan. All 3 mentors are accomplished scientists at the Fred Hutchinson Cancer Research Center (FHCRC) and have distinguished themselves as leaders in their fields and successful mentors of junior investigators. Dr. Ceballos's training program will include participation in the FHCRC and University of Washington Biomedical Research Integrity (BRI) Series, online training in the responsible conduct of research, and formal coursework in Social and Ethical Issues in Public Health. Environment. The FHCRC is ideally suited for the development of Dr. Ceballos's research career and the conduct of the proposed research plan. The FHCRC has a long-standing commitment to the development of productive, independent cancer prevention and control scientists through a variety of training programs. In fact, the goals of the current Strategic Plan for the FHCRC include developing effective strategies for mentoring, recruitment, promotion, and retention of excellent scientists, and promoting opportunities for successful interdisciplinary research. Other aspects of the FHCRC environment that make it a particularly attractive choice for the development of Dr. Ceballos's career and the conduct of the proposed research include demonstrated excellence in cancer prevention and control sciences. This is a rich environment in which Dr. Ceballos will have regular contact with scientists who are leaders in a wide range of relevant fields. Research Plan. Among Hispanics, the 5-year cause-specific survival rate across all stages of female reproductive cancers (breast, uterine, cervical, ovarian) has been steadily improving. As the population of U.S. Hispanics grows from 15% in 2009 to a projected 25% of the U.S. population by 2050, there will be a need to develop resources that support the growing number of Hispanic cancer survivors. This is particularly true as the psychosocial well-being of Hispanic survivors tends to be significantly lower than that of non-Hispanic Whites (NHW). Cancer survivors can experience distress from long-term medical (i.e., fatigue), financial (i.e., job loss), and socio-emotional (i.e., fear of recurrence) burdens of survivorship well beyond completion of primary treatment. However, the addition of linguistic and socio-cultural barriers can increase the distress experienced by Hispanic survivors. The importance of addressing psychosocial well-being of Hispanic survivors is further heightened by the well-established link between chronic distress and dysregulation of physiological biomarkers (e.g., cortisol, c-reactive protein) associated with cancer comorbidities and survivorship. While informational and social support resources have emerged as potent attenuators of the psychosocial and potential physiological burdens of cancer survivorship, the availability and uptake of such programs among Hispanic survivors is greatly limited. To address this disparity and potentially ameliorate the physiological implications of prolonged psychosocial distress, the goals of the proposed investigation are to conduct a two-phased investigation in which a culturally-appropriate Spanish-language support program, based on Social-Cognitive Theory, will be developed. Qualitative research techniques will be used to develop the program (Phase 1) and the program will be evaluated using a randomized control trial and biopsychosocial approach (Phase 2). The specific aims of the proposed investigation are to (1) develop and deliver a culturally appropriate Spanish-language support program for Hispanic female survivors of reproductive cancers living in a rural community, (2) evaluate the effect of the Spanish-language support resource on validated measures of quality of life and psychosocial well-being and, (3) evaluate the effect of the support resource on measures of serum c-reactive protein and salivary cortisol. Specific aim 1 will be accomplished during Phase 1 of the study while specific aims 2 and 3 will be accomplished during Phase 2. Phase 1 of the study will utilize 20 one-on- one interviews and 4 focus groups to assess the applicability of psychosocial needs (identified in the survivorship and health disparities literature) to rural Hispanic female survivors, probe for factors unique to the sample demographic (e.g., low education/income, rural), and assess program materials. Phase 2 of the study will include 80 women who underwent treatment for a reproductive cancer within the past 5 years. Participants will be randomized to the support intervention or delayed-intervention control group. A community based participatory research (CBPR) approach will be integrated into the program development and delivery to address the cultural issue of respecto (deference to authority or social status, in an effort to enhance the cultural-appropriateness and sustainability of the program, empower community members, and encourage their participation in research. PUBLIC HEALTH RELEVANCE: The proposed project will address a significant gap in levels of distress and quality of life experienced by Hispanic cancer survivors living in rural communities using a biopsychosocial approach. The project will include development of a culturally-appropriate support program for post-treatment cancer survivors, followed by, a randomized control trial in which the program is implemented and evaluated. Psychosocial and biological outcomes will be used to assess the impact of the program on rural Hispanic cancer survivors.

描述（由申请人提供）：候选人。 Ceballos博士是一位有积极进取的年轻研究者，目的是成为癌症健康差异领域的独立研究者。作为一名生物行为健康科学家，她有兴趣将自己的心理肌内分泌学培训（PNE）应用于文化适当的行为和社会心理癌症生存干预措施的发展和评估。尽管Ceballos博士在生物行为癌症研究方面拥有丰富的培训和经验，但该职业发展计划的主要目的是在Ceballos博士在定性方法，文化能力和计划发展方面的指导培训的经验上建立经验，为她提供了实现自己的目标所需的工具，以实现成为一项独立研究者进行研究以解决癌症健康差异的独立研究。为了帮助她实现上述目标，她的职业发展计划将包括教学培训（课程，研讨会和讲习班），参与科学会议，手稿开发，提交NIH赠款申请以及高级科学家的直接指导。 Ceballos博士将获得她的主要导师Beti Thompson博士的指导，并获得了Karen Syrjala博士和Anne Mctiernan博士的指导。所有3位导师都是弗雷德·哈钦森癌症研究中心（FHCRC）的科学家，并以其领域的领导者和初级研究人员的成功导师而脱颖而出。 CEBALLOS博士的培训计划将包括参加FHCRC和华盛顿大学生物医学研究完整性（BRI）系列，负责任的研究的在线培训以及公共卫生中社会和道德问题的正式课程。 环境。 FHCRC非常适合开发Ceballos博士的研究生涯和拟议研究计划的行为。 FHCRC通过各种培训计划对生产，独立的癌症预防和控制科学家的发展具有长期的承诺。实际上，FHCRC当前的战略计划的目标包括制定有效的策略，以指导，招聘，晋升和保留优秀的科学家，并促进成功的跨学科研究机会。 FHCRC环境的其他方面使其成为塞巴洛斯博士职业生涯发展以及拟议研究的行为的特别有吸引力的选择，包括在癌症预防和控制科学方面表现出卓越的表现。这是一个丰富的环境，在该环境中，塞巴洛斯博士将与科学家定期接触，这些科学家是各种相关领域的领导者。 研究计划。在西班牙裔中，女性生殖癌（乳房，子宫，宫颈，卵巢）的所有阶段的5年特异性生存率一直在稳步改善。随着美国西班牙裔人口的人口从2009年的15％增长到2050年的预计美国人口的25％，需要开发资源来支持日益增长的西班牙裔癌症幸存者。这尤其如此，因为西班牙裔幸存者的社会心理福祉往往比非西班牙裔白人（NHW）明显低。癌症幸存者可能会因长期医疗（即疲劳），财务（即失业）和社会情感（即对复发的恐惧）对生存的负担的困扰，远远超出了初级治疗的完成。但是，增加语言和社会文化障碍可以增加西班牙裔幸存者所经历的困扰。通过与癌症合并症和生存期相关的生理生物标志物（例如，皮质醇，C-反应蛋白）之间建立良好的联系，解决西班牙裔幸存者的社会心理健康的重要性。尽管信息和社会支持资源已成为癌症生存的心理和潜在生理负担的有力衰减，但西班牙裔幸存者中这种计划的可用性和吸收受到极大限制。为了解决这一差异并有可能改善长期的社会心理困扰的生理含义，拟议的研究的目标是进行两步调查，在该研究中，将开发基于社会认知理论的文化适当的西班牙语支持计划。定性研究技术将用于开发该程序（第1阶段），并将使用随机对照试验和生物心理社会方法（第2阶段）评估该程序。拟议的调查的具体目的是（1）为居住在农村社区中的生殖癌症的西班牙裔女性幸存者制定并提供适当的文化西班牙语支持计划，（2）评估西班牙语支持资源对经过验证的生活质量和心理社会良好的良好级别和（3）评估措施的验证措施的效果皮质醇。 Specific aim 1 will be accomplished during Phase 1 of the study while specific aims 2 and 3 will be accomplished during Phase 2. Phase 1 of the study will utilize 20 one-on- one interviews and 4 focus groups to assess the applicability of psychosocial needs (identified in the survivorship and health disparities literature) to rural Hispanic female survivors, probe for factors unique to the sample demographic (e.g., low education/income, rural), and assess program materials.该研究的第2阶段将包括80名在过去5年内接受生殖癌症治疗的女性。参与者将被随机分配到支持干预或延迟干预对照组。基于社区的参与研究（CBPR）方法将纳入计划的开发和交付中，以解决尊重文化问题（对权威或社会地位的尊重，以增强计划的文化认可和可持续性，授权社区成员，并鼓励他们参与研究。 公共卫生相关性：拟议的项目将通过生物心理社会方法来解决居住在农村社区中的西班牙癌症幸存者所经历的困扰和生活质量的差距。该项目将包括为治疗后癌症幸存者制定适合文化的支持计划，然后是一项随机对照试验，在该试验中实施和评估该计划。心理社会和生物学结果将用于评估该计划对西班牙裔癌症幸存者的影响。