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 博士是一位积极进取的年轻研究者，目标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，她有兴趣将她在心理神经内分泌学 (PNE) 方面的培训应用于开发和评估适合文化的行为和心理社会癌症生存干预措施。虽然 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标是基于 Ceballos 博士在定性方法、文化能力和项目开发方面的指导培训经验，为她提供实现她成为一名独立研究者的目标所需的工具，该研究人员进行研究以解决癌症健康差异。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）、参加科学会议、撰写手稿、提交 NIH 拨款申请以及资深科学家的直接指导。 Ceballos 博士将接受她的主要导师 Beti Thompson 博士以及共同导师 Karen Syrjala 博士和 Anne McTiernan 博士的指导。所有 3 名导师都是 Fred Hutchinson 癌症研究中心 (FHCRC) 的杰出科学家，并且是各自领域的领导者和初级研究人员的成功导师。 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诚信 (BRI) 系列、负责任研究行为的在线培训以及公共卫生社会和道德问题的正式课程。 环境。 FHCRC 非常适合 Ceballos 博士研究生涯的发展和拟议研究计划的实施。 FHCRC 长期致力于通过各种培训项目培养富有成效、独立的癌症预防和控制科学家。事实上，FHCRC 当前战略计划的目标包括制定有效的战略来指导、招聘、晋升和留住优秀科学家，并促进成功的跨学科研究的机会。 FHCRC 环境的其他方面使其成为对 Ceballos 博士的职业发展和拟议研究的进行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的卓越表现。在这个丰富的环境中，塞巴洛斯博士将与各个相关领域的领导科学家定期接触。 研究计划。在西班牙裔中，女性生殖癌症（乳腺癌、子宫癌、宫颈癌、卵巢癌）各个阶段的 5 年特定原因生存率一直在稳步提高。随着美国拉美裔人口从 2009 年占美国总人口的 15% 增长到 2050 年预计将达到 25%，因此需要开发资源来支持不断增长的拉美裔癌症幸存者数量。尤其如此，因为西班牙裔幸存者的社会心理健康状况往往明显低于非西班牙裔白人 (NHW)。在完成主要治疗后，癌症幸存者可能会因长期的医疗（即疲劳）、经济（即失业）和社会情感（即担心复发）生存负担而遭受痛苦。然而，语言和社会文化障碍的增加可能会增加西班牙裔幸存者所经历的痛苦。慢性痛苦和与癌症合并症和生存相关的生理生物标志物（例如皮质醇、C反应蛋白）失调之间的明确联系进一步凸显了解决西班牙裔幸存者社会心理健康问题的重要性。虽然信息和社会支持资源已成为癌症幸存者心理社会和潜在生理负担的有效减轻剂，但西班牙裔幸存者对此类计划的可用性和接受程度却非常有限。为了解决这种差异并可能改善长期社会心理困扰的生理影响，拟议调查的目标是进行两阶段的调查，其中基于社会认知理论的文化上适当的西班牙语支持计划将被实施。发达。将使用定性研究技术来开发该计划（第一阶段），并将使用随机对照试验和生物心理社会方法对该计划进行评估（第二阶段）。拟议调查的具体目标是 (1) 为生活在农村社区的西班牙裔生殖癌症女性幸存者制定和提供文化上适当的西班牙语支持计划，(2) 评估西班牙语支持资源对经验证的生活质量和社会心理健康指标，(3) 评估支持资源对血清 C 反应蛋白和唾液皮质醇指标的影响。具体目标 1 将在研究的第一阶段完成，具体目标 2 和 3 将在第二阶段完成。研究的第一阶段将利用 20 次一对一访谈和 4 个焦点小组来评估社会心理需求的适用性（在生存和健康差异文献中确定）农村西班牙裔女性幸存者，探究样本人口特有的因素（例如，低教育/收入、农村），并评估计划材料。该研究的第二阶段将包括 80 名在过去 5 年内接受过生殖癌症治疗的女性。参与者将被随机分配到支持干预组或延迟干预对照组。基于社区的参与性研究（CBPR）方法将被纳入项目的开发和交付中，以解决尊重的文化问题（尊重权威或社会地位，努力增强项目的文化适宜性和可持续性，赋予社区权力）成员，并鼓励他们参与研究。 公共卫生相关性：拟议项目将采用生物心理社会方法解决生活在农村社区的西班牙裔癌症幸存者在痛苦程度和生活质量方面存在的重大差距。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，然后进行一项实施和评估该计划的随机对照试验。心理社会和生物学结果将用于评估该计划对农村西班牙裔癌症幸存者的影响。