Enhancing Cancer Care Of Rural Dwellers Through Telehealth and Engagement (ENCORE)

通过远程医疗和参与加强农村居民的癌症护理 (ENCORE)

• 批准号: 10165375
• 负责人: Debra L Friedman
• 金额: $ 15万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165375
• 关键词: Academic Medical Centers; Address; Adult; Attention; Cancer Center; Cancer Patient; Caring; Catchment Area; Characteristics; Clinical Trials; Clinical effectiveness; Colorectal Cancer; Communities; Community Hospitals; Comprehensive Cancer Center; Comprehensive Health Care; Control Groups; Country; County; Data; Disease; Distant; Education; Employment; Evaluation; Face; Future; Goals; Health; Health Insurance; Health system; Hospitals; Incidence; Income; Individual; Information Technology; Institution; Insurance Coverage; Intervention; Interview; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Malignant neoplasm of prostate; Methods; Mississippi; Molecular; Mutation; Newly Diagnosed; Oncologist; Oncology; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Play; Population; Poverty; Process; Prognostic Marker; Progression-Free Survivals; Provider; Public Health; Quality of Care; Randomized; Recommendation; Research Design; Role; Rural; Rural Community; Rural Hospitals; Rural Population; Self Management; Service delivery model; Specialized Center; Supportive care; Surveys; Tennessee; Testing; Therapeutic; Travel; Underserved Population; United States; attentional control; base; cancer care; cancer therapy; care delivery; community partnership; design; disparity reduction; effectiveness clinical trial; effectiveness implementation study; evidence base; implementation research; implementation strategy; improved; improved outcome; malignant breast neoplasm; mortality; mortality disparity; multidisciplinary; patient-clinician communication; patient-level barriers; predictive marker; primary outcome; programs; psychosocial; recruit; relapse patients; response; rural area; rural cancer care; rural counties; rural dwellers; rural patients; rural underserved; secondary outcome; social health determinants; targeted agent; telehealth; therapy design; treatment adherence; treatment planning; tumor; uptake

The proposed project is submitted in response to RFA-CA-18-026, providing an “IT-enabled, team-based care delivery models … to deliver comprehensive, coordinated, high-quality cancer-related care to rural low-income and/or underserved populations.” There are widening mortality disparities among rural cancer patients, particularly those who live in counties with persistent poverty, making it critical to develop interventions to improve outcomes for these patients. Therefore, the proposed study is based at seven rural hospitals in Tennessee and Mississippi, states with large rural populations encompassing a third and a half of the population, respectively. With barriers at the health system, provider and patient level, multi-level remotely-delivered interventions that enable rural patients and providers to access expertise housed at a comprehensive cancer center hold tremendous promise. Through the proposed study, we will employ a Type 1 Hybrid Effectiveness-Implementation design, which includes a traditional clinical effectiveness trial along with a process evaluation of the intervention delivery and implementation. Specifically, we will evaluate the 1) clinical effectiveness of a multi-level telehealthbased intervention for rural hospitals consisting of provider-level access to a molecular tumor board and patientlevel access to supportive care; and 2) facilitators and barriers to future larger scale dissemination and implementation of this multilevel intervention, designed to enhance quality of rural cancer care delivery. The intervention consists of non-randomized provider-level access to a tumor board which incorporates disease, patient and molecular tumor characteristics to enhance treatment options, together with randomized patient-level access to a self-management intervention versus attention control. The Consolidated Framework for Implementation Research will be used to identify barriers and facilitators. These efforts are possible due to existing community partnerships already in place, which will be leveraged to bring comprehensive care available at our cancer center to rural cancer patients and providers through telehealth. To further underscore the importance of our efforts, the Southern United States in which our academic cancer center is based has amongst the highest cancer mortality rates, and is the region of focus for this application. Our short-term goals are to explore means by which to enhance cancer care among rural cancer patients through broadly and remotely sharing expertise available at our cancer center with rural underserved communities in our region. Our long-term goals are to disseminate evidence-based strategies to improve outcomes among rural cancer patients.

拟议项目是根据 RFA-CA-18-026 提交的，旨在提供“IT 支持、基于团队的护理” 交付模式……为农村低收入人群提供全面、协调、高质量的癌症相关护理 和/或服务不足的人群。”农村癌症患者之间的死亡率差距不断扩大， 特别是那些生活在持续贫困县的人们，因此制定干预措施以改善贫困状况至关重要 因此，拟议的研究基于田纳西州和田纳西州的七家乡村医院。 密西西比州农村人口较多，分别占总人口的三分之一和一半。 由于卫生系统、提供者和患者层面存在障碍，多层次的远程干预措施 使农村患者和提供者能够获得综合癌症中心的专业知识 通过拟议的研究，我们将采用 1 类混合有效性实施。 设计，其中包括传统的临床有效性试验以及干预的过程评估 具体来说，我们将评估 1) 多层次远程医疗的临床有效性。 对乡村医院的干预包括提供者层面的分子肿瘤委员会和患者层面的访问 获得支持性护理；2) 未来更大规模传播的促进因素和障碍； 实施这一多层次干预措施，旨在提高农村癌症护理服务的质量。 干预措施包括非随机提供者级别的肿瘤委员会访问，其中包括疾病、 患者和分子肿瘤特征，以及随机患者水平，以增强治疗选择 获得自我管理干预与注意力控制的综合框架。 实施研究将用于确定这些努力之所以成为可能的原因。 现有的社区伙伴关系已经到位，将利用这些伙伴关系提供全面的护理 在我们的癌症中心通过远程医疗向农村癌症患者和提供者进一步强调。 我们努力的重要性，我们学术癌症中心所在的美国南部 癌症死亡率最高，也是本应用的重点领域。 探索通过广泛和远程方式加强农村癌症患者癌症护理的方法 与我们地区服务欠缺的农村社区分享我们癌症中心的专业知识。 目标是传播基于证据的策略，以改善农村癌症患者的治疗结果。