Improving adherence to posttreatment follow-up care for rural lung cancer survivors through a community-clinical survivorship care team model

通过社区临床生存护理团队模式提高农村肺癌幸存者治疗后随访护理的依从性

• 批准号: 10283707
• 负责人: Marquita W. Lewis-Thames
• 金额: $ 16.76万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10283707
• 关键词: Active Learning; Address; Adherence; Adopted; Advocate; Aftercare; Cancer Center; Cancer Control; Cancer Survivor; Cancer Survivorship; Caregivers; Caring; Clinical; Communities; Community Health; Community Health Aides; Cost Analysis; County; Data; Development; Distal; Division of Cancer Control and Population Sciences; Early Diagnosis; Economics; Exploration, Preparation, Implementation, and Sustainment; Face; Financial Hardship; Financial Support; Future; Geography; Goals; Health; Health Care Costs; Health Professional; Incidence; Intervention; Interview; Light; Link; Literature; Malignant neoplasm of lung; Mentors; Mentorship; Methods; Modeling; Monitor; Oncologist; Outcome; Participant; Patients; Phase; Preparation; Process; Program Development; Provider; Recommendation; Recurrence; Research; Research Project Grants; Resources; Role; Rural; Rural Appalachia; Rural Community; Site; Social Workers; Specialist; Support Groups; Survival Rate; Survivors; Time; Training; Travel; Treatment outcome; Trust; Universities; Visit; acceptability and feasibility; barrier to care; base; cancer care; cancer health disparity; care coordination; care outcomes; career; clinical care; disparity elimination; early screening; effectiveness implementation trial; feasibility testing; follow-up; group counseling; health disparity; implementation cost; implementation framework; implementation science; improved; improved outcome; insight; medically underserved; member; programs; rural area; rural dwellers; rurality; screening; side effect; skills; social; social health determinants; socioeconomics; success; survival disparity; survivorship; sustainability framework; symptom management; telehealth; therapy development; trial design; urban setting

Project/Summary: Rural lung cancer survival rates have lagged behind the national average for decades. A key contributor to recent survival disparities is fragmented survivorship care, leaving rural survivors without supports to facilitate survivorship care and adherence to follow-up care. Rural survivors often receive their care from specialists located in distal, urban centers, where travel, social, and financial burdens threaten adherence to follow-up care. Further, urban healthcare professionals are unaware of rural resources and encumbered by finding rural community resources needed to overcome barriers to care. Thus, a community-clinical survivorship care team is a promising strategy to improve timely follow-up care and provide linkages to community resources. A rural community health worker (CHW) that is knowledgeable about local resources and the socio-economic barriers to survivorship care is a fitting community agent on a community-clinical team. The success of community-clinical care teams to improve care coordination and health outcomes is well documented, but few of these studies investigate rural survivorship care or the integration of a CHW in the team model. Also, a gap in the literature exists regarding the implementation of a CHW-clinical survivorship care team model to improve rural survivorship outcomes. To address this critical gap, the research examines the implementation of a CHW- clinical survivorship care team to improve adherence to follow-up care for rural lung cancer survivors. The aims of this project are to 1) assess perspectives on desired CHW roles and their processes for interacting with clinical care team members in a community-clinical survivorship care team; 2) test the feasibility and initial acceptability of CENTRAL, and 3) evaluate the implementation of CENTRAL to identify factors that influence its sustained use in a multi-site effectiveness-implementation trial design R01. CENTRAL will be adapted from an existing patient navigation research program, and interviews with key stakeholders to inform CHW roles and processes for working with clinical care teams (Aim 1). Dr. Lewis-Thames will pilot CENTRAL (N=60) with rural lung cancer survivors to assess its acceptability and feasibility (Aim 2). Aim 3 will provide insights on facilitators and barriers of implementing CENTRAL via the EPIS (exploration, preparation, implementation, sustainment) implementation framework through an analysis of implementation costs and interviews with CENTRAL participants, CHWs and providers. This K01 involves a training plan consisting of coursework, seminars, experiential learning, and mentorship by an established team of experts. The research is conducted at Northwestern University and affiliated rural-serving Cancer Centers which offer superior facilities and resources to provide training in intervention development and adaption, implementation science, cost-analysis, and rural survivorship care. The outlined training plan will enable Dr. Lewis-Thames to accomplish her long-term career goal to become an independent cancer disparities implementation. The proposed project is relevant to the NCI's Division of Cancer Control and Population Science research emphasis on rural cancer control and health disparities.

项目/总结：农村地区肺癌存活率几十年来一直落后于全国平均水平。一个关键