My long-term career goal is to become a leader in our nation's fight to eliminate disparities and improve health outcomes among racial/ethnic and socioeconomically-disadvantaged cancer survivors. Specifically, I desire to become a nationally-recognized outcomes researcher who: 1) develops and disseminates effective strategies to improve adherence to evidence-based cancer care; and 2) leads collaborative and productive transdisciplinary science that advances the field of cancer disparities research. I have substantial training in health services/outcomes research using secondary data analytic approaches (e.g., large administrative database analyses) to investigate disparities in pharmaceutical treatment use among disadvantaged populations. Training facilitated by this National Cancer Institute (NCI) Mentored Research Scientist Development Award to Promote Diversity (K01) will provide me with the protected time to obtain the theoretical knowledge and methodological skills necessary to achieve my long-term career goal. My training goals for this proposed K01 are to: a) develop skills in qualitative research methods; b) develop skills in the development and testing of behavioral interventions, including multi-level approaches; c) expand my knowledge of health communication; and d) increase my scholarly productivity in cancer disparities research. My mentors and I have developed a three-pronged strategy to achieve my career goals and ensure that my research training needs are addressed: 1) a strong, interdisciplinary team of mentors and collaborators who will guide my research and career development; 2) an innovative research project integrated with my training goals that is both scientifically relevant and rigorous in its design and methods; and 3) a schedule of didactic coursework, workshops, seminars and professional interactions that build upon the existing resources of the University of South Carolina and South Carolina's only NCI-designated cancer center-the Hollings Cancer Center of the Medical University of South Carolina. My proposed research plan seeks to address the paucity of existing intervention research focused on improving adherence to adjuvant hormonal therapy (AHT), particularly among racial and socioeconomically disadvantaged groups who experience excess rates of breast cancer mortality. Current clinical guidelines recommend hormone-receptor positive breast cancer survivors take AHT for at least 5 years. However, less than half of patients are adherent to guidelines and suboptimal AHT adherence is associated with increased risk of breast cancer mortality. Research has extensively documented socio-demographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors that can be modified (e.g., knowledge, patient-provider communication) and targeted by interventions. Identifying these modifiable intervention targets is critical to the development of efficacious strategies to improve adherence. Therefore, the overall goal of this study is to develop and test a theory-based, multi-level intervention to improve adherence to AHT among breast cancer survivors from racial and socioeconomically-disadvantaged backgrounds.
The specific aims of this study are to: 1) explore multi- level (e.g., patient, healthcare system) factrs that influence adherence to AHT; 2) develop a theory-based, multi-level intervention to improve adherence to AHT; and 3) pilot and evaluate a theory-based, multi-level intervention. The proposed studies will provide training, mentorship, and research experience that will provide the foundation for my career as an independent investigator committed to improving health outcomes and eliminating disparities among the growing cancer survivor population.
The proposed research will address a significant gap in our knowledge of the modifiable factors that influence breast cancer survivors' adherence to adjuvant hormonal therapy (AHT), and will result in the development of a theory-based, multi-level intervention that may improve AHT adherence among racial/ethnic and socio- economically-disadvantaged (eg, Medicaid-insured) survivors who experience excess rates of breast cancer mortality. This intervention will be the first of its kind and has the potential to improve AHT adherence in an underserved population known for poor AHT adherence rates and for being disproportionately affected by breast cancer disparities.
