An Implementation Study to Integrate a Self-Management Support Model Into Routine Cancer Care for Rural Patients

将自我管理支持模式融入农村患者常规癌症护理的实施研究

• 批准号: 10452052
• 负责人: Bonny Morris
• 金额: $ 7.42万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10452052
• 关键词: Address; Adherence; Age-Years; Area; Automobile Driving; Award; Behavioral; Cancer Control; Cancer Hospital; Cancer Patient; Cancer Survivor; Characteristics; Classification; Clinical; Code; Communities; Computerized Medical Record; Continuity of Patient Care; Data; Development; Division of Cancer Control and Population Sciences; Ecological momentary assessment; Education; Electronic Mail; Enabling Factors; Family; Fellowship; Funding; Future; Generations; Geography; Goals; Health; Health Insurance Portability and Accountability Act; Health Technology; Healthcare; Intervention; Interview; Malignant Neoplasms; Mediating; Methodology; Methods; Mind; Modeling; Motivation; Oncology; Outcome; Participant; Patients; Patterns of Care; Phase; Population; Positioning Attribute; Postdoctoral Fellow; Probability Samples; Provider; Psychiatric Social Work; Research; Research Personnel; Research Project Grants; Research Training; Rural; Rural Community; Rural Population; Sampling; Self Management; Structure; Surveys; Survivors; System; Target Populations; Technology; Text Messaging; Time; Training; Treatment outcome; Underserved Population; Voice; acceptability and feasibility; base; cancer health disparity; cancer prevention; cancer therapy; care coordination; care delivery; cohort; community engagement; cost; design; digital; digital health; emerging adult; experience; health care availability; health disparity; implementation efforts; implementation science; implementation study; improved; improved outcome; innovation; member; mobile application; mortality; multidisciplinary; neglect; neoplasm registry; patient engagement; patient population; personalized approach; population based; pre-doctoral; prospective; protective factors; recruit; rural area; rural cancer care; rural dwellers; rural health disparities; rural patients; secondary outcome; skills; social; sociodemographics; tailored messaging; theories; treatment adherence; two way texting; urban disparity

Project Summary. The nearly 3 million US cancer survivors residing in rural areas experience 10% higher cancer mortality compared to their urban counterparts, in part due to poorer cancer treatment adherence. Reasons for rural-urban disparities in cancer treatment adherence are not fully understood. The majority of research to-date has focused on health claims data and small-sample survey data. Moreover, extant data has often neglected the protective and enabling factors that are characteristic of rural communities. A deeper understanding of factors driving cancer treatment non-adherence in rural populations is necessary to design targeted, asset-based interventions to reduce rural health disparities and improve outcomes. The premise of the proposed research is that multi-level factors contribute to the observed rural-urban differences in cancer treatment adherence and outcomes, including sociodemographic inequities and diminished access to healthcare, psychosocial services, and technological advances. Rural cultural factors serve as barriers and facilitators to treatment adherence and may be positively impacted by digitally-mediated interventions. The purpose of the proposed research is to elucidate social and behavioral factors encompassing rural culture as it relates to oncology treatment non-adherence and delineate factors amenable to targeted, tailored approaches to improve rural oncology outcomes. These goals will be accomplished by a rigorous mixed methods approach utilizing population-based surveys, semi-structured interviews, and ecological momentary assessment, supported by community engagement across study phases to capitalize on strengths of rural culture while minimizing barriers. A highly qualified multi-disciplinary team has been assembled to support my research and training goals in mixed methodology and rural community engagement. The proposed F99/K00 application targets the NCI's emerging priority of rural cancer control and aligns with current NCI funding initiatives in rural oncology and implementation science. Completion of this unique pre to post-doctoral fellowship transition award will provide me with the skills and experience necessary to be a highly trained cancer control researcher with specific expertise in 1) rural populations, 2) health disparities, 3) patterns of care, and 4) care coordination and delivery - four of the seven NCI Division of Cancer Control and Population Sciences areas of research emphasis, thus expertly preparing me to advance the field of rural cancer control through the development of innovative and scalable interventions addressing the self-management support needs of this underserved population.

项目摘要。居住在农村地区的近300万美国癌症幸存者的发病率要高10% 癌症死亡率与城市癌症死亡率相比，部分原因是癌症治疗依从性较差。 城乡癌症治疗依从性差异的原因尚不完全清楚。大多数人 到目前为止，研究的重点是健康索赔数据和小样本调查数据。此外，现有数据具有 往往忽视农村社区特有的保护性和扶持性因素。更深一层的 了解农村人群癌症治疗不依从性的驱动因素是设计所必需的 有针对性的、以资产为基础的干预措施，以减少农村健康差距并改善结果。的前提是 建议的研究是多层次的因素对观察到的城乡癌症差异有贡献。 治疗依从性和结果，包括社会人口不平等和获得治疗机会减少 医疗保健、心理社会服务和技术进步。农村文化因素成为障碍和障碍 促进者坚持治疗，并可能受到数字媒介干预的积极影响。这个 这项研究的目的是阐明围绕着乡村文化的社会和行为因素。 与肿瘤学治疗不坚持有关，并描述可采用有针对性的、量身定制的方法的因素 以改善农村肿瘤学成果。这些目标将通过严格的混合方法实现。 利用基于人口的调查、半结构化访谈和生态瞬时评估， 在研究阶段得到社区参与的支持，以利用农村文化的优势，同时 最大限度地减少障碍。已经组建了一支高素质的多学科团队来支持我的研究和 混合方法和农村社区参与的培训目标。建议的F99/K00申请 目标是NCI正在出现的农村癌症控制优先事项，并与目前NCI在农村地区的资助倡议保持一致 肿瘤学和实施学。完成这一独特的从博士后到博士后奖学金的过渡 该奖项将为我提供成为一名训练有素的癌症控制研究人员所需的技能和经验 具有1)农村人口、2)健康差距、3)护理模式和4)护理协调方面的专门知识 和交付--NCI癌症控制和人口科学部七个研究领域中的四个 强调，从而熟练地为我做好准备，通过发展 创新且可扩展的干预措施，可满足服务不足的客户的自我管理支持需求 人口。