Policy implementation research on health benefit mandates for fertility preservation services to improve access to care in young cancer survivors

关于保留生育服务的健康福利要求的政策实施研究，以改善年轻癌症幸存者获得护理的机会

• 批准号: 10527220
• 负责人: Sara Blythe McMenamin
• 金额: $ 22.16万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10527220
• 关键词: Adolescent and Young Adult; Adoption; Advocacy; Age; Attention; California; Cancer Patient; Cancer Survivor; Caring; Clinic; Clinical; Collaborations; Counseling; Data; Data Collection; Development; Diagnosis; Distal; Effectiveness; Embryo; Environment; Evidence based practice; Exploration Preparation Implementation and Sustainment; Fertility; Financial Hardship; Focus Groups; Future; Generations; Health; Health Benefit; Health Insurance; Health Policy; Health Services Accessibility; Health Status; Illinois; Improve Access; Infertility; Insurance; Insurance Benefits; Insurance Carriers; Interview; Investigation; Knowledge; Late Effects; Laws; Malignant Childhood Neoplasm; Malignant Neoplasms; Mediator of activation protein; Medical; Methods; New York; Newly Diagnosed; Oncology; Oocytes; Outcome; Ovarian Tissue; Parents; Patient-Focused Outcomes; Patients; Persons; Phase; Policies; Preparation; Process; Qualitative Research; Reporting; Risk; Scanning; Services; Specific qualifier value; Statutes and Laws; Surveys; Survivors; Time; United States National Institutes of Health; Variant; adverse outcome; cancer therapy; contextual factors; cost; design; effectiveness testing; fertility improvement; fertility preservation; implementation determinants; implementation facilitation; implementation research; implementation science; implementation strategy; improved; innovation; multi-site trial; novel strategies; oocyte cryopreservation; prevent; reproductive; response; sperm cell; sperm cryopreservation; sustainability framework; theories; uptake; young cancer survivor

Nearly 90,000 adolescents and young adults ages 15 to 39 are diagnosed with cancer each year in the U.S. (AYA survivors). Fertility preservation care before cancer treatment (i.e., infertility risk counseling and fertility preservation services such as oocyte and sperm freezing) is an evidence-based practice that effectively decreases infertility after cancer, a devastating outcome. In response to cost barriers that contribute to low utilization and financial burden and distress, 11 states recently passed benefit mandate laws requiring health insurance plans to include fertility preservation benefits, with additional state and federal legislation pending. These health policies may have substantial impact on preventing infertility and mitigating medical financial hardship, but clinic and patient stakeholders report that mandated benefits are not reaching cancer patients. In implementation science, there is a knowledge gap about how contextual factors in and across the multiple levels that are engaged in implementing a health policy can inform the design of deliberate implementation strategies. Thus, the objective is to conduct a theory-informed investigation of health insurance benefit mandate implementation, in order to derive strategies to increase fertility preservation care. Guided by the EPIS framework, this developmental proposal focuses on the exploration phase via a contextual assessment of multiple levels (insurance regulators, insurers, clinics and AYA survivors) (Aim 1) and the preparation phase through co- developing with stakeholders implementation strategies for benefit mandate required fertility preservation care (Aim 2). In Aim 1, we will examine determinants of implementation, service and patient outcomes in the outer and inner contexts, as well as bridging factors between them. We will conduct surveys, document reviews, interviews and focus groups, and data will be analyzed by rapid assessment to inform subsequent data collection. In Aim 2, we will specify implementation strategies for benefit mandates and refine them with stakeholders through surveys, interviews, and focus groups. We will generate a toolkit of refined implementation strategies to evaluate in a future trial. Through a policy scan of all passed state benefit mandates, we selected California, Illinois, and New York as generalizable states because they represent key variations in environments for fertility preservation benefit mandates. The transdisciplinary team has existing, productive collaborations and complementary expertise in fertility preservation care, health policy, qualitative research and implementation science. This proposal is responsive to the Childhood Cancer STAR Act of 2018, timely in assessing new fertility preservation benefit mandates, innovative in applying implementation science methods to health policy processes and outcomes and expanding the empirical evidence on policy implementation strategies, and of potential high clinical impact through generation of novel strategies to increase access to fertility preservation and decrease adverse clinical outcomes and financial hardship in AYA survivors. Beyond fertility preservation, study results will also have implications for the ~2,000 current benefit mandates implemented across the U.S.

在美国，每年有近90,000名青少年和15至39岁的年轻人被诊断出患有癌症 （AYA幸存者）。癌症治疗前的生育保养护理（即不育风险咨询和生育 保存服务（例如卵母细胞和精子冷冻）是一种基于证据的实践，有效地 癌症后的不育症降低，这是毁灭性的结果。响应成本障碍，导致低 利用和财务负担和困扰，最近有11个州通过了要求健康的福利授权法律 保险计划，包括生育保存福利，以及额外的州和联邦立法。 这些健康政策可能会对预防不育和减轻医疗财务产生重大影响 苦难，但是诊所和患者利益相关者报告说，要求的福利没有到达癌症患者。在 实施科学，关于如何在多个层面中的上下文因素如何 致力于实施卫生政策的人可以为故意实施策略的设计提供信息。 因此，目的是对理论了解健康保险福利授权的调查 实施，为了得出增加生育保健护理的策略。在Epis框架的指导下， 该发展提案通过对多个级别的上下文评估重点放在探索阶段 （保险监管机构，保险公司，诊所和AYA幸存者）（AIM 1）以及通过共同的准备阶段 通过利益相关者实施策略制定福利授权所需的生育保养护理 （目标2）。在AIM 1中，我们将研究外部实施，服务和患者结果的决定因素 和内在环境以及它们之间的桥接因素。我们将进行调查，文件审查， 访谈和焦点小组以及数据将通过快速评估进行分析，以告知随后的数据收集。 在AIM 2中，我们将指定实施策略的福利授权，并与利益相关者完善它们 通过调查，访谈和焦点小组。我们将生成一个精致实施策略的工具包 在以后的试验中评估。通过对所有通过的州福利授权的政策扫描，我们选择了加利福尼亚 伊利诺伊州和纽约是可推广的国家，因为它们代表了生育环境的关键变化 保存福利命令。跨学科团队有现有的生产性合作，并且 生育保养，卫生政策，定性研究和实施方面的补充专业知识 科学。该提案对2018年儿童癌症之星的反应迅速，及时评估新的生育能力 保存福利授权，将实施科学方法应用于卫生政策时的创新性 过程和结果，并扩大有关政策实施策略的经验证据 通过产生新的策略来增加获得生育能力的潜在高临床影响 并减少AYA幸存者的不良临床结果和经济困难。超越生育能力， 研究结果还将对美国实施的约200,000项当前福利授权产生影响