Patient Navigation in Gynecologic Oncology: Improving Care among Rural Endometrial Cancer Patients

妇科肿瘤患者导航：改善农村子宫内膜癌患者的护理

• 批准号: 10589236
• 负责人: Lisa Patterson Spees
• 金额: $ 13.48万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589236
• 关键词: Academic Medical Centers; Address; Adherence; Administrator; Cancer Patient; Caring; Cause of Death; Client satisfaction; Clinical Nurse Specialists; Colorectal Cancer; Data; Effectiveness; Endometrial Carcinoma; Ensure; Evidence based intervention; Future; Goals; Guidelines; Gynecologic Oncologist; Gynecologic Oncology; Health; Hospitals; Intervention; Intervention Studies; Interview; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Medical Oncology; Mission; Modeling; National Institute on Minority Health and Health Disparities; Oncology; Operative Surgical Procedures; Outcome; Outcome Study; Patients; Population; Quality of Care; Radiation Oncologist; Research; Research Methodology; Research Personnel; Rural; Rural Community; Structure; Testing; Time; Training; Travel; Treatment outcome; Underserved Population; Variant; Woman; barrier to care; cancer care; cancer health disparity; cancer therapy; care outcomes; community engaged research; cost; cost effective intervention; design; disorder risk; disparity reduction; effectiveness implementation design; effectiveness implementation study; effectiveness implementation trial; evidence base; health disparity; implementation design; implementation evaluation; implementation science; implementation strategy; improved; intervention mapping; malignant breast neoplasm; medically underserved; medically underserved population; mortality; novel; patient population; programs; rural area; rural disparities; rural dwellers; rural patients; systematic review; theories; therapy design; tool; treatment as usual; treatment disparity; urban area

PROJECT SUMMARY Rural residents with endometrial cancer (EC), the most prevalent gynecologic cancer in the US, have 8- 17% higher odds of mortality than their urban counterparts. As the number of new EC cases is expected to increase 50% by 2030, this urban-rural disparity is expected to continue widening. Contributing to this disparity is the reduced receipt of guideline-concordant treatment; in particular, rural patients with EC are less likely to receive comprehensive surgical care, the cornerstone of regional stage EC treatment. The overall objective of this project is to identify and target multilevel barriers to receiving guideline- concordant treatment among rural EC patients by developing and piloting a patient navigation intervention. Patient navigation interventions can address a multitude of barriers faced by medically underserved cancer patients and have been shown to shorten time to initiating treatment, increase receipt of and adherence to treatment, and improve patient satisfaction. However, because of the substantial variation in the design and delivery of patient navigation interventions, developing effective and cost-effective interventions for new contexts and populations has become a major challenge; among treatment-related patient navigation interventions, most have focused on patients with breast and colorectal cancers. Unlike these cancer patients, EC patients have different needs, such as requiring treatment to be directed by a gynecologic oncologist, who often are only located near urban areas or at academic medical centers. Only 10% of gynecologic oncologists practice in rural areas, and as a result, rural EC patients often travel far distances for care. In the proposed study, I will identify multilevel barriers to receiving guideline-concordant treatment among rural women with EC (Aim 1), use intervention mapping to design a patient navigation intervention (Aim 2), and pilot a patient navigation intervention (Aim 3). Using intervention mapping to design an EC navigation intervention will not only precisely target the multilevel barriers to treatment but also will optimize the fit and implementation of the navigation program within the gynecologic oncology setting. This approach is novel in that it integrates the identification of appropriate implementation strategies into the program’s design. This project will provide preliminary data for an R01 application to test the developed patient navigation intervention in a Type 1, hybrid effectiveness-implementation trial. The expected outcomes of this study will contribute to the National Institute on Minority Health and Health Disparities’ mission of using interventions to eliminate health disparities among medically underserved populations. Additionally, I will receive training in (1) community-engaged research methods to understand the multi-level determinants of cancer care equity, (2) designing interventions to fit specific populations and context, and (3) conducting intervention studies. This project will contribute to my long-term goal of becoming an independent investigator who develops and evaluates interventions to reduce disparities in cancer care and outcomes among underserved populations.

项目摘要 子宫内膜癌（EC）的农村居民是美国最普遍的妇科癌症，患有8-- 死亡率比其城市同行高17％。由于新EC案件的数量预计 到2030年增加了50％，预计这种城市农村差异将继续宽度。导致这种差异 是否减少了指导方案治疗的收到；特别是，EC的粗糙患者不太可能 接受全面的手术护理，这是区域阶段EC治疗的基石。 该项目的总体目的是确定和针对多层次障碍，以获得指南 - 通过开发和驾驶患者导航干预措施，在农村EC患者中进行一致治疗。 患者导航干预措施可以解决医疗服务不足的癌症面临的多种障碍 患者并已显示出缩短开始治疗的时间，增加收到并依从性 治疗并提高患者满意度。但是，由于设计和 提供患者导航干预措施，开发有效且具有成本效益的新干预措施 环境和人口已成为一个主要挑战。在与治疗有关的患者导航中 干预措施，大多数专注于乳腺癌和有色癌症的患者。与这些癌症患者不同， EC患者有不同的需求，例如需要由妇科肿瘤学家指导的治疗，他 通常仅位于城市地区或学术医疗中心。只有10％的妇科肿瘤学家 在农村地区进行练习，结果，农村EC患者经常走很远的护理距离。在提议中 研究，我将确定在EC的农村妇女中接受指导方案治疗的多层次障碍 （AIM 1），使用干预映射设计患者导航干预（AIM 2），然后驾驶患者 导航干预（AIM 3）。使用干预映射设计EC导航干预不会 仅准确针对多层治疗障碍，但也将优化 妇科肿瘤设置中的导航计划。这种方法是新颖的，因为它整合了 将适当的实施策略标识到该计划的设计中。 该项目将为R01应用程序提供初步数据，以测试开发的患者导航 干预1型混合有效性试验。这项研究的预期结果将 为国家少数民族健康与健康差异的使命做出贡献，即使用干预措施 消除了医学不足的人群中的健康差异。此外，我将接受（1）的培训 社区参与的研究方法了解癌症护理公平的多层次决定者，（2） 设计干预措施以适合特定人群和环境，以及（3）进行干预研究。这 项目将有助于我成为发展和发展的独立调查员的长期目标 评估干预措施以减少癌症护理的差异和服务不足人群的结果。