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: 10684621
• 负责人: Marquita W. Lewis-Thames
• 金额: $ 13.06万
• 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/10684621
• 关键词: Active Learning; Address; Adherence; Adopted; Advocate; Aftercare; Cancer Center; Cancer Control; Cancer Survivor; Cancer Survivorship; Caregivers; Caring; Clinical; Communities; Community Developments; Community Health; Community Health Aides; Cost Analysis; Counseling; 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; Managed Care; Mentors; Mentorship; Methods; Modeling; Monitor; Oncologist; Outcome; Participant; Patients; Phase; PrP gene; 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; Training; Travel; Treatment outcome; Trust; Universities; Urban Health; Visit; acceptability and feasibility; barrier to care; cancer care; cancer health disparity; care coordination; career; clinical care; community engagement; disparity elimination; early screening; effectiveness/implementation trial; feasibility testing; follow-up; health disparity; implementation cost; implementation evaluation; implementation framework; implementation science; improved; improved outcome; insight; medically underserved; member; outcome disparities; patient navigation; patient navigator; programs; rural area; rural dwellers; rurality; screening; side effect; skills; social; social health determinants; socioeconomics; success; survival disparity; survivorship; 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：数十年来，农村肺癌生存率落后于全国平均水平。钥匙 最近生存差异的贡献者是分散的生存护理，而农村幸存者没有支持 促进生存护理和遵守后续护理。农村幸存者经常从 位于城市中心远端的专家，旅行，社会和经济负担威胁着遵守 后续护理。此外，城市医疗保健专业人员没有意识到农村资源，而是由 找到克服护理障碍所需的农村社区资源。因此，社区临床生存 护理团队是一种有希望的策略，可以改善及时的后续护理并提供与社区资源的联系。 对当地资源和社会经济知识渊博的农村社区卫生工作者（CHW） 生存护理的障碍是社区临床团队的合适社区代理。成功的成功 社区临床护理团队改善了护理协调和健康成果，但很少有 在这些研究中，研究了农村生存护理或团队模型中CHW的整合。另外，差距 文献存在有关实施CHW临床生存护理团队模型的文献 农村生存结果。为了解决这个关键的差距，研究研究了CHW-的实施 临床生存护理团队，以提高对农村肺癌幸存者的后续护理的依从性。目的 该项目的内容是1）评估有关所需的CHW角色的观点及其与临床互动的过程 社区临床生存护理团队的护理团队成员； 2）测试可行性和初始可接受性 中央和3）评估中央的实施，以确定影响其持续的因素 在多站点有效性试验设计R01中使用。中央将从现有的 患者导航研究计划，以及与主要利益相关者的访谈以告知CHW角色和流程 与临床护理团队合作（AIM 1）。刘易斯 - 塔姆斯博士将与农村肺癌一起试行中央（n = 60） 幸存者评估其可接受性和可行性（AIM 2）。 AIM 3将提供有关促进者和障碍的见解 通过EPIP（探索，准备，实施，维持）实施实施中心的实施 通过分析实施成本和中央参与者，CHW和访谈的框架 提供者。该K01涉及一个培训计划，包括课程工作，研讨会，体验式学习和 由既定的专家团队的指导。该研究是在西北大学和 附属的农村服务癌症中心，提供了卓越的设施和资源来提供培训 干预开发和适应，实施科学，成本分析和农村生存护理。这 概述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，成为一个 独立的癌症差异实施。拟议的项目与NCI的癌症分工有关 控制与人口科学研究的重点是农村癌症控制和健康差异。

项目成果

Examining Access to Digital Technology by Race and Ethnicity and Child Health Status Among Chicago Families.

• DOI: 10.1001/jamanetworkopen.2022.28992
• 发表时间: 2022-08-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Kan, Kristin;Heard-Garris, Nia;Bendelow, Anne;Morales, Lu;Lewis-Thames, Marquita W.;Davis, Matthew M.;Heffernan, Marie
• 通讯作者: Heffernan, Marie

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

• DOI: 10.1007/s10552-022-01599-2
• 发表时间: 2022-08
• 期刊: CANCER CAUSES & CONTROL
• 影响因子: 2.3
• 作者: Hirko, Kelly A.;Xu, Huiwen;Rogers, Laura Q.;Martin, Michelle Y.;Roy, Siddhartha;Kelly, Kimberly M.;Christy, Shannon M.;Ashing, Kimlin Tam;Yi, Jean C.;Lewis-Thames, Marquita W.;Meade, Cathy D.;Lu, Qian;Gwede, Clement K.;Nemeth, Julianna;Ceballos, Rachel M.;Menon, Usha;Cueva, Katie;Yeary, Karen;Klesges, Lisa M.;Baskin, Monica L.;Alcaraz, Kassandra I.;Ford, Sabrina
• 通讯作者: Ford, Sabrina