Improving cancer survivorship care delivery in Latino survivors: telehealth & lay health educators

改善拉丁裔幸存者的癌症生存护理服务：远程医疗

• 批准号: 10304575
• 负责人: Rachel M. Ceballos
• 金额: $ 31.56万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10304575
• 关键词: Abbreviations; Academy; Address; Adverse effects; American; American Society of Clinical Oncology; Awareness; Breast; Breast Cancer survivor; Cancer Burden; Cancer Histology; Cancer Information Service; Cancer Patient; Cancer Survivor; Cancer Survivorship; Caring; Characteristics; Clinic; Clinical Trials; Colorectal; Communication; Communities; Community Clinical Oncology Program; Competence; Continuance of life; Country; Data; Development; Evidence based practice; Feedback; Female; Foundations; Future; Goals; Health; Health Educators; Health Personnel; Health Professional; Health Services; Healthcare Systems; Intervention; Interview; Knowledge; Language; Late Effects; Latino; Linguistics; Lung Lymphoma; Malignant Neoplasms; Medicine; Methods; Minority Groups; Modeling; Morbidity - disease rate; National Cancer Institute; Nurses; Oncology; Oncology Nurse; Outcome; Participant; Patient Education; Patients; Persons; Phase; Physicians; Population; Process; Professional Organizations; Promoting Action on Research Implementation in Health Services framework; Prostate; Public Health; Publishing; Quality of life; Randomized; Randomized Clinical Trials; Recording of previous events; Research; Resources; Role; Rural; Self Efficacy; Signal Transduction; Specialist; Standardization; Structure; Surveys; Survivors; Testing; Training; Underserved Population; Washington; base; bilingualism; cancer care; cancer health disparity; cancer therapy; cancer type; care delivery; care providers; comorbidity; efficacy evaluation; experience; follow-up; health care settings; implementation framework; implementation science; implementation strategy; implementation study; improved; innovation; male; oncology program; patient-clinician communication; prevent; prostate cancer survivors; recruit; routine care; sex; survivorship; telehealth; tool; tumor

PROJECT SUMMARY In this R21 application, we address NCI’s Provocative Question #8 by proposing a pilot randomized clinical trial to test an innovative strategy of using telehealth and bilingual lay health educators to provide linguistically and culturally appropriate cancer survivorship care for Latinos. Latinos are now the largest minority population in the US. However, compared with non-Latino Whites, they continue to experience significant disparities in cancer care, including survivorship care. These disparities are attributable to a multitude of systemic and cultural factors and contribute to a greater burden of cancer-related comorbidities and a lower quality of life. Factors that may be amenable to interventions include disparities in patient-provider communication, due in part to language barriers and limited culture competence among healthcare providers. Survivorship care plans (SCPs) may improve patient knowledge of survivorship issues and improve coordination between oncology specialists and primary care providers. They have been recommended by the National Academy of Medicine along with multiple national and professional organizations. However, the delivery of SCPs in a comprehensive fashion has been difficult, especially in under-resourced settings. Overall, research into the Latino cancer survivorship experience has been limited, with few studies examining the impact of SCPs among Latino survivors. Most studies have focused only on breast cancer survivors, and often feature resource-intensive oncology nursing or physician-led interventions. To address these gaps in knowledge, we propose to recruit a mixture of urban and rural Latino cancer survivors of the 5 most common cancer histologies (breast, colorectal, lung, lymphoma, and prostate) from academic- and community-based oncology clinics in Washington State. Our specific goals are to determine, in randomized fashion, the feasibility and preliminary efficacy of SCPs delivered using remote-based lay health educators vs SCPs alone, with a focus on whether proximal outcomes (survivors’ knowledge of their cancer history and their self-efficacy towards their follow-up care needs) can be improved. The proposal leverages NCI’s Cancer Information Service, with its pool of survivorship-trained, bilingual, lay health educators. We also propose, using a mixed-method approach, to obtain feedback from study participants (Latino cancer survivors) via qualitative semi-structured interviews, and to assess their primary care providers’ knowledge and self-efficacy regarding survivorship care. Finally, we will apply the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework to inform future implementation strategies to integrate SCP delivery and more comprehensive survivorship care for Latino cancer survivors into routine care. The results of this multi-level proposal will provide key preliminary data to inform the development and application of a larger, robustly powered randomized clinical trial, as well as complementary strategies to facilitate the development of effective and sustainable survivorship care for Latino cancer patients.

项目概要 在此 R21 申请中，我们通过提出一项试点随机临床试验来解决 NCI 的挑衅性问题 #8 测试利用远程医疗和双语非专业健康教育者提供语言和服务的创新策略 为拉丁裔提供文化上适当的癌症生存护理现在是美国最大的少数族裔人口。 然而，与非拉丁裔白人相比，他们在癌症方面仍然存在显着差异。 这些差异可归因于多种系统和文化因素。 并导致癌症相关合并症负担加重和生活质量下降。 接受干预措施，包括部分由于语言造成的患者与提供者沟通的差异 幸存者护理计划 (SCP) 可能存在障碍和文化能力有限。 提高患者对生存问题的了解，并改善肿瘤专家和患者之间的协调 他们得到了美国国家医学院和多个初级保健提供者的推荐。 然而，以全面的方式提供 SCP 已成为可能。 总体而言，对拉丁裔癌症生存经历的研究很困难，尤其是在资源贫乏的地区。 很少有研究考察 SCP 对拉丁裔幸存者的影响。 仅关注乳腺癌幸存者，通常以资源密集型肿瘤护理或医生主导的方式为特色 为了解决这些知识差距，我们建议招募城市和农村的拉丁裔混合人才。 5 种最常见癌症组织学（乳腺癌、结直肠癌、肺癌、淋巴瘤和前列腺癌）的癌症幸存者 来自华盛顿州学术和社区肿瘤诊所的我们的具体目标是确定， 以随机方式，使用远程非专业医疗提供 SCP 的可行性和初步功效 教育工作者与单独的 SCP 比较，重点是近期结果（幸存者对癌症的了解）是否 该提案利用了 NCI 的帮助。 我们还拥有癌症信息服务中心，拥有经过生存培训的双语非专业健康教育工作者。 建议使用混合方法来获取研究参与者（拉丁裔癌症幸存者）的反馈 通过定性半结构化访谈，评估初级保健提供者的知识和自我效能 最后，我们将实施健康研究实施促进行动。 服务 (PARIHS) 实施科学框架，为未来的实施战略提供信息，以整合 将 SCP 交付和更全面的生存护理纳入拉丁裔癌症幸存者的常规护理结果。 这个多层次提案的一部分将提供关键的初步数据，为更大的、 强有力的随机临床试验，以及促进开发的补充策略 为拉丁裔癌症患者提供有效且可持续的生存护理。