Systems Support Mapping in Guiding Self-Management in Stage I-III Colorectal Cancer Survivors

Study Overview
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Brief Summary
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This pilot trial studies how well systems support mapping works in guiding self-management in stage I-III colorectal cancer survivors. Systems support mapping helps participants to see complex self-management activities on paper, which makes them more actionable. Behavioral interventions, such as systems support mapping, may help colorectal cancer survivors facilitate self-awareness, create motivation for behavior change, and guide self-management.

Detailed Description
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PRIMARY OBJECTIVES: I. To evaluate the feasibility of the systems support mapping (MAP) intervention in colorectal cancer survivors, as characterized by enrollment, intervention adherence, and retention rates. SECONDARY OBJECTIVES: I. To evaluate intervention acceptability as characterized by participant ratings. II. To describe outcome variability to inform future studies. III. To identify multi-level contextual factors influencing self-management (SM). IV. To qualitatively assess feasibility, acceptability using semi-structured interviews. V. To examine how study results vary by rural-urban context. OUTLINE: Participants complete MAP in-clinic over 60-90 minutes. After completion of study, participants are followed-up for up to 2 weeks.

Official Title
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Use of Systems Support Mapping to Guide Patient-Driven Self-Management in Rural and Urban Cancer Survivors

Conditions
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Cancer Survivor, Stage I Colorectal Cancer AJCC v8, Stage II Colorectal Cancer AJCC v8, Stage IIA Colorectal Cancer AJCC v8, Stage IIB Colorectal Cancer AJCC v8, Stage IIC Colorectal Cancer AJCC v8, Stage III Colorectal Cancer AJCC v8, Stage IIIA Colorectal Cancer AJCC v8, Stage IIIB Colorectal Cancer AJCC v8, Stage IIIC Colorectal Cancer AJCC v8

Intervention / Treatment
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* Other: Interview
* Other: Questionnaire Administration
* Behavioral: System Support Mapping


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with stage I-III colorectal cancer Within 2 years of completing active treatment for colorectal cancer Cognitively able to complete interviews as judged by the study team Able to understand, read and write English Exclusion Criteria: Declined participation in the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Supportive Care (MAP)<br>Participants complete MAP in-clinic over 60-90 minutes. | Other: Interview<br>* Ancillary studies<br>Other: Questionnaire Administration<br>* Ancillary studies<br>Behavioral: System Support Mapping<br>* Complete MAP<br>* Other names: MAP Intervention; System Support Mapping Intervention; MAP;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Enrollment Rate | To be calculated as the percent of eligible participants approached who agree to participate. Will use one-sample tests of negative binomial probabilities and binomial proportions to compare rates of feasibility to hypothesized values. Rates will be summarized using point estimates and 95% confidence intervals. | Up to 1 year | 
| Participation Rate | To be calculated as the percent of participants who complete the study intervention among those enrolled. Will use one-sample tests of negative binomial probabilities and binomial proportions to compare rates of feasibility to hypothesized values. Rates will be summarized using point estimates and 95% confidence intervals. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Retention Rate | To be calculated as the proportion of participants who complete the study measures among those enrolled. Will use one-sample tests of negative binomial probabilities and binomial proportions to compare rates of feasibility to hypothesized values. Rates will be summarized using point estimates and 95% confidence intervals. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported Ratings of Intervention Acceptability | Descriptive statistics will be used to summarize participant ratings of acceptability of intervention. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Measures of Autonomy Assessed by Index of Autonomous Functioning | Each item in the scale ranges from 0-5, where 0=not at all true and 5=completely true. Scale is a mean of these items and thus ranges from the same minimum of 0 to the same maximum of 5. A higher score represent higher degree of autonomy. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Self-efficacy for Managing Cancer - Chronic Disease Scale | Scale is a mean of physical and emotional functional management of chronic disease. Each of which runs from 1 (not at all confident) to 10 (totally confident). A higher score represents a higher degree of confidence in self-efficacy. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Self-Efficacy for Managing Symptoms - Patient Reported Outcomes Measurement Information System (PROMIS) Short Form | Overall score is based emotional and physical management of symptoms and is converted to a norm-based score that ranges from 0-100. Higher score means more of construct or response of managing symptoms. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| PROMIS - Relatedness Assessed by Healing Encounters and Attitudes Lists (HEAL) Patient-Provider Connection | The overall score is based on participant's relatedness to interventionists and is converted to a norm-based score that ranges from 26.6-72.5. Higher score on the HEAL measure means a higher degree of patient-provider connection as assessed by the patient. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Psychological Stress Assessed by Perceived Stress Scale | Descriptive statistics (means, standard deviations) will be used to summarize proximal outcomes and change in health outcomes by assessment measure. The primary interest will be in estimating the variance for use in planning future studies. A 4-item questionnaires to assess participants' stress during the intervention at baseline and at two weeks with a difference of both time points. Scoring scale is from 0-4 ( 0 - never and 4 - very often). Scoring range is 0-16 with the higher score indicating higher stress. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Symptoms Assessed by Patient-Reported Outcomes Measurement Information System (PROMIS) Profile 29 | PROMIS instruments contain a fixed number of items from seven PROMIS domains: depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities. The PROMIS-29, a generic health-related quality of life survey, assesses each of the 7 PROMIS domains with 4 questions. The questions are ranked on a 5-point Likert Scale. There is also one 11-point rating scale for pain intensity. Norm-based scores have been calculated for each domain on the PROMIS measures, so that a score of 50 represents the mean or average of the reference population. A score of 60 means that the person is one standard deviation above the reference population. On symptom oriented domains of PROMIS-29 (anxiety, depression, fatigue, pain interference, and sleep disturbance), higher scores represent worse symptomatology. On the function oriented domains (physical functioning and social role) higher scores represent better functioning. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Health Behaviors Assessed by Items on Tobacco Use | Descriptive statistics will be used to summarize proximal outcomes. Participants were asked questions about their health behavior related to their past or present smoking behaviors (i.e. packs per day, last time they smoked) in order to help improve upon the information received to offer support for future studies. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Qualitative Assessment of Feasibility With Semi-structured Interviews | Will conduct a qualitative content analysis. Qualitative data will be sent to an external vendor to be transcribed. Two internal study team members will double-code at least 10% of coding of transcripts from the semi-structured interviews and resolve any disagreements to ensure that robust and unbiased results are achieved. Will evaluate qualitative and quantitative analyses in a mixed-methods framework for consistency and discrepancies across all analyses to refine the protocol. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Qualitative Analysis of Systems Support Maps | The internal study team will work with collaborators through an iterative process to facilitate a qualitative content analysis of the large quantity of textual MAP data. Will examine all qualitative analyses by urban-rural status as classified using Rural Urban Commuting Area Codes. Qualitative results will be summarized by urban-rural status. Will also compare MAP results by rural-urban status. | Up to 1 year | 
| Health Behaviors Assessed by Items on Physical Activity | Participant's ability to participate in physical activities (types of activities, intensity, etc.) will be assessed. Descriptive statistics will be used to summarize proximal outcomes. The primary interest will be in estimating the variance for use in planning future studies. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Health Behaviors Assessed by Items on Use of Complementary Health Approaches | Participants will assess the use of complementary or alternative therapies use since first diagnosed with cancer. Descriptive statistics will be used to summarize proximal outcomes. The primary interest will be in estimating the variance for use in planning future studies. | Approximately 1.5-2 hours at baseline visit in clinic with a 2-week follow-up 2 weeks later | 
| Qualitative Assessment of Acceptability With Semi-structured Interviews | Will conduct a qualitative content analysis. Qualitative data will be sent to an external vendor to be transcribed. Two internal study team members will double-code at least 10% of coding of transcripts from the semi-structured interviews and resolve any disagreements to ensure that robust and unbiased results are achieved. Will evaluate qualitative and quantitative analyses in a mixed-methods framework for consistency and discrepancies across all analyses to refine the protocol. | Up to 1 year | 
| Qualitative Assessment of Changes in Outcomes With Semi-structured Interviews | Will conduct a qualitative content analysis. Qualitative data will be sent to an external vendor to be transcribed. Two internal study team members will double-code at least 10% of coding of transcripts from the semi-structured interviews and resolve any disagreements to ensure that robust and unbiased results are achieved. Will evaluate qualitative and quantitative analyses in a mixed-methods framework for consistency and discrepancies across all analyses to refine the protocol. | Up to 1 year |