Examining the Relationship Between Spatial Accessibility to Care, FT, and HRQoL Among Rural Cancer Survivors

检查农村癌症幸存者中护理空间可达性、FT 和 HRQoL 之间的关系

• 批准号: 10381198
• 负责人: DONALD ROSENSTEIN
• 金额: $ 19.64万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10381198
• 关键词: Address; Area; Behavior; Cancer Patient; Cancer Survivor; Caring; Characteristics; Continuity of Patient Care; Data; Effectiveness; Enrollment; Financial cost; Funding; Health; Health Services Accessibility; Health behavior; Healthcare; Income; Intervention; Interview; Joints; Link; Malignant Neoplasms; Maps; Mission; Modeling; North Carolina; Oncology; Patients; Pattern; Population; Primary Health Care; Process; Program Acceptability; Prospective Studies; Public Health; Research; Research Design; Research Infrastructure; Rural; Site; Socioeconomic Status; Surveys; Testing; Time; Training; Travel; United States National Institutes of Health; barrier to care; cancer care; cancer diagnosis; cost; design; disability; experience; financial toxicity; health care availability; health care model; health care service utilization; health related quality of life; help-seeking behavior; improved; informant; innovation; parent grant; racial and ethnic; rural dwellers

ABSTRACT The proposed supplemental project leverages the existing survey design for Lessening the Impact of Financial Toxicity (LIFT) Study (5R01CA240092-02) to examine the effects of financial toxicity on healthcare help- seeking and care utilization among rural cancer patients. The parent grant funds a prospective study designed to evaluate the implementation and effectiveness of a Financial Navigation (FN) intervention within rural oncology settings in North Carolina, (1) leveraging key informant stakeholder interviews to produce process maps to characterize the context of rural oncology practices; (2) offering training, technical support, and coaching for financial navigators in rural oncology settings to improve FN implementation; and 3) evaluating the effect of FN on FT, health-related quality of life (HRQoL), harmful care-altering behavior, program acceptability, and responsiveness to patients’ concerns. Whereas the objective of the parent grant is to evaluate the implementation and effectiveness of FN within rural oncology settings, the proposed supplemental project leverages the research infrastructure developed by the team to further map out the effects of FT on healthcare help-seeking among rural cancer survivors across five (5) intervention sites in rural North Carolina. The proposed supplemental project seeks to adapt existing models of healthcare help-seeking to explain healthcare access and utilization to understand how rural cancer survivors enrolled in a FN intervention in North Carolina access care. The overall objective of the proposed supplemental study is to examine how FT) and care access are experienced differentially by rural cancer populations. This supplemental project will link the survey data with spatially-referenced data, including area-level characteristics, such as socio-economic status, income, and racial/ethnic composition, as well as patient-level data, such as travel distances/times to cancer care and routine (primary) care. The central hypothesis is that both FT and the spatial (in)accessibility of healthcare modify rural cancer survivors’ healthcare use patterns. The central hypothesis will be tested through three (3) aims: (1) To explore the relationship between FT and the spatial barriers to care prior to and after receipt of cancer diagnosis and financial toxicity among rural cancer survivors (2) To analyze the associations between spatial access to cancer care and level of FT among rural cancer survivors. (3) To examine the relationships between FT, and care continuity among rural cancer survivors, controlling for spatial access to care. The research proposed in this application is innovative, with a focus on adapting models of access to health care to better address the experiences of rural cancer patients.

摘要 拟议的补充项目利用现有的调查设计，以减少财务影响 毒性(LIFT)研究(5R01CA240092-02)，以研究金融毒性对医疗保健帮助的影响- 农村癌症患者就诊及护理利用现状分析。父母资助了一项设计的前瞻性研究 评估农村金融导航(FN)干预的实施和效果 北卡罗来纳州的肿瘤学环境，(1)利用关键线人利益相关者访谈来制定流程 描述农村肿瘤学实践背景的地图；(2)提供培训、技术支持和 对农村肿瘤学环境中的金融导航员进行培训，以改进FN的实施；以及3)评估 FN对FT、健康相关生活质量(HRQOL)、有害护理改变行为、计划的影响 可接受性，以及对患者关切的反应。鉴于家长赠款的目标是 评估FN在农村肿瘤学环境中的实施和有效性，拟议的补充 该项目利用团队开发的研究基础设施，进一步制定了金融时报对 北卡罗来纳州农村五(5)个干预点的农村癌症幸存者寻求医疗帮助。 拟议的补充项目旨在调整现有的医疗保健帮助模式-寻求解释 医疗保健获取和利用情况了解农村癌症幸存者如何参加#年的FN干预 北卡罗来纳州接入护理中心。拟议补充研究的总体目标是研究英国《金融时报》如何) 农村癌症人群的感受有所不同。这个补充项目将链接到 具有空间参考数据的调查数据，包括区域一级的特征，如社会经济特征 身份、收入和种族/民族构成，以及患者级别的数据，如旅行距离/时间 癌症护理和常规(初级)护理。中心假设是FT和空间(In)可达性 医疗保健的发展改变了农村癌症幸存者的医疗保健使用模式。核心假说将得到检验 通过三(3)个目标：(1)探讨注意的空间障碍与FT之间的关系 农村癌症存活者接受癌症诊断和经济毒性后(2)分析 农村癌症幸存者获得癌症护理的空间途径与FT水平之间的关系。(3)至 在农村癌症幸存者中检验FT和护理连续性之间的关系，并对空间进行控制 获得护理的途径。本申请中提出的研究是创新的，重点是使模型适应 获得医疗保健，以更好地解决农村癌症患者的经历。