A Randomized Controlled Trial to Improve Health Insurance Literacy and Surveillance among Young Adult Cancer Survivors

提高年轻成年癌症幸存者的健康保险知识和监测的随机对照试验

基本信息

批准号：
10660663
负责人：
Anne C Kirchhoff
金额：
$ 67.27万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-14 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10660663
关键词：
Address Adult Affect Aftercare Age Behavioral Model Behavioral Sciences Breast Cancer Survivor Caring Clinics and Hospitals Colorectal Cancer Cost Effectiveness Analysis Data Diagnosis Education Electronic Health Record Enrollment Ethnic Origin Financial Hardship Future Goals Guidelines Health Insurance Health Services Accessibility Healthcare Healthcare Systems Hispanic Hospitals Insurance Intervention Interview Knowledge Latinx Link Location Lymphoma Malignant Neoplasms Medical Care Costs National Cancer Institute National Comprehensive Cancer Network Operative Surgical Procedures Outcome Parents Participant Pathway interactions Patient Self-Report Patient-Focused Outcomes Policies Population Radiation Randomized Randomized, Controlled Trials Recommendation Recurrence Recurrent Malignant Neoplasm Reporting Resources Rural Sampling Schools Services Subgroup Surveys Survivors Testing Time Treatment Cost United States Universities Utah Work arm barrier to care budget impact cancer care cancer recurrence cancer therapy chemotherapy childhood cancer survivor comparison control cost cost effectiveness data infrastructure data integration design economic evaluation efficacy evaluation efficacy testing evidence base experience financial toxicity follow-up health application health service use improved improved outcome intervention effect literacy oncology service patient navigation pilot test pilot trial primary outcome programs randomized trial recruit rurality sarcoma secondary outcome success survivorship tool treatment arm treatment as usual virtual health virtual patient young adult

项目摘要

ABSTRACT The first year after cancer treatment ends is a critical time to establish survivorship care for young adult (YA) cancer survivors ages 26 to 39. Receipt of evidence-based survivorship care, including surveillance for cancer recurrence based on national guidelines, remain low among YA survivors. At the same time, YAs ages 26 to 39 have the highest rate of both uninsurance and underinsurance among US adults. Our team’s prior work demonstrated that YA cancer survivors report low understanding of their health insurance and the services it covers, which affects their ability to navigate care. Together, these issues can lead to significant access to care barriers and severe medical cost consequences for this population. This proposal addresses the urgent need to improve YA cancer survivors’ health insurance literacy and decrease financial toxicity, thus improving their ability to receive recommended survivorship care. Guided by Andersen and Aday’s Behavioral Model of Health Services Use, we developed and pilot-tested a 4-session virtual patient navigation intervention for YA cancer survivors that was adapted from a pilot program for childhood cancer survivors. Initial results support feasibility, acceptability, and preliminary efficacy of both of these pilot trials with YA survivors ages 26 to 39. We now propose a randomized controlled trial to test the efficacy of this program (“CHAT-S”) to improve health insurance literacy, financial toxicity due to medical costs, and post-treatment surveillance for recurrence among YA cancer survivors ages 26 to 39. We plan to randomize N=300 (N=200 intervention; N=100 usual care) YAs with breast, testicular, lymphoma, sarcoma, and colorectal cancer who have completed initial treatment within the past year from 14 locations in the University of Utah Healthcare (UUHC) and Intermountain Healthcare (IH) systems. UUHC and IH have many rural (20%) and Hispanic/Latinx (18%) YA cancer survivors; we will oversample these important subgroups. We will determine whether CHAT-S improves health insurance literacy and financial toxicity at 6-month follow-up (primary outcomes). Further, UUHC and IH have an integrated data infrastructure which allows us to capture electronic health records and claims data to investigate whether CHAT-S improves surveillance care for recurrence at 18-month follow-up (secondary outcome). We will explore moderators (e.g., rurality, ethnicity) of the intervention effects. Finally, to inform future dissemination, we will conduct a budget impact analysis and a short-term and long-term time horizon cost-effectiveness analysis of CHAT-S. This proposal addresses the National Cancer Institute’s goal of improving the care of cancer survivors and mitigating financial toxicity. We will demonstrate that a virtual health insurance literacy intervention can improve insurance literacy, financial toxicity, and surveillance care among YA cancer survivors, and provide guidance to improving survivorship care across the United States.

抽象的癌症治疗结束后的第一年是建立年轻成人生存护理（YA）的关键时机癌症幸存者26至39岁。收到循证生存护理，包括癌症的监测基于国家准则的复发，在YA冲浪者中仍然很低。同时，YAS年龄在26岁至在美国成年人中，有39人的不感知和不足的比率最高。我们团队的先前工作证明YA癌症的存活报告报告对其健康保险及其服务的了解较低封面，会影响他们的护理能力。这些问题在一起可能会导致大量的护理机会该人群的障碍和严重的医疗成本后果。该提议解决了迫切需求改善YA癌症存活的健康保险素养并降低财务毒性，从而改善其能够获得推荐的生存护理。在安德森（Andersen）和阿达（Aday）的健康行为模型的指导下服务使用，我们开发并进行了试点测试的YA癌症的4条虚拟患者导航干预措施从儿童癌症生存的试点计划改编的幸存者。初始结果支持可行性，这两个试验试验的可接受性和初步效率，年龄在26至39岁之间。我们现在提出一项随机对照试验，以测试该计划的效率（“ CHAT-S”）以改善健康状况保险素养，由于医疗费用而导致的财务毒性以及治疗后的监视 YA癌症存活26至39岁。我们计划随机化n = 300（n = 200个干预; n = 100通常的护理）yas 在乳房，有证明的，淋巴瘤，肉瘤和结直肠癌的情况下完成了初始治疗过去一年，犹他大学医疗保健（UUHC）和Intermountain Healthcare（IH）的14个地点系统。 UUHC和IH有许多农村（20％）和西班牙裔/拉丁裔（18％）YA癌症的存活；我们将超过这些重要的亚组。我们将确定CHAT-S是否提高健康保险素养和6个月随访的财务毒性（主要结果）。此外，UUHC和IH具有集成数据基础架构使我们能够捕获电子健康记录并要求数据调查是否 CHAT-S改善了18个月随访（次要结果）的重复检查的监视护理。我们将探索干预效果的主持人（例如粗糙度，种族）。最后，为了告知未来的传播，我们将进行预算影响分析以及短期和长期范围的成本效益 CHAT-S的分析。该建议旨在解决国家癌症研究所的目标癌症幸存者并减轻财务毒性。我们将证明虚拟健康保险素养干预可以提高YA癌症的保险素养，财务毒性和监视护理幸存者，并为改善美国生存护理提供指导。