Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer
Communicating health information and improving coordination with primary care (CHIIP): Rationale and design of a randomized cardiovascular health promotion trial for adult survivors of childhood cancer
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DOI：
10.1016/j.cct.2019.105915
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发表时间：
2020-02-01
影响因子：
2.2
通讯作者：
Oeffinger, Kevin C.
中科院分区：
文献类型：
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作者：
Chow, Eric J.;Baldwin, Laura-Mae;Oeffinger, Kevin C.
背景：被诊断患有癌症的儿童的长期存活率超过80%。值得注意的是，过早的心血管疾病已成为领先的非癌症的原因，这些survivors.Methods/设计之间的晚期mortality：这个随机对照试验（RCT; NCT 03104543）的重点是成年参与者在儿童癌症幸存者研究确定为缺血性心脏病或心力衰竭的高风险，由于他们的癌症治疗。参与者接受基于家庭的血压评估和实验室检查，以确定未诊断和/或治疗不足的高血压，血脂异常和糖尿病的患病率。然后，将那些具有异常值的患者纳入RCT，以测试为期12个月的个性化远程交付生存护理计划（SCP）干预的有效性，该干预旨在减少这三种目标疾病的治疗不足。该干预措施近似于一个临床的遭遇，是基于慢性病自我管理strategies.Results：与750的目标，目前有342 742符合条件的参与者接近已登记（46.1%）。最初，我们将参与者随机分配到不同的招募策略，包括更短的方法包和分层同意，但没有发现参与率的显著差异（40.7%至42.9%; p = 0.95）。随后，随着前期无条件激励支票的增加，参与率略有提高（50美元对25美元：50.7%对44.1%; p = 0.10）。总的来说，50美元的前期激励的财务影响是成本中性的，并可能节省成本，与25美元的前期incentive.Conclusion：整体研究将确定如果美国国家医学院推荐的SCP干预可以改善儿童癌症长期幸存者的心血管结局。随着时间的推移，修改征聘战略可能会提高参与率。
Background: Long-term survival for children diagnosed with cancer exceeds 80%. Notably, premature cardiovascular disease has become the leading non-cancer cause of late mortality among these survivors.Methods/design: This randomized controlled trial (RCT; NCT03104543) focuses on adult participants in the Childhood Cancer Survivor Study identified as high risk for ischemic heart disease or heart failure due to their cancer treatment. Participants undergo a home-based evaluation of blood pressure and laboratory tests to determine the prevalence of undiagnosed and/or undertreated hypertension, dyslipidemia, and diabetes. Those with abnormal values are then enrolled in an RCT to test the efficacy of a 12-month personalized, remotely delivered survivorship care plan (SCP) intervention designed to reduce undertreatment of these three target conditions. The intervention approximates a clinical encounter and is based on chronic disease self-management strategies.Results: With a goal of 750, currently 342 out of 742 eligible participants approached have enrolled (46.1%). Initially, we randomized participants to different recruitment strategies, including shorter approach packets and a tiered consent, but did not find significant differences in participation rates (40.7% to 42.9%; p = .95). Subsequently, slightly greater participation was seen with larger upfront unconditional incentive checks ($50 vs. $25: 50.7% vs. 44.1%; p = .10). Overall, the financial impact of the $50 upfront incentive was cost neutral, and possibly cost-saving, vs. a $25 upfront incentive.Conclusion: The overall study will determine if a National Academy of Medicine-recommended SCP intervention can improve cardiovascular outcomes among long-term survivors of childhood cancer. Modifications to the recruitment strategy may improve participation rates over time.