Pilot Project 1: Creating Bridges to Reproductive Health Care for Rural Adolescent and Young Adult Cancer Survivors

试点项目 1：为农村青少年和青年癌症幸存者搭建生殖保健桥梁

• 批准号: 10762275
• 负责人: Hui-Chun Irene Su
• 金额: $ 7.87万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762275
• 关键词: Adolescent and Young Adult; Aftercare; California; Cancer Patient; Cancer Science; Cancer Survivor; Cancer Survivorship; Caring; Catchment Area; Clinic; Clinical; Communities; Community Clinical Oncology Program; Consult; Consultations; Continuity of Patient Care; Contraceptive methods; County; Data; Diagnosis; Discipline of Nursing; Distress; Effectiveness; Effectiveness of Interventions; Evaluation; Faculty; Female Adolescents; Fertility; Focus Groups; Future; Geography; Health; Health Insurance; Health Personnel; Health Professional; Healthcare; Hispanic; Hispanic Populations; Infertility; Intervention; Interview; Latina; Learning; Linguistics; Malignant Neoplasms; Menopausal Symptom; Methods; Mexico; Newly Diagnosed; Nursing Faculty; Oncology; Outcome; Parents; Pathway interactions; Patients; Pilot Projects; Premature Ovarian Failure; Quality of Care; Quality of life; Reporting; Reproductive Health; Reproductive Medicine; Research; Research Personnel; Resource-limited setting; Resources; Risk; Rural; Rural Community; Social Work; Social Workers; Specialist; Structure; Survivors; Underserved Population; Universities; Work; adverse pregnancy outcome; anticancer research; arm; cancer care; cancer education; care delivery; clinical care; community engagement; design; effectiveness evaluation; experience; feasibility testing; health care delivery; health disparity; health equity; health literacy; high risk; hybrid type 1 trial; implementation measures; implementation outcomes; implementation science; improved; low health literacy; medically underserved; multi-component intervention; multi-site trial; neoplasm resource; novel; oncofertility; outreach; patient navigation; pilot test; primary outcome; psychosocial; remote communities; reproductive; rural Hispanic; rural area; rural healthcare; screening; shared decision making; survivorship; telehealth; uptake

PROJECT SUMMARY/ ABSTRACT – PILOT PROJECT Reproductive health care in cancer patients is an unmet need in Imperial County, a medically underserved, rural region of the Cancer Research and Education to Advance HealTh Equity (CREATE) Partnership’s catchment area with a predominantly Hispanic population. Reproductive health is a major issue for adolescent and young adult (AYA) cancer survivors because they can experience higher risks of infertility, adverse pregnancy outcomes, and unmet informational needs. Reproductive health care effectively reduces risks, but uptake is low because there are no scalable interventions to support the implementation of routine reproductive health care in underserved, geographically remote communities. Guided by the Cancer Survivorship Care Quality Framework, this pilot proposal seeks to adapt and pilot test a multi-component intervention to improve reproductive health care uptake by female AYA cancer survivors. The intervention has three components derived from our prior work: 1) a reproductive risk summary (RS) and survivorship care plan on reproductive health (SCP-R), 2) navigation, and 3) telehealth reproductive consults. In Aim 1, we will adapt the RS and SCP-R in English and Spanish to be responsive to the cultural, health literacy, and socio-ecological needs of Latina AYA survivors through focus groups with AYA survivors and parents/guardians, and semi-structured interviews with healthcare providers. We will also systematically evaluate barriers and facilitators to reproductive health care in Imperial County and examine how to fit the multi-component intervention to this setting, through focus groups with survivors and parents/guardians and interviews with healthcare providers and clinic staff. In Aim 2, we will conduct feasibility testing of the multicomponent intervention in a single arm pilot hybrid type 1 trial (evaluating effectiveness and observing implementation). The primary outcome is engagement in reproductive health care by 15 newly diagnosed and 15 post-treatment AYA survivors. Secondarily, we will qualitatively assess effectiveness, fit and implementation outcomes with AYA survivors, healthcare providers and health clinic staff. The proposal directly targets a critical health disparity faced by female AYA survivors in our catchment area and need for partnership between rural community health professionals and urban specialists to deliver quality reproductive survivorship care. We will generate a novel, scalable intervention and preliminary data to support a future multi-site trial on intervention effectiveness in increasing reproductive care in rural, medically underserved oncology settings. The partnership between SDSU, CRCD and UCSD researchers will be strengthened with collaborative learning, community engagement, and increased capacity of trainees to support future cancer research in Imperial County.

项目概要/摘要-试点项目 在帝国县，癌症患者的生殖保健是一个未得到满足的需求， 癌症研究和教育促进健康公平（CREATE）伙伴关系的农村地区 以西班牙裔人口为主的集水区。生殖健康是青少年面临的一个主要问题 和年轻成人（AYA）癌症幸存者，因为他们可能会经历更高的不孕风险， 怀孕结果以及未满足的信息需求。生殖保健能有效降低风险，但 采用率低，因为没有可扩展的干预措施来支持常规生殖保健的实施 在服务不足、地理位置偏远的社区提供保健服务。癌症幸存者护理（Cancer Survivorship Care） 质量框架，这一试点提案旨在调整和试点测试一个多组成部分的干预措施，以改善 AYA癌症女性幸存者接受生殖保健服务的情况。干预措施有三个组成部分 从我们以前的工作：1）生殖风险总结（RS）和生存护理计划的生殖 健康（SCP-R），2）导航和3）远程健康生殖咨询。在目标1中，我们将调整RS， SCP-R的英语和西班牙语版，以满足以下群体的文化、卫生知识和社会生态需求： 通过与AYA幸存者和父母/监护人的焦点小组， 与医疗保健提供者的访谈。我们还将系统地评估障碍和促进因素， 生殖保健在帝国县，并探讨如何适应多组分干预， 通过与幸存者和父母/监护人的焦点小组以及与医疗保健提供者的访谈， 和诊所工作人员。在目标2中，我们将在单组中进行多组分干预的可行性测试 试点混合1型试验（评价有效性和观察实施情况）。主要结局是 15名新诊断的和15名治疗后的艾滋病毒/艾滋病幸存者参与生殖保健。 其次，我们将定性评估AYA幸存者的有效性、适应性和实施结果， 医疗保健提供者和诊所工作人员。该提案直接针对以下群体面临的严重健康差距： 在我们的集水区的女性AYA幸存者和农村社区卫生之间的伙伴关系的需要 专业人员和城市专家提供高质量的生殖生存护理。我们会创作一部小说， 可扩展的干预措施和初步数据，以支持未来对干预措施有效性的多中心试验， 在医疗服务不足的农村肿瘤环境中增加生殖保健。之间的伙伴关系 SDSU，CRCD和UCSD研究人员将通过协作学习，社区 参与，并提高学员的能力，以支持未来的癌症研究在帝国县。