Patient Priorities Survivorship Care for Older Women with Breast Cancer
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PROJECT SUMMARY/ABSTRACT Although older women derive a similar degree of benefit from breast cancer survivorship guidelines as their younger counter-parts, there are other issues such as multiple medical comorbidities and unique care needs that may impact survivorship outcomes. The frequent interactions with the health system and clinician visits, negotiating conflicting information about symptoms and treatments, adapting recommendations into daily routines, managing medications can increase the treatment burden experienced by older women with breast cancer. Currently, there are no available approaches to guide patients in considering the complexity of shifting from managing a potentially life-limiting disease to managing multiple chronic conditions along with cancer survivorship needs. The literature supports that when older women with breast cancer learn about their healthcare priorities, they engage more in the treatment decision-making process. In the proposed project, I will use a Patient Priorities Care framework to explore older breast cancer survivors' priorities and health care preferences for high-quality breast cancer survivorship. The framework will include two components: (1) a health priorities identification session with a facilitator, and (2) an encounter with the oncology provider to discuss changes in the patient's care plan to align it with his/her priorities. My overall hypothesis is that prioritizing patients' priorities is feasible and facilitates individualized survivorship care for older women with breast cancer and multiple chronic conditions. An advisory panel composed of oncologists, geriatricians, and patient advocates will provide regular feedback throughout the refinement and adaptation of the Patient Priorities Care framework to the breast cancer survivorship context and engage in an iterative process of development. After incorporating feedback from the advisory panel to create an adapted version of the framework, we will carry out a quasi-experimental pilot study with the objective of evaluating the feasibility of using the framework in the Oncology clinic and provide empirical estimates of treatment effect sizes by measuring treatment burden and quality of life at 3 months, adherence to basic and priorities driven survivorship care recommendations at 12 months. Ultimately, the results of this project will provide initial direction of intended improvement which will be verified in a larger powered future trial. Furthermore, through my work on this project and the proposed training activities, I will strengthen my skill-set in decision- making, qualitative/mixed-methods methodology and clinical trial design which will allow me to transition to my long-term goal of becoming an established independent investigator.
