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

• 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
• 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

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为年轻人 (YA) 建立生存护理的关键时期 26 至 39 岁的癌症幸存者。接受循证幸存者护理，包括癌症监测 根据国家指南，26 岁至 26 岁的青少年幸存者中的复发率仍然较低。 在我们团队之前的研究中，39 人的无保险和保险不足率最高。 YA 癌症幸存者对他们的健康保险及其服务了解甚少 覆盖，这会影响他们获得护理的能力，这些问题可能会导致他们获得大量护理的机会。 该提案解决了这一人群的迫切需求。 提高青少年癌症幸存者的健康保险素养并减少经济毒性，从而改善他们的健康状况 接受安徒生和阿戴健康行为模型指导下推荐的生存护理的能力。 服务使用，我们开发并试点测试了针对 YA 癌症的 4 次虚拟患者导航干预 改编自儿童癌症幸存者试点计划的幸存者，初步结果支持可行性， 这两项针对 26 至 39 岁青少年青少年幸存者的试点试验的可接受性和初步效果。我们现在 提出一项随机对照试验来测试该计划（“CHAT-S”）改善健康的功效 保险素养、医疗费用造成的经济毒性以及治疗后复发监测 年龄为 26 至 39 岁的 YA 癌症幸存者。我们计划随机分配 N=300 名 YA（N=200 名干预；N=100 名常规护理）YA 患有乳腺癌、睾丸癌、淋巴瘤、肉瘤和结直肠癌并已在 过去一年来自犹他大学医疗保健 (UUHC) 和山间医疗保健 (IH) 的 14 个地点 UUHC 和 IH 有许多农村 (20%) 和西班牙裔/拉丁裔 (18%) 青少年癌症幸存者； 我们将确定 CHAT-S 是否可以提高健康保险知识。 此外，UUHC 和 IH 还拥有综合数据。 基础设施使我们能够捕获电子健康记录和索赔数据，以调查是否 CHAT-S 改善了 18 个月随访时复发的监测护理（次要结果）。 探索干预效果的调节因素（例如农村、种族）最后，为未来的传播提供信息。 我们将进行预算影响分析以及短期和长期的成本效益 CHAT-S 的分析该提案解决了国家癌症研究所改善患者护理的目标。 我们将展示虚拟健康保险知识。 干预可以提高青少年癌症患者的保险素养、财务毒性和监测护理 幸存者，并为改善美国各地的幸存者护理提供指导。