Women in Survivorship Healthcare (WISH): Implementation of a Nurse Navigation Model for Medically Underserved Breast and Gynecologic Cancer Survivors using Project ECHO

女性幸存者医疗保健 (WISH)：使用 ECHO 项目为医疗服务不足的乳腺癌和妇科癌症幸存者实施护士导航模型

• 批准号: 10021610
• 负责人: Andrew Louis Sussman
• 金额: $ 19.77万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021610
• 关键词: Address; American Cancer Society; American Society of Clinical Oncology; Cancer Model; Cancer Survivor; Cancer Survivorship; Caring; Communication; Communities; Community Healthcare; Community Medicine; Companions; Competence; Comprehensive Cancer Center; Continuity of Patient Care; Counseling; Data Collection; Diagnosis; Discipline of obstetrics; Educational Curriculum; Effectiveness; Endometrial Carcinoma; Ensure; Environment; Face; Family Practice; Funding Opportunities; General Practices; Geriatrics; Guidelines; Gynecology; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Institute of Medicine (U.S.); Internal Medicine; Knowledge; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Measures; Modeling; New Mexico; Nurses; Oncologist; Outcome; Patient Care; Patients; Population Growth; Population Heterogeneity; Preventive; Primary Health Care; Process; Provider; Recommendation; Reporting; Research; Research Personnel; Research Support; Risk stratification; Role; Rural Minority; Service delivery model; Specialist; Testing; Training; Universities; Woman; adverse outcome; aging population; base; cancer therapy; cancer type; care outcomes; care providers; cohort; comorbidity; ethnic diversity; expectation; experience; feasibility trial; follow-up; geographic population; improved; innovation; large scale data; malignant breast neoplasm; medically underserved; meetings; member; multidisciplinary; novel; older patient; oncology service; patient oriented; preference; primary care setting; provider networks; recruit; screening; socioeconomic disparity; socioeconomics; standard of care; survivorship; systematic review; treatment planning

Project Summary/Abstract There are currently over 15 million cancer survivors in the US and this number is expected to exceed 20 million by 2026 due to population aging and growth. In 2006, the Institute of Medicine (IOM) released a landmark report outlining recommendations, including use of a survivorship care plan (SCP) to address the needs of cancer survivors, and other organizations have issued guidelines to improve survivorship care. Despite this recognition, research clearly documents the persistence of unmet needs among cancer survivors including less than optimal preventive and cancer surveillance screening rates. Several barriers have been identified in the effort to achieve optimal survivorship care: the current health care system is fragmented, difficult to navigate and communication between oncologists and primary care providers is often minimal. Further, a predicted shortage of oncologists/oncology services in relation to increases in cancer survivors highlights the need for alternative solutions. These circumstances underscore the urgent need to develop more effective models of care integration. The IOM, American Cancer Society and the American Society of Clinical Oncology all emphasize the importance of enhancing the role of primary care providers (PCPs)–general practice, family practice, obstetrics and gynecology, geriatrics, and internal medicine–in survivorship care. The use of SCPs is increasingly common, yet research has demonstrated implementation barriers that limit their effectiveness. Despite research aimed at implementing integrated care models, systematic reviews conclude that no standard of care exists for survivorship models. Encouragingly, studies have shown no differences in adverse outcomes of patients cared for by PCPs as compared to oncologists for certain cancer types. Prior research conducted by members of our research team, which serves as the basis for this proposal, found that both PCPs and patients are willing to participate in a survivorship care model. New Mexico, a large, rural, minority- majority state, with deep socioeconomic disparities that limit access to care, presents an ideal environment to advance implementation of SCPs in a broader integrated care model. In order to systematically develop and implement a survivorship care model, we have convened a partnership between community-based primary care providers, researchers and clinicians in the University of New Mexico Comprehensive Cancer Center (UNMCCC) and Departments of Family and Community Medicine, Obstetrics and Gynecology, and Project ECHO (Extension for Community Healthcare Outcomes), an innovative telementoring platform. The overall objective of the ECHO Women in Survivorship for Health (WISH) study is to implement and assess a survivorship care model by training a network of primary care providers through Project ECHO and then transitioning patients through nurse navigation and coordinated follow-up with a multidisciplinary specialist care team at the UNMCCC.

项目摘要/摘要 目前美国有超过1500万癌症幸存者，这一数字预计将超过2000万 到2026年，由于人口老龄化和增长。2006年，医学研究所(IOM)发布了一项里程碑式的 概述建议的报告，包括使用生存护理计划(SCP)来满足 癌症幸存者和其他组织已经发布了指导方针，以改善生存护理。尽管如此 认识到，研究清楚地记录了癌症幸存者中未得到满足的需求的持久性，包括 而不是最佳的预防和癌症监测筛查率。已经确定了以下几个障碍 努力实现最佳生存护理：当前的医疗保健系统支离破碎，难以驾驭 而且肿瘤学家和初级保健提供者之间的沟通往往很少。此外，据预测， 与癌症幸存者增加有关的肿瘤学家/肿瘤学服务短缺突出表明有必要 替代解决方案。 这些情况突出表明，迫切需要开发更有效的综合护理模式。 国际移民组织、美国癌症学会和美国临床肿瘤学会都强调 加强初级保健提供者作用的重要性--全科医学、家庭医学、产科 以及妇科、老年科和内科--生存护理。SCP的使用越来越多 然而，研究表明，实施障碍限制了它们的有效性。 尽管研究旨在实施综合护理模式，但系统审查得出的结论是，没有 生存模型的护理标准是存在的。令人鼓舞的是，研究表明，在不良反应方面没有差别。 与某些癌症类型的肿瘤学家相比，接受初级保健医生护理的患者的结果。前期研究 作为这项提案的基础，我们的研究团队成员进行的调查发现， 儿科医生和病人都愿意参与生存护理模式。新墨西哥州，一个庞大的农村少数民族- 多数州有着严重的社会经济差距，限制了获得护理的机会，为 在更广泛的综合护理模式中推进SCP的实施。为了系统地发展和 实施幸存者护理模式，我们召集了以社区为基础的初级保健机构之间的伙伴关系 新墨西哥大学综合癌症中心的护理提供者、研究人员和临床医生 (联合国儿童基金会)以及家庭和社区医学、产科和妇科以及项目部 Echo(社区医疗保健成果扩展)，一个创新的远程监护平台。整体而言 Echo妇女为健康而生存(Wish)研究的目标是实施和评估 生存护理模式，通过Project Echo培训初级保健提供者网络，然后 通过护士导航和多学科专科护理的协调随访来过渡患者 联合国特种部队的小分队。