Multimedia caregiver education program to improve outcomes for children with cancer in low-resource settings

多媒体护理人员教育计划可改善资源匮乏地区癌症儿童的治疗结果

基本信息

批准号：
10739825
负责人：
Kristin Schroeder
金额：
$ 36.94万
依托单位：
DUKE UNIVERSITY
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：
2023-09-22 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10739825
关键词：
Address Attitude Behavioral Benchmarking Cancer Patient Cancer Survivorship Caregivers Case Management Child Clinic Clinical Clinical Data Collaborations Communities Comprehension Consensus Country Data Data Collection Diagnosis Disparity E-learning Education Educational Materials Ensure Equity Evaluation Family Feedback Foundations Funding Future Goals Health Educators Health education Health system Home Hospital Referrals Housing Human Resources Income Individual Infrastructure International Intervention Knowledge Learning Module Malignant Childhood Neoplasm Malignant Neoplasms Medical Medical center Methods Mobile Health Application Modality Multimedia Newly Diagnosed Outcome Parents Patient Abandonment Patient-Focused Outcomes Patients Phase Printing Process Provider Psychosocial Assessment and Care Quality of Care Randomized Records Research Research Design Research Project Grants Research Support Residual state Resource-limited setting Resources Scientific Advances and Accomplishments Self Administration Self-control as a personality trait Site Supportive care Survival Rate System Tablet Computer Tablets Tanzania Technology Telephone Text Text Messaging Time Treatment Side Effects Voice Work academic standard acceptability and feasibility barrier to care cancer care cancer diagnosis cancer education cancer survival cancer therapy care costs care providers caregiver education chemotherapy cost cost effectiveness digital digital health digital media effectiveness evaluation experience health training implementation determinants implementation science improved improved outcome individualized medicine innovation literacy low and middle-income countries mHealth meetings multidisciplinary patient navigation patient navigator pediatric patients programs research and development routine practice satisfaction scale up social norm social stigma standard of care successful intervention survival disparity therapy design therapy development training opportunity treatment planning

项目摘要

ABSTRACT: Each year, low- and middle-income countries (LMICs) account for over 85% of the 400,000 newly diagnosed pediatric cancer cases. Survival rates in LMICs are 5-25% compared to 80% in high-income countries (HICs). The largest single contributor to this disparity is treatment abandonment. Many societal, health system, and individual level barriers impact treatment abandonment, including low caregiver knowledge about cancer and its treatment, social norms, low perceived behavioral self-control to obtain cancer care, cost and limited supportive infrastructure. At Bugando Medical Centre (BMC), one of three childhood cancer referral hospitals in Tanzania, treatment abandonment rates were 40% with a 20% 2-year overall survival rate. In 2014, BMC and Duke formed a collaborative capacity development and research partnership and developed several interventions targeting low supportive care infrastructure and cost, providing free patient housing, a patient navigation program, and chemotherapy at no cost to the families, which reduced treatment abandonment from 40 to 23%. However, while caregiver education is standard in HIC, implementation of previously designed interventions targeting caregiver knowledge, attitudes and perceived self-control have been challenging due to human resource limitations and community literacy rates of <50%. There is an urgent need for innovative education strategies to address this barrier to treatment completion. Digital health strategies such as videos or voice-overs can provide an important alternative modality to provider-led education but have not been evaluated for use in LMIC settings or for their impact on treatment. This multidisciplinary international team previously developed mNavigator, a tablet-based digital case management system that records demographic and outcome data and provides tailored treatment guidance based on provider entered clinical information. This R21/R33 proposal seeks to leverage this established technology to evaluate two digital education strategies to improve caregiver knowledge about their child’s cancer diagnosis and its treatment: 1) multimedia education modules accessed on clinic tablets and (2) targeted education text messages sent directly to the caregiver’s phone. In the R21 phase, we seek to digitally and culturally adapt education media and evaluate caregiver acceptance of developed content. In the R33 phase, we will use a factorial study design to evaluate their impact as compared to standard education on treatment abandonment. Intervention development will be guided by our strong parent and stakeholder advisory board and the use of implementation science principles for end user engagement, to contribute to our understanding of not only what works in the context of digital health education for pediatric cancer but how it works. The proposed Tanzanian led digital media adaptation and annual Tanzanian childhood cancer advisor board meetings will provide opportunities for training on the use of mHealth applications, discussion of future collaborative research, and provide guidance on scale up and dissemination within the country to ensure continued mHealth research opportunities extending well beyond this current proposal.

摘要：每年，低收入和中等收入国家（LMIC）占40万新近的85％以上诊断为小儿癌病例。 LMIC的生存率为5-25％，而高收入国家为80％（HICS）。造成这种差异的最大贡献者是遗弃治疗。许多社会，卫生系统，个人水平障碍会影响遗弃的治疗，包括对癌症的低照顾者知识及其治疗，社会规范，低感知的行为自我控制，以获得癌症护理，成本和有限支持基础架构。在Bugando医疗中心（BMC），这是三个儿童癌症转诊医院之一坦桑尼亚，治疗遗弃率为40％，2年总生存率为20％。 2014年，BMC和杜克建立了协作能力发展和研究合作伙伴关系，并开发了几个针对低支持护理基础设施和成本，提供免费患者住房的干预措施，患者导航计划和化学疗法无需支付家庭，从而减少了治疗的遗弃 40％至23％。但是，尽管护理人员教育在HIC中是标准的，但以前设计的实施针对护理人员知识，与会者和感知自我控制的干预措施已受到挑战人力资源限制和社区识字率<50％。迫切需要创新教育策略以解决这一治疗障碍的障碍。数字健康策略，例如视频或配音可以为提供者主导的教育提供重要的替代方式，但尚未评估用于LMIC环境或对治疗的影响。这个多学科国际团队以前发达的mnavigator，基于平板电脑的数字案例管理系统，记录人口统计学和结果数据并根据提供者输入的临床信息提供量身定制的治疗指南。此R21/R33 提案旨在利用这项既定技术来评估两个改进的数字教育策略护理人员了解孩子的癌症诊断及其治疗：1）多媒体教育模块可在诊所平板电脑和（2）个有针对性的教育短信直接发送给护理人员手机上。在 R21阶段，我们试图通过数字和文化适应教育媒体并评估护理人员接受开发内容。在R33阶段，我们将使用阶乘研究设计来评估它们的影响对遗弃治疗的标准教育。干预开发将由我们的坚强父母指导以及利益相关者顾问委员会以及使用实施科学原则来最终用户参与，不仅有助于我们对小儿数字健康教育的有效工作的理解癌症但是它的工作原理。拟议的坦桑尼亚LED数字媒体改编和年度坦桑尼亚童年癌症顾问董事会会议将为使用MHealth应用程序提供培训的机会，讨论未来的合作研究，并提供规模和传播的指导确保继续MHealth研究机会的国家范围超出了当前的建议。