The EPICS (Engaging Primary care in Cancer Survivorship) study: A trial of novel models of care for cancer survivors
EPICS(癌症幸存者的初级保健)研究:癌症幸存者护理新模式的试验
基本信息
- 批准号:10418631
- 负责人:
- 金额:$ 73.97万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-06-01 至 2025-05-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAftercareAgeBreast Cancer Risk FactorBreast Cancer survivorCaliforniaCancer DetectionCancer ModelCancer PatientCancer SurvivorCancer SurvivorshipCaringChronic DiseaseCluster randomized trialColonoscopyColorectal CancerCommunicationCommunitiesComplexComputerized Medical RecordDataDetectionDiseaseEffectivenessGrowthGuidelinesHealthcareHealthcare SystemsHospitalizationHospitalsIndividualInstitutionIntegrated Health Care SystemsInternationalKnowledgeLate EffectsLipidsLiteratureLocalized DiseaseLong-Term EffectsMalignant NeoplasmsMammographyMeasuresMedicalMedical centerModelingNatureNewly DiagnosedObservational StudyOncologyOutcomePatient Outcomes AssessmentsPatientsPerceptionPhasePhysiciansPilot ProjectsPopulationPreventive carePrimary Health CareProviderQuality of CareQuality of lifeRecurrenceReportingResearchResourcesRiskRisk ManagementSelf EfficacyServicesStructureSurvivorsSystemTestingTimeTrainingVaccinationWorkbasecancer carecancer recurrencecancer therapycardiovascular risk factorcare coordinationcare deliverycare providerscare systemscomorbiditydisorder preventionefficacy testinghealth care settingsimprovedmalignant breast neoplasmnovelpatient populationpatient-clinician communicationpreferenceprimary outcomeprospectivepsychosocialrandomized trialrisk stratificationsecondary outcomesurvivorshiptreatment as usualtrial comparingurgent care
项目摘要
PROJECT SUMMARY/ABSTRACT
Significant growth in the number of cancer patients, particularly those ≥65 years, is predicted within the U.S
over the next 20 years. The majority of these patients will enter into a prolonged post-treatment survivorship
phase of care. However, we are currently facing unprecedented challenges in survivorship care delivery.
Serious gaps in the care of survivors have been identified, including underuse of guideline-recommended
cancer surveillance services, such as annual mammography for breast cancer survivors and colonoscopy for
colorectal cancer (CRC) survivors, and underuse of recommended preventive care services such as
vaccinations, lipid testing and cardiovascular risk management, and disease screenings. Compounding these
issues, our current oncology workforce is insufficient to care for the rapidly growing population of survivors.
Primary care provider (PCP)-led survivorship care is a feasible model of survivorship care. In observational
studies, survivors who receive care that involves PCPs received higher quality of care; international
randomized trials comparing PCP-led to oncology-led survivorship care have shown no significant differences
in time to detection of cancer recurrence or quality of life for early-stage survivors. However, there is a paucity
of high-quality research on models of survivorship care in the U.S, particularly in community-based settings,
seriously limiting our ability to provide high-quality cancer survivorship care. To address these issues, we will
conduct a prospective cluster randomized trial of two models of cancer survivorship care in early-stage, low-
risk breast cancer and CRC survivors cared for in a community-based, integrated health care setting. Building
on our pilot work and drawing on the empirical literature, we will test the efficacy of an embedded PCP model
(experimental condition) in which PCPs are embedded within an oncology practice and will care for low-risk
survivors who will be transitioned at 12 months post-treatment. These PCPs will be given training in cancer
survivorship care focused on cancer surveillance and chronic disease prevention. This model will be compared
to the extant oncology physician model (usual care) that is the default condition in this healthcare system. The
primary outcome will be receipt of guideline-recommended care (e.g., cancer surveillance, preventive care),
assessed over a 36-month period. Secondary outcomes will include patient-reported outcomes using validated
measures of patient-provider communication, care coordination, quality of life, self-efficacy in managing care,
and other measures. We will also compare utilization of unplanned care (hospitalizations, urgent care) and
receipt of non-recommended care. We will explore PCP perceptions of confidence in delivery of survivorship
care. We will conduct this trial in 8 large, hospital-based medical centers of an integrated health care system,
Kaiser Permanente Southern California, with approximately 2,000 early-stage breast and CRC survivors. Our
results will provide more definitive evidence on the effectiveness of a scalable model of PCP-led survivorship
care, addressing the critical shortage of oncology providers while maintaining or improving quality.
项目概要/摘要
预计美国癌症患者数量将显着增长,尤其是 65 岁以上的患者
未来20年。这些患者中的大多数将进入长期治疗后生存期
护理阶段。然而,我们目前在幸存者护理服务方面面临着前所未有的挑战。
已发现幸存者护理方面存在严重差距,包括未充分利用指南建议的措施
癌症监测服务,例如每年为乳腺癌幸存者进行乳房X光检查,为乳腺癌幸存者提供结肠镜检查
结直肠癌 (CRC) 幸存者,以及未充分利用推荐的预防性护理服务,例如
疫苗接种、血脂检测和心血管风险管理以及疾病筛查。复合这些
问题在于,我们目前的肿瘤学人力不足以照顾快速增长的幸存者群体。
初级保健提供者(PCP)主导的生存护理是一种可行的生存护理模式。在观察中
研究表明,接受 PCP 参与护理的幸存者获得了更高质量的护理;国际的
比较 PCP 主导的生存护理与肿瘤学主导的生存护理的随机试验显示没有显着差异
及时检测癌症复发或早期幸存者的生活质量。然而,还有一个不足
对美国幸存者护理模式的高质量研究,特别是在社区环境中,
严重限制了我们提供高质量癌症生存护理的能力。为了解决这些问题,我们将
对早期、低水平癌症生存护理的两种模式进行前瞻性整群随机试验
高危乳腺癌和结直肠癌幸存者在基于社区的综合医疗保健环境中得到护理。建筑
根据我们的试点工作并借鉴实证文献,我们将测试嵌入式 PCP 模型的有效性
(实验条件)PCP 融入肿瘤学实践并将照顾低风险
幸存者将在治疗后 12 个月发生转变。这些 PCP 将接受癌症培训
生存护理的重点是癌症监测和慢性病预防。这个模型将被比较
现有的肿瘤医生模式(常规护理)是该医疗保健系统的默认条件。这
主要结局将是接受指南推荐的护理(例如癌症监测、预防性护理),
评估为期 36 个月。次要结果将包括使用经过验证的患者报告的结果
患者与提供者沟通、护理协调、生活质量、护理管理自我效能的衡量标准,
及其他措施。我们还将比较计划外护理(住院、紧急护理)和
接受非推荐的护理。我们将探讨 PCP 对生还者信心的看法
关心。我们将在 8 个大型综合医疗保健系统的医院医疗中心进行这项试验,
南加州 Kaiser Permanente 拥有大约 2,000 名早期乳腺癌和结直肠癌幸存者。我们的
结果将为 PCP 主导的可扩展生存模型的有效性提供更明确的证据
护理,解决肿瘤学提供者的严重短缺问题,同时保持或提高质量。
项目成果
期刊论文数量(0)
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Erin Elizabeth Hahn其他文献
Erin Elizabeth Hahn的其他文献
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{{ truncateString('Erin Elizabeth Hahn', 18)}}的其他基金
The EPICS (Engaging Primary care in Cancer Survivorship) study: A trial of novel models of care for cancer survivors
EPICS(癌症幸存者的初级保健)研究:癌症幸存者护理新模式的试验
- 批准号:
10616741 - 财政年份:2020
- 资助金额:
$ 73.97万 - 项目类别:
Project 2: Patterns of Care and Patient Experiences During Early Survivorship Among AYA Cancer Survivors
项目 2:AYA 癌症幸存者早期生存期间的护理模式和患者体验
- 批准号:
10658899 - 财政年份:2020
- 资助金额:
$ 73.97万 - 项目类别:
Project 2: Patterns of Care and Patient Experiences During Early Survivorship Among AYA Cancer Survivors
项目 2:AYA 癌症幸存者早期生存期间的护理模式和患者体验
- 批准号:
10477008 - 财政年份:2020
- 资助金额:
$ 73.97万 - 项目类别:
Project 2: Patterns of Care and Patient Experiences During Early Survivorship Among AYA Cancer Survivors
项目 2:AYA 癌症幸存者早期生存期间的护理模式和患者体验
- 批准号:
10263881 - 财政年份:2020
- 资助金额:
$ 73.97万 - 项目类别:
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