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: 10684621
• 负责人: Marquita W. Lewis-Thames
• 金额: $ 13.06万
• 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/10684621
• 关键词: Active Learning; Address; Adherence; Adopted; Advocate; Aftercare; Cancer Center; Cancer Control; Cancer Survivor; Cancer Survivorship; Caregivers; Caring; Clinical; Communities; Community Developments; Community Health; Community Health Aides; Cost Analysis; Counseling; 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; Managed Care; Mentors; Mentorship; Methods; Modeling; Monitor; Oncologist; Outcome; Participant; Patients; Phase; PrP gene; 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; Training; Travel; Treatment outcome; Trust; Universities; Urban Health; Visit; acceptability and feasibility; barrier to care; cancer care; cancer health disparity; care coordination; career; clinical care; community engagement; disparity elimination; early screening; effectiveness/implementation trial; feasibility testing; follow-up; health disparity; implementation cost; implementation evaluation; implementation framework; implementation science; improved; improved outcome; insight; medically underserved; member; outcome disparities; patient navigation; patient navigator; programs; rural area; rural dwellers; rurality; screening; side effect; skills; social; social health determinants; socioeconomics; success; survival disparity; survivorship; 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/综述：几十年来，农村肺癌存活率一直落后于全国平均水平。一把钥匙 造成近期生存差距的因素是零散的生存护理，使农村幸存者得不到支持 以促进生存护理和坚持后续护理。农村幸存者通常从 位于偏远城市中心的专家，在那里旅行、社会和经济负担可能会威胁到坚持 随访。此外，城市医疗保健专业人员不了解农村资源，并受到 寻找克服护理障碍所需的农村社区资源。因此，社区临床的生存 护理团队是一种很有前途的战略，可以改善及时的后续护理，并提供与社区资源的联系。 了解当地资源和社会经济状况的农村社区卫生工作者(CHW) 生存障碍护理是社区临床团队中一个合适的社区代理人。的成功之处 社区-临床护理团队改善护理协调和健康结果的记录很好，但很少 在这些研究中，调查了农村生存护理或将CHW整合到团队模型中。此外，还有一个缺口， 存在关于实施CHW-临床生存护理团队模式以改进的文献 农村生存结果。为了解决这一关键差距，研究检查了CHW- 临床生存护理团队提高农村肺癌幸存者对随访护理的依从性。目标 该项目的目的是：1)评估期望的CHW角色及其与临床互动的过程的观点 社区-临床生存护理团队中的护理团队成员；2)测试可行性和初步可接受性 3)评价中央政策的实施情况，找出影响其持续性的因素 用于多点有效性实施试验设计R01。中环将改编自现有的 患者导航研究计划，以及与关键利益相关者的访谈，以告知CHW的角色和流程 与临床护理团队合作(目标1)。刘易斯-泰晤士河医生将引导中部(N=60)农村肺癌患者 幸存者评估其可接受性和可行性(目标2)。目标3将提供对促进者和障碍的见解 通过EPIS(探索、准备、实施、维持)实施中央 通过对实施成本的分析和与中央参与者、社区卫生组织和 供应商。本K01课程包括培训计划，包括课程、研讨会、体验式学习和 由成熟的专家团队进行指导。这项研究在西北大学进行， 附属的为农村服务的癌症中心，提供优越的设施和资源，提供培训 干预措施的发展和适应、实施科学、成本分析和农村生存护理。这个 概述的培训计划将使Lewis-Thames博士能够实现她的长期职业目标，成为一名 独立的癌症差异实施。拟议的项目与国家癌症研究所的癌症部门有关 控制和人口科学研究强调农村癌症控制和健康差距。

项目成果

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

• DOI: 10.1007/s10552-022-01599-2
• 发表时间: 2022-08
• 期刊: CANCER CAUSES & CONTROL
• 影响因子: 2.3
• 作者: Hirko, Kelly A.;Xu, Huiwen;Rogers, Laura Q.;Martin, Michelle Y.;Roy, Siddhartha;Kelly, Kimberly M.;Christy, Shannon M.;Ashing, Kimlin Tam;Yi, Jean C.;Lewis-Thames, Marquita W.;Meade, Cathy D.;Lu, Qian;Gwede, Clement K.;Nemeth, Julianna;Ceballos, Rachel M.;Menon, Usha;Cueva, Katie;Yeary, Karen;Klesges, Lisa M.;Baskin, Monica L.;Alcaraz, Kassandra I.;Ford, Sabrina
• 通讯作者: Ford, Sabrina

Examining Access to Digital Technology by Race and Ethnicity and Child Health Status Among Chicago Families.

• DOI: 10.1001/jamanetworkopen.2022.28992
• 发表时间: 2022-08-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Kan, Kristin;Heard-Garris, Nia;Bendelow, Anne;Morales, Lu;Lewis-Thames, Marquita W.;Davis, Matthew M.;Heffernan, Marie
• 通讯作者: Heffernan, Marie