Pilot Project 1: Creating Bridges to Reproductive Health Care for Rural Adolescent and Young Adult Cancer Survivors

试点项目 1：为农村青少年和青年癌症幸存者搭建生殖保健桥梁

• 批准号: 10762146
• 负责人: Helina Hoyt
• 金额: $ 7.18万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762146
• 关键词: Adolescent and Young Adult; Aftercare; California; Cancer Patient; Cancer Science; Cancer Survivor; Cancer Survivorship; Caring; Catchment Area; Clinic; Clinical; Communities; Community Clinical Oncology Program; Consult; Consultations; Continuity of Patient Care; Contraceptive methods; County; Data; Diagnosis; Discipline of Nursing; Distress; Effectiveness; Effectiveness of Interventions; Evaluation; Faculty; Female Adolescents; Fertility; Focus Groups; Future; Geography; Health; Health Insurance; Health Personnel; Health Professional; Healthcare; Hispanic; Hispanic Populations; Infertility; Intervention; Interview; Latina; Learning; Linguistics; Malignant Neoplasms; Menopausal Symptom; Methods; Mexico; Newly Diagnosed; Nursing Faculty; Oncology; Outcome; Parents; Pathway interactions; Patients; Pilot Projects; Premature Ovarian Failure; Quality of Care; Quality of life; Reporting; Reproductive Health; Reproductive Medicine; Research; Research Personnel; Resource-limited setting; Resources; Risk; Rural; Rural Community; Social Work; Social Workers; Specialist; Structure; Survivors; Underserved Population; Universities; Work; adverse pregnancy outcome; anticancer research; arm; cancer care; cancer education; care delivery; clinical care; community engagement; design; effectiveness evaluation; experience; feasibility testing; health care delivery; health disparity; health equity; health literacy; high risk; hybrid type 1 trial; implementation measures; implementation outcomes; implementation science; improved; low health literacy; medically underserved; multi-component intervention; multi-site trial; neoplasm resource; novel; oncofertility; outreach; patient navigation; pilot test; primary outcome; psychosocial; remote communities; reproductive; rural Hispanic; rural area; rural healthcare; screening; shared decision making; survivorship; telehealth; uptake

PROJECT SUMMARY/ ABSTRACT – PILOT PROJECT Reproductive health care in cancer patients is an unmet need in Imperial County, a medically underserved, rural region of the Cancer Research and Education to Advance HealTh Equity (CREATE) Partnership’s catchment area with a predominantly Hispanic population. Reproductive health is a major issue for adolescent and young adult (AYA) cancer survivors because they can experience higher risks of infertility, adverse pregnancy outcomes, and unmet informational needs. Reproductive health care effectively reduces risks, but uptake is low because there are no scalable interventions to support the implementation of routine reproductive health care in underserved, geographically remote communities. Guided by the Cancer Survivorship Care Quality Framework, this pilot proposal seeks to adapt and pilot test a multi-component intervention to improve reproductive health care uptake by female AYA cancer survivors. The intervention has three components derived from our prior work: 1) a reproductive risk summary (RS) and survivorship care plan on reproductive health (SCP-R), 2) navigation, and 3) telehealth reproductive consults. In Aim 1, we will adapt the RS and SCP-R in English and Spanish to be responsive to the cultural, health literacy, and socio-ecological needs of Latina AYA survivors through focus groups with AYA survivors and parents/guardians, and semi-structured interviews with healthcare providers. We will also systematically evaluate barriers and facilitators to reproductive health care in Imperial County and examine how to fit the multi-component intervention to this setting, through focus groups with survivors and parents/guardians and interviews with healthcare providers and clinic staff. In Aim 2, we will conduct feasibility testing of the multicomponent intervention in a single arm pilot hybrid type 1 trial (evaluating effectiveness and observing implementation). The primary outcome is engagement in reproductive health care by 15 newly diagnosed and 15 post-treatment AYA survivors. Secondarily, we will qualitatively assess effectiveness, fit and implementation outcomes with AYA survivors, healthcare providers and health clinic staff. The proposal directly targets a critical health disparity faced by female AYA survivors in our catchment area and need for partnership between rural community health professionals and urban specialists to deliver quality reproductive survivorship care. We will generate a novel, scalable intervention and preliminary data to support a future multi-site trial on intervention effectiveness in increasing reproductive care in rural, medically underserved oncology settings. The partnership between SDSU, CRCD and UCSD researchers will be strengthened with collaborative learning, community engagement, and increased capacity of trainees to support future cancer research in Imperial County.

项目摘要/摘要 – 试点项目 在因皮里尔县，癌症患者的生殖保健服务是一个未得到满足的需求，该县医疗服务不足， 癌症研究和农村教育促进健康公平 (CREATE) 合作伙伴关系的地区 以西班牙裔人口为主的集水区，生殖健康是青少年的一个主要问题。 和年轻成人 (AYA) 癌症幸存者，因为他们可能会经历更高的不孕、不良反应风险 妊娠结果和未满足的信息需求有效地降低了风险，但 接受率较低是因为没有可扩展的干预措施来支持常规生殖的实施 在癌症幸存者护理的指导下，为服务水平低下、地理位置偏远的社区提供医疗保健。 质量框架，该试点提案旨在调整和试点测试多组成部分的干预措施，以改进 女性 AYA 癌症幸存者对生殖保健的接受程度 该干预措施由三个部分组成。 来自我们之前的工作：1）生殖风险总结（RS）和生殖幸存者护理计划 健康 (SCP-R)、2) 导航和 3) 远程医疗生殖咨询 在目标 1 中，我们将调整 RS 和 英语和西班牙语版 SCP-R 旨在响应文化、健康素养和社会生态需求 拉丁裔 AYA 幸存者，通过 AYA 幸存者和家长/监护人的焦点小组，以及半结构化 我们还将系统地评估医疗保健提供者的障碍和促进因素。 帝国县的生殖保健，并研究如何适应多成分干预 通过幸存者和父母/监护人的焦点小组以及与医疗保健提供者的访谈进行设置 在目标 2 中，我们将在单臂中进行多成分干预的可行性测试。 混合型 1 试点试验（评估有效性并观察实施情况）。 15 名新诊断的 AYA 幸存者和 15 名治疗后的 AYA 幸存者参与生殖保健。 其次，我们将定性评估 AYA 幸存者的有效性、适应性和实施结果， 该提案直接针对医疗保健提供者和诊所工作人员面临的严重健康差距。 我们学区的女性 AYA 幸存者以及农村社区卫生部门之间建立伙伴关系的必要性 专业人士和城市专家提供优质的生殖生存护理我们将产生一种新颖的、 可扩展的干预措施和初步数据，以支持未来干预有效性的多站点试验 加强农村、医疗服务不足的肿瘤学环境中的生殖保健。 SDSU、CRCD 和 UCSD 研究人员将通过协作学习、社区得到加强 参与度，以及提高学员支持帝国县未来癌症研究的能力。