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：每年新增 40 万人口中，低收入和中等收入国家 (LMIC) 占 85% 以上。中低收入国家确诊的儿童癌症病例的存活率为 5-25%，而高收入国家的存活率为 80%。（高收入国家）。造成这种差异的最大因素是许多社会、卫生系统的放弃。个人水平的障碍影响治疗放弃，包括护理人员对癌症的了解较低及其治疗、社会规范、获得癌症护理的低认知行为自我控制、成本和有限布甘多医疗中心 (BMC) 是该国三所儿童癌症转诊医院之一。 2014 年，坦桑尼亚的治疗放弃率为 40%，2 年总生存率为 20%。杜克大学建立了合作能力开发和研究伙伴关系，并开发了多项针对低支持性护理基础设施和成本的干预措施，提供免费的患者住房、患者导航计划和化疗对家庭来说是免费的，这减少了放弃治疗的情况 40% 至 23% 然而，虽然护理人员教育是 HIC 的标准做法，但仍实施先前设计的教育。针对照顾者知识、态度和自控能力的干预措施一直具有挑战性，因为人力资源有限且社区识字率<50% 迫切需要创新。解决完成治疗障碍的教育策略，例如视频或数字健康策略。画外音可以为提供者主导的教育提供一种重要的替代方式，但尚未得到评估该多学科国际团队之前曾在中低收入国家中使用或对治疗产生影响。开发了mNavigator，基于平板电脑的数字病例管理系统，可记录人口统计数据和结果数据并根据提供者输入的临床信息提供定制的治疗指导。该提案旨在利用这一既定技术来评估两个数字化教育战略的改进护理人员关于孩子癌症诊断及其治疗的知识：1) 多媒体教育模块通过诊所平板电脑访问，以及 (2) 直接发送到护理人员手机的有针对性的教育短信。在 R21 阶段，我们寻求在数字和文化上适应教育媒体，并评估护理人员对教育媒体的接受程度在 R33 阶段，我们将使用析因研究设计来评估其影响进行比较。关于放弃治疗的标准化教育将由我们坚强的家长指导。和利益相关者咨询委员会以及利用实施科学原则促进最终用户参与，不仅有助于我们了解儿科数字健康教育背景下的有效方法坦桑尼亚主导的数字媒体适应和年度坦桑尼亚童年。癌症顾问委员会会议将提供移动医疗应用程序使用培训的机会，讨论未来的合作研究，并为扩大和传播提供指导国家确保持续的移动医疗研究机会远远超出当前的提案。