Improving adherence to posttreatment follow-up care for rural lung cancer survivors through a community-clinical survivorship care team model

通过社区临床生存护理团队模式提高农村肺癌幸存者治疗后随访护理的依从性

• 批准号: 10480833
• 负责人: Marquita W. Lewis-Thames
• 金额: $ 16.76万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10480833
• 关键词: Active Learning; Address; Adherence; Adopted; Advocate; Aftercare; Cancer Center; Cancer Control; Cancer Survivor; Cancer Survivorship; Caregivers; Caring; Clinical; Communities; Community Health; Community Health Aides; Cost Analysis; County; Data; Development; Distal; Division of Cancer Control and Population Sciences; Early Diagnosis; Economics; Exploration Preparation Implementation and Sustainment; Face; Financial Hardship; Financial Support; Future; Geography; Goals; Health; Health Care Costs; Health Professional; Incidence; Intervention; Interview; Light; Link; Literature; Malignant neoplasm of lung; Mentors; Mentorship; Methods; Modeling; Monitor; Oncologist; Outcome; Participant; Patients; Phase; Preparation; Process; Program Development; Provider; Recommendation; Recurrence; Research; Research Project Grants; Resources; Role; Rural; Rural Appalachia; Rural Community; Site; Social Workers; Specialist; Support Groups; Survival Rate; Survivors; Time; Training; Travel; Treatment outcome; Trust; Universities; Visit; acceptability and feasibility; barrier to care; base; cancer care; cancer health disparity; care coordination; care outcomes; career; clinical care; disparity elimination; early screening; effectiveness implementation trial; feasibility testing; follow-up; group counseling; health disparity; implementation cost; implementation evaluation; implementation framework; implementation science; improved; improved outcome; insight; medically underserved; member; programs; rural area; rural dwellers; rurality; screening; side effect; skills; social; social health determinants; socioeconomics; success; survival disparity; survivorship; sustainability framework; symptom management; telehealth; therapy development; trial design; urban setting

Project/Summary: Rural lung cancer survival rates have lagged behind the national average for decades. A key contributor to recent survival disparities is fragmented survivorship care, leaving rural survivors without supports to facilitate survivorship care and adherence to follow-up care. Rural survivors often receive their care from specialists located in distal, urban centers, where travel, social, and financial burdens threaten adherence to follow-up care. Further, urban healthcare professionals are unaware of rural resources and encumbered by finding rural community resources needed to overcome barriers to care. Thus, a community-clinical survivorship care team is a promising strategy to improve timely follow-up care and provide linkages to community resources. A rural community health worker (CHW) that is knowledgeable about local resources and the socio-economic barriers to survivorship care is a fitting community agent on a community-clinical team. The success of community-clinical care teams to improve care coordination and health outcomes is well documented, but few of these studies investigate rural survivorship care or the integration of a CHW in the team model. Also, a gap in the literature exists regarding the implementation of a CHW-clinical survivorship care team model to improve rural survivorship outcomes. To address this critical gap, the research examines the implementation of a CHW- clinical survivorship care team to improve adherence to follow-up care for rural lung cancer survivors. The aims of this project are to 1) assess perspectives on desired CHW roles and their processes for interacting with clinical care team members in a community-clinical survivorship care team; 2) test the feasibility and initial acceptability of CENTRAL, and 3) evaluate the implementation of CENTRAL to identify factors that influence its sustained use in a multi-site effectiveness-implementation trial design R01. CENTRAL will be adapted from an existing patient navigation research program, and interviews with key stakeholders to inform CHW roles and processes for working with clinical care teams (Aim 1). Dr. Lewis-Thames will pilot CENTRAL (N=60) with rural lung cancer survivors to assess its acceptability and feasibility (Aim 2). Aim 3 will provide insights on facilitators and barriers of implementing CENTRAL via the EPIS (exploration, preparation, implementation, sustainment) implementation framework through an analysis of implementation costs and interviews with CENTRAL participants, CHWs and providers. This K01 involves a training plan consisting of coursework, seminars, experiential learning, and mentorship by an established team of experts. The research is conducted at Northwestern University and affiliated rural-serving Cancer Centers which offer superior facilities and resources to provide training in intervention development and adaption, implementation science, cost-analysis, and rural survivorship care. The outlined training plan will enable Dr. Lewis-Thames to accomplish her long-term career goal to become an independent cancer disparities implementation. The proposed project is relevant to the NCI's Division of Cancer Control and Population Science research emphasis on rural cancer control and health disparities.

项目/摘要：几十年来，农村肺癌生存率一直落后于全国平均水平。一把钥匙 造成近期生存差异的一个因素是幸存者护理支离破碎，导致农村幸存者得不到支持 促进幸存者护理和坚持后续护理。农村幸存者经常得到来自以下机构的照顾： 位于偏远城市中心的专家，​​那里的旅行、社会和经济负担威胁到遵守 后续护理。此外，城市医疗保健专业人员不了解农村资源，并受到农村资源的阻碍。 寻找克服护理障碍所需的农村社区资源。因此，社区临床生存率 护理团队是一项很有前途的策略，可以改善及时的后续护理并提供与社区资源的联系。 了解当地资源和社会经济的农村社区卫生工作者 (CHW) 幸存者护理的障碍是社区临床团队中合适的社区代理人。的成功 改善护理协调和健康结果的社区临床护理团队已有详细记录，但很少 其中一些研究调查了农村生存护理或社区卫生工作者在团队模式中的整合。另外，还有一个差距 现有文献涉及实施 CHW 临床生存护理团队模型以改善 农村生存结果。为了解决这一关键差距，该研究考察了 CHW- 临床生存护理团队旨在提高农村肺癌幸存者的后续护理依从性。目标 该项目的目的是 1) 评估对所需 CHW 角色及其与临床互动过程的看法 社区临床生存护理团队的护理团队成员； 2）测试可行性和初步可接受性 CENTRAL 的实施，以及 3) 评估 CENTRAL 的实施，以确定影响其持续的因素 用于多站点有效性实施试验设计 R01。 CENTRAL 将根据现有的 患者导航研究计划，以及与主要利益相关者的访谈，以了解 CHW 的角色和流程 与临床护理团队合作（目标 1）。 Lewis-Thames 博士将针对农村肺癌试点 CENTRAL (N=60) 幸存者评估其可接受性和可行性（目标 2）。目标 3 将提供有关促进因素和障碍的见解 通过 EPIS（探索、准备、实施、维持）实施 CENTRAL 通过对实施成本的分析以及对 CENTRAL 参与者、CHW 和 提供商。 K01 涉及一个培训计划，包括课程作业、研讨会、体验式学习和 由已建立的专家团队提供指导。该研究是在西北大学进行的 附属的农村癌症中心提供优质的设施和资源来提供培训 干预措施的制定和适应、实施科学、成本分析和农村幸存者护理。这 概述的培训计划将使刘易斯泰晤士博士能够实现她的长期职业目标，成为一名 独立的癌症差异实施。拟议项目与 NCI 癌症部门相关 控制和人口科学研究重点关注农村癌症控制和健康差异。