The overall goal of this career development application is to enable Dr. Hudson to become an independent researcher in cancer survivorship and primary care research. The numbers of cancer survivors are rapidly increasing. Breast and prostate cancer survival exceeds 75%. More than half of individuals already diagnosed with cancer are expected to survive for more than 5 years. Primary care providers are seen for one out of three cancer care office visits. Primary care foci of care coordination and continuity are necessary for achieving better survivor care. However, research on primary care providers'impact on survivor outcomes is fairly underdeveloped. Two new studies suggest that survivors who see both oncologists and primary care physicians are more likely to receive recommended follow-up care than patients who see one or the other. However, there is no research that examines how patients think about these options for care, their decision making processes or the impact of these factors on receiving follow-up care. Using a combination of interviewing and survey research methodologies, the proposed studies build on each other to (1) explore early stage breast and prostate cancer survivors'attitudes toward primary care for follow-up cancer screening and (2) develop and validate a survey instrument to be implemented in a study that describes primary care usage and assesses cognitive-affective, patient support and demographic factors that affect how survivors use specialists and primary care physicians for follow-up care. The training plan proposed supports this research by providing necessary advanced mentoring and coursework in health psychology, risk perception, decision making, cancer biology and epidemiology. This will enable the PI to effectively conduct the proposed studies and provide a strong, evidence based foundation for later development of a testable intervention that helps survivors more effectively work with primary care providers around their follow-up cancer care. This program of training and research will be critical to identifying common and important quality of life problems faced by survivors and identifying mechanisms and risk factors underlying these problems. Most importantly, the knowledge gained from these studies is essential for development and testing of theory guided interventions that focus on providing new strategies to more effectively address survivor care in the primary care setting.
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