Rebecca Shelby

Overview:

Rebecca Shelby, Ph.D. is an Associate Professor with Tenure in the Department of Psychiatry and Behavioral Sciences at Duke University and the Director of Education and Training for the Duke Cancer Patient Support Program.  Dr. Shelby is a member of the Duke Pain Prevention and Treatment Research Program and the Duke Cancer Control and Population Sciences Program. Dr. Shelby completed her graduate training in clinical psychology at the Ohio State University and her clinical internship and postdoctoral fellowship at Duke University Medical Center.  Her research focuses on developing and evaluating behavioral interventions for cancer patients, management of cancer pain and treatment side effects, and improving adherence to recommended care. Dr. Shelby serves on the Duke clinical psychology internship faculty and supervises clinical psychology fellows, interns, and clinical psychology graduate practicum students completing clinical rotations as part of the Duke Cancer Patient Support Program.   

Positions:

Associate Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
School of Medicine

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2006

Ohio State University

Grants:

Improving Adherence to Recommended Surveillance in Breast Cancer Survivors

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Mammography Pain in Breast Cancer Survivors

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
Awarded By
National Institutes of Health
Role
PI-Fellow
Start Date
End Date

Best Quality of Care from a Distance (BQal-D): Maintaining High Quality Care for Hormone Receptor Positive Metastatic Breast Cancer during the COVID Pandemic

Administered By
Medicine, Medical Oncology
Awarded By
Pfizer, Inc.
Role
Co Investigator
Start Date
End Date

Addressing Fertility Information Needs and Fertility-related Distress among Female Adult Survivors of Childhood Cancer

Administered By
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Home-Based Hematopoietic Cell Transplantation in the United States.

Patients undergoing allogeneic (allo) and autologous (auto) hematopoietic cell transplantation (HCT) require extensive hospitalizations or daily clinic visits for the duration of their transplantation. Home HCT, wherein patients live at home and providers make daily trips to the patient's residence to perform assessments and deliver any necessary interventions, may enhance patient quality of life and improve outcomes. We conducted the first study of home HCT in the United States to evaluate this model in the US healthcare setting and to determine the effect on clinical outcomes and quality of life. This case-control study evaluated patients who received home HCT at Duke University in Durham, North Carolina, from November 2012 to March 2018. Each home HCT patient was matched with 2 controls from the same institution who had received standard treatment based on age, disease, and type of transplant for outcomes comparison. Clinical outcomes were abstracted from electronic health records, and quality of life was assessed via Functional Assessment of Cancer Therapy-Bone Marrow Transplant. Clinical outcomes were compared with Student's t-test or Fisher's exact test (continuous variables) or chi-square test (categorical variables). Quality of life scores were compared using the Student t-test. All analyses used a significance threshold of 0.05. Twenty-five patients received home HCT, including 8 allos and 17 autos. Clinical outcomes were not significantly different between the home HCT patients and their matched controls; home HCT patients had decreased incidence of relapse within 1 year of transplantation. Pre-HCT quality of life was well preserved for autologous home HCT patients. This Phase I study demonstrated that home HCT can be successfully implemented in the United States. There was no evidence that home HCT outcomes were inferior to standard-of-care treatment, and patients undergoing autologous home HCT were able to maintain their quality of life. A Phase II randomized trial of home versus standard HCT is currently underway to better compare outcomes and costs.
Authors
Sung, AD; Giri, VK; Tang, H; Nichols, KR; Lew, MV; Bohannon, L; Ren, Y; Jung, S-H; Dalton, T; Bush, A; Van Opstal, J; Artica, A; Messina, J; Shelby, R; Frith, J; Lassiter, M; Burleson, J; Leonard, K; Potter, AS; Choi, T; Gasparetto, CJ; Horwitz, ME; Long, GD; Lopez, RD; Sarantopoulos, S; Chao, NJ
MLA Citation
Sung, Anthony D., et al. “Home-Based Hematopoietic Cell Transplantation in the United States.Transplant Cell Ther, vol. 28, no. 4, Apr. 2022, pp. 207.e1-207.e8. Pubmed, doi:10.1016/j.jtct.2022.01.015.
URI
https://scholars.duke.edu/individual/pub1506925
PMID
35066211
Source
pubmed
Published In
Transplant Cell Ther
Volume
28
Published Date
Start Page
207.e1
End Page
207.e8
DOI
10.1016/j.jtct.2022.01.015

Symptom Communication Preferences and Communication Barriers for Young Adult Cancer Survivors and Their Health Care Providers.

Purpose: Effective communication between young adult (YA; aged 18-39 years) cancer survivors and their health care providers is critical for managing post-treatment symptoms. Yet, little is known about YAs' and providers' preferences for and barriers to symptom communication, variables important for developing interventions to improve and optimize YA-provider communication. Methods: YA survivors (N = 21) and oncology providers (N = 11) rank ordered their preferred methods for symptom communication and top communication barriers. Interviews were conducted to obtain qualitative data (i.e., preferred methods for, barriers, and suggestions to improve symptom communication). Interviews were transcribed, and thematic qualitative analysis was used. Results: Sixty-two percent of YAs preferred communicating using the electronic messaging system affiliated with the medical record (MyChart), whereas providers (100%) preferred communicating during in-person clinic visits. Qualitative data from YAs pointed to benefits of MyChart, including ease of use and rapid responses. Providers acknowledged that, although efficient, high message volumes and expectations for rapid responses were barriers to MyChart. Providers described benefits of in-person visits, including visually assessing patients' concerns, providing immediate support, and more safely managing symptoms. Lack of time (48%) was YAs' top communication barrier, whereas providers endorsed patients not bringing up symptoms (64%). Qualitative data reflected patient-level (e.g., embarrassment/discomfort, lack of skills) and provider-level (e.g., forgetting to ask about a symptom) barriers. YAs and providers offered strategies to improve communication. Conclusion: Survivor- and provider-level communication interventions that account for YAs' and providers' differing communication preferences and directly address communication barriers unique to survivors' developmental stage may be necessary to improve symptom communication.
Authors
MLA Citation
Dorfman, Caroline S., et al. “Symptom Communication Preferences and Communication Barriers for Young Adult Cancer Survivors and Their Health Care Providers.J Adolesc Young Adult Oncol, Jan. 2022. Pubmed, doi:10.1089/jayao.2021.0172.
URI
https://scholars.duke.edu/individual/pub1506644
PMID
35049386
Source
pubmed
Published In
J Adolesc Young Adult Oncol
Published Date
DOI
10.1089/jayao.2021.0172

DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS.

BACKGROUND: Weight gain is common for breast cancer survivors and associated with disease progression, recurrence, and mortality. Traditional behavioral programs fail to address symptoms (i.e., pain, fatigue, distress) experienced by breast cancer survivors that may interfere with weight loss and fail to capitalize on the concordance in weight-related health behaviors of couples. This study aimed to develop and examine the feasibility and acceptability of a behavioral weight and symptom management intervention for breast cancer survivors and their intimate partners. MATERIALS AND METHODS: Interviews were conducted with N=14 couples with overweight/obesity to develop the intervention. Intervention feasibility and acceptability were examined through a single-arm pilot trial (N=12 couples). Patterns of change in intervention targets were examined for survivors and partners. RESULTS: Themes derived from interviews were used to develop the 12-session couple-based intervention, which included components from traditional behavioral weight management interventions, appetite awareness training, and cognitive and behavioral symptom management protocols. Couples also worked together to set goals, create plans for health behavior change, and adjust systemic and relationship barriers to weight loss. Examples were tailored to the experiences and symptom management needs of breast cancer survivors and partners. The intervention demonstrated feasibility (attrition: 8%; session completion: 88%) and acceptability (satisfaction). Survivors and partners experienced reductions in weight and improvements in physical activity, eating behaviors, emotional distress, and self-efficacy. Survivors evidenced improvements in fatigue and pain. CONCLUSIONS: A behavioral weight and symptom management intervention for breast cancer survivors and partners is feasible, acceptable, and is potentially efficacious.
Authors
MLA Citation
Dorfman, Caroline S., et al. “DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS.J Cancer Rehabil, vol. 5, 2022, pp. 7–16. Pubmed, doi:10.48252/JCR57.
URI
https://scholars.duke.edu/individual/pub1511950
PMID
35253020
Source
pubmed
Published In
J Cancer Rehabil
Volume
5
Published Date
Start Page
7
End Page
16
DOI
10.48252/JCR57

Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.

BACKGROUND: As treatments for cancer have improved, more people are surviving cancer. However, compared to people without a history of cancer, cancer survivors are more likely to die of cardiovascular disease (CVD). Increased risk for CVD-related mortality among cancer survivors is partially due to lack of medication adherence and problems that exist in care coordination between cancer specialists, primary care physicians, and cardiologists. METHODS/DESIGN: The Onco-primary care networking to support TEAM-based care (ONE TEAM) study is an 18-month cluster-randomized controlled trial with clustering at the primary care clinic level. ONE TEAM compares the provision of the iGuide intervention to patients and primary care providers versus an education-only control. For phase 1, at the patient level, the intervention includes video vignettes and a live webinar; provider-level interventions include electronic health records-based communication and case-based webinars. Participants will be enrolled from across North Carolina one of their first visits with a cancer specialist (e.g., surgeon, radiation or medical oncologist). We use a sequential multiple assignment randomized trial (SMART) design. Outcomes (measured at the patient level) will include Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of management of three CVD comorbidities using laboratory testing (glycated hemoglobin [A1c], lipid profile) and blood pressure measurements; (2) medication adherence assessed pharmacy refill data using Proportion of Days Covered (PDC); and (3) patient-provider communication (Patient-Centered Communication in Cancer Care, PCC-Ca-36). Primary care clinics in the intervention arm will be considered non-responders if 90% or more of their participating patients do not meet the modified HEDIS quality metrics at the 6-month measurement, assessed once the first enrollee from each practice reaches the 12-month mark. Non-responders will be re-randomized to either continue to receive the iGuide 1 intervention, or to receive the iGuide 2 intervention, which includes tailored videos for participants and specialist consults with primary care providers. DISCUSSION: As the population of cancer survivors grows, ONE TEAM will contribute to closing the CVD outcomes gap among cancer survivors by optimizing and integrating cancer care and primary care teams. ONE TEAM is designed so that it will be possible for others to emulate and implement at scale. TRIAL REGISTRATION: This study (NCT04258813) was registered in clinicaltrals.gov on February 6, 2020.
Authors
Zullig, LL; Shahsahebi, M; Neely, B; Hyslop, T; Avecilla, RAV; Griffin, BM; Clayton-Stiglbauer, K; Coles, T; Owen, L; Reeve, BB; Shah, K; Shelby, RA; Sutton, L; Dinan, MA; Zafar, SY; Shah, NP; Dent, S; Oeffinger, KC
MLA Citation
Zullig, Leah L., et al. “Low-touch, team-based care for co-morbidity management in cancer patients: the ONE TEAM randomized controlled trial.Bmc Fam Pract, vol. 22, no. 1, Nov. 2021, p. 234. Pubmed, doi:10.1186/s12875-021-01569-8.
URI
https://scholars.duke.edu/individual/pub1501851
PMID
34794388
Source
pubmed
Published In
Bmc Family Practice
Volume
22
Published Date
Start Page
234
DOI
10.1186/s12875-021-01569-8

Sexual and Reproductive Health Concerns

This book provides a clinically useful resource for evaluation and management of the symptoms and issues that burden survivors of breast cancer.
Authors
Shelby, R; Coleman, J; Arthur, S; Acharya, K; Heath, A; Flather, M; Westbrook, K; Dorfman, C
MLA Citation
Shelby, Rebecca, et al. “Sexual and Reproductive Health Concerns.” Common Issues in Breast Cancer Survivors: A Practical Guide to Evaluation and Management, edited by Gretchen Kimmick et al., Springer, 2021.
URI
https://scholars.duke.edu/individual/pub1518979
Source
manual
Published Date