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: 10208824
• 负责人: Debra L. Friedman
• 金额: $ 65.78万
• 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/10208824
• 关键词: Academic Medical Centers; Address; Adult; Attention; Cancer Center; Cancer Patient; Caring; Catchment Area; Characteristics; Clinical Trials; Clinical effectiveness; Colorectal Cancer; Community Hospitals; Comprehensive Cancer Center; Comprehensive Health Care; Consolidated Framework for Implementation Research; Control Groups; Country; County; Data; Disease; Dissemination and Implementation; 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; dissemination strategy; effectiveness clinical trial; effectiveness implementation design; effectiveness implementation study; evidence base; 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; remote delivery; 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; underserved community; 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.

拟议的项目是针对RFA-CA-18-026提交的，该项目提供了“基于IT的，基于团队的护理 交付模型…将全面的，协调的高质量癌症相关护理提供给低收入的低收入 和/或服务不足的人群。”农村癌症患者的死亡率差异扩大， 特别是那些居住在持续贫困的县的人，这是制定干预措施以改善的至关重要的 这些患者的结果。因此，拟议的研究基于田纳西州的七家农村医院和 密西西比州的乡村人口众多，分别包括三分之一半人口。 在卫生系统，提供者和患者水平的障碍中，多层次远程交付的干预措施 使粗糙的患者和提供者能够获得在综合癌症中心持有的专业知识 巨大的希望。通过拟议的研究，我们将采用1型混合有效性实现 设计，其中包括传统的临床有效性试验以及对干预的过程评估 交付和实施。特别是，我们将评估1）基于远程医疗的临床有效性 包括提供者级别访问分子肿瘤板和患者级别的粗糙医院的干预措施 获得支持护理； 2）促进者和未来大规模传播的障碍和 实施这种多层干预措施，旨在提高农村癌症护理的质量。 干预措施包括非随机提供者级别的访问权限的肿瘤板，该肿瘤板融合了疾病， 患者和分子肿瘤特征以增强治疗选择，并随机患者级 访问自我管理干预与注意力控制。合并的框架 实施研究将用于识别障碍和促进者。由于这些努力是可能的 现有的社区合作伙伴关系已经到位，将利用这些伙伴关系来提供全面的护理 在我们的癌症中心通过远程医疗为粗糙的癌症患者和提供者提供。进一步强调 我们的努力的重要性，我们的学术癌症中心所在的美国南部的重要性 癌症死亡率最高，是该应用的重点区域。我们的短期目标是 探索通过广泛而遥远的农村癌症患者增强癌症护理的手段 与我们地区服务不足的社区提供的癌症中心共享专业知识。我们的长期 目标是传播基于证据的策略，以改善农村癌症患者的预后。