A multi-level mixed methods examination of treatment non-adherence among rural oncology patients

农村肿瘤患者治疗不依从性的多层次混合方法检查

• 批准号: 10017930
• 负责人: Bonny Morris
• 金额: $ 3.92万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-13 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017930
• 关键词: Address; Adherence; Age-Years; Area; Automobile Driving; Award; Behavioral; Cancer Control; Cancer Hospital; Cancer Patient; Cancer Survivor; Characteristics; Classification; Clinical; Code; Communities; Computerized Medical Record; Continuity of Patient Care; Data; Development; Division of Cancer Control and Population Sciences; Ecological momentary assessment; Education; Electronic Mail; Enabling Factors; Family; Fellowship; Funding; Future; Generations; Geography; Goals; Health; Health Insurance Portability and Accountability Act; Health Technology; Healthcare; Intervention; Interview; Malignant Neoplasms; Mediating; Methodology; Methods; Mind; Motivation; Oncology; Outcome; Participant; Patients; Patterns of Care; Phase; Population; Positioning Attribute; Postdoctoral Fellow; Probability Samples; Provider; Psychiatric Social Work; Research; Research Personnel; Research Project Grants; Research Training; Rural; Rural Community; Rural Population; Sampling; Self Management; Structure; Surveys; Survivors; System; Target Populations; Technology; Text Messaging; Time; Training; Treatment outcome; Underserved Population; Voice; base; cancer health disparity; cancer prevention; cancer therapy; care coordination; care delivery; cohort; cost; design; digital; emerging adult; experience; health care availability; health disparity; implementation science; improved; improved outcome; innovation; member; mobile application; mortality; multidisciplinary; neglect; neoplasm registry; patient engagement; patient population; personalized approach; population based; pre-doctoral; prospective; protective factors; recruit; rural area; rural cancer care; rural dwellers; rural health disparities; secondary outcome; skills; social; sociodemographics; tailored messaging; theories; treatment adherence; urban disparity

Project Summary. The nearly 3 million US cancer survivors residing in rural areas experience 10% higher cancer mortality compared to their urban counterparts, in part due to poorer cancer treatment adherence. Reasons for rural-urban disparities in cancer treatment adherence are not fully understood. The majority of research to-date has focused on health claims data and small-sample survey data. Moreover, extant data has often neglected the protective and enabling factors that are characteristic of rural communities. A deeper understanding of factors driving cancer treatment non-adherence in rural populations is necessary to design targeted, asset-based interventions to reduce rural health disparities and improve outcomes. The premise of the proposed research is that multi-level factors contribute to the observed rural-urban differences in cancer treatment adherence and outcomes, including sociodemographic inequities and diminished access to healthcare, psychosocial services, and technological advances. Rural cultural factors serve as barriers and facilitators to treatment adherence and may be positively impacted by digitally-mediated interventions. The purpose of the proposed research is to elucidate social and behavioral factors encompassing rural culture as it relates to oncology treatment non-adherence and delineate factors amenable to targeted, tailored approaches to improve rural oncology outcomes. These goals will be accomplished by a rigorous mixed methods approach utilizing population-based surveys, semi-structured interviews, and ecological momentary assessment, supported by community engagement across study phases to capitalize on strengths of rural culture while minimizing barriers. A highly qualified multi-disciplinary team has been assembled to support my research and training goals in mixed methodology and rural community engagement. The proposed F99/K00 application targets the NCI's emerging priority of rural cancer control and aligns with current NCI funding initiatives in rural oncology and implementation science. Completion of this unique pre to post-doctoral fellowship transition award will provide me with the skills and experience necessary to be a highly trained cancer control researcher with specific expertise in 1) rural populations, 2) health disparities, 3) patterns of care, and 4) care coordination and delivery - four of the seven NCI Division of Cancer Control and Population Sciences areas of research emphasis, thus expertly preparing me to advance the field of rural cancer control through the development of innovative and scalable interventions addressing the self-management support needs of this underserved population.

项目摘要。居住在农村地区的近 300 万美国癌症幸存者的生存率高出 10% 与城市同行相比，癌症死亡率较高，部分原因是癌症治疗依从性较差。 城乡癌症治疗依从性差异的原因尚不完全清楚。大多数 迄今为止的研究主要集中在健康声称数据和小样本调查数据上。而且，现有资料有 往往忽视了农村社区特有的保护性和有利因素。更深层次的 了解导致农村人口不遵守癌症治疗的因素对于设计 有针对性的、基于资产的干预措施，以减少农村健康差距并改善结果。前提是 拟议的研究表明，多层次因素导致了所观察到的城乡癌症差异 治疗依从性和结果，包括社会人口不平等和获得治疗的机会减少 医疗保健、心理社会服务和技术进步。乡村文化因素成为障碍 促进治疗依从性，并可能受到数字介导干预措施的积极影响。这 拟议研究的目的是阐明农村文化的社会和行为因素，因为它 与肿瘤治疗不依从性相关，并明确了适合有针对性的、量身定制的方法的因素 改善农村肿瘤治疗结果。这些目标将通过严格的混合方法来实现 利用基于人口的调查、半结构化访谈和生态瞬时评估， 在整个学习阶段的社区参与的支持下，利用乡村文化的优势，同时 最大限度地减少障碍。已经组建了一支高素质的多学科团队来支持我的研究和 混合方法和农村社区参与的培训目标。拟议的 F99/K00 应用 针对 NCI 农村癌症控制这一新兴优先事项，并与 NCI 目前在农村地区的资助计划保持一致 肿瘤学和实施科学。完成这一独特的博士前奖学金过渡 该奖项将为我提供成为一名训练有素的癌症控制研究人员所需的技能和经验 具有 1) 农村人口、2) 健康差异、3) 护理模式和 4) 护理协调方面的具体专业知识 和交付 - NCI 癌症控制和人口科学部门七个研究领域中的四个 重点，从而使我做好准备，通过开发以下项目来推进农村癌症控制领域： 创新且可扩展的干预措施，满足服务不足的群体的自我管理支持需求 人口。