As pointed out in landmark publications by the Institute of Medicine and the American Cancer Society, African Americans experience worse health outcomes following cancer diagnosis than any other racial or ethnic group in the U.S. Rural African American elders experience multiple vulnerabilities due to aging-related, economic, geographic, political, and socio-historical factors that can have additive effects and contribute to significant inequalities in cancer-related outcomes. The National Institute of Nursing Research, the National Cancer Institute, and the Institute of Medicine have repeatedly called for additional research on the experiences of cancer survivors at high risk for health disparities, such as rural African American elders and their caregivers. The goal of the proposed research is to generate knowledge about early cancer survivorship for rural African American elders with cancer and their caregivers. This goal will be achieved through an innovative approach framed in the sociology of the work of chronic illness. In their classic study of chronic illness, Unending Work and Care, Corbin and Strauss define this """"""""work"""""""" as, """"""""a set of tasks performed by an individual or a couple, alone or in conjunction with others, to carry out a plan of action designed to manage one or more aspects of the illness and the lives of ill people and their partners"""""""". To date, no studies have specifically described the work of rural African American elders or their caregivers in the months following completion of cancer treatment. The proposed study aims to describe what constitutes """"""""work"""""""" during early cancer survivorship and how it is managed by rural African American elders with cancer and their caregivers in the context of their goals during this period, their everyday lives, and their overall cancer experiences. A prospective longitudinal case study design, including qualitative and quantitative data collection and analysis techniques, will be used to examine these questions. This study will take advantage of a unique opportunity to explore cases of early cancer survivorship among African American elder survivor-caregiver dyads participating in an on-going randomized-controlled trial of a nurse-led cancer navigation intervention in rural counties of central Virginia. Findings from this research will be used to develop or refine conceptual models of early cancer survivorship for African American elders in a rural setting, to be tested and applied by the applicant in future studies aimed at developing measurement tools and interventions to improve survivorship outcomes in this population. This application addresses priority aims of the National Institute of Nursing Research, including eliminating health disparities among rural and minority populations and improving outcomes for cancer survivors and their caregivers.

Public Health Relevance

This research is relevant to several areas of research emphasis at the National Institute of Nursing Research (NINR), specifically those related to alleviating health disparities and addressing quality of life issues for survivors of cancer and their caregivers. Findings of the proposed study will increase knowledge about cancer survivorship experiences of rural-dwelling African American elders and their caregivers. This knowledge will lay the groundwork for the future development of strategies aimed at improving the lives and health-related outcomes of rural and minority elders with cancer and those who support them.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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Johns Hopkins University
Schools of Nursing
United States
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Klimmek, Rachel; Wenzel, Jennifer (2012) Adaptation of the illness trajectory framework to describe the work of transitional cancer survivorship. Oncol Nurs Forum 39:E499-510
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Klimmek, Rachel; Snow, Denise; Wenzel, Jennifer (2010) Insurance-related and financial challenges reported by managed care enrollees with breast cancer. Clin J Oncol Nurs 14:598-606