Improving cancer survivorship care delivery in Latino survivors: telehealth & lay health educators

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PROJECT SUMMARY In this R21 application, we address NCI’s Provocative Question #8 by proposing a pilot randomized clinical trial to test an innovative strategy of using telehealth and bilingual lay health educators to provide linguistically and culturally appropriate cancer survivorship care for Latinos. Latinos are now the largest minority population in the US. However, compared with non-Latino Whites, they continue to experience significant disparities in cancer care, including survivorship care. These disparities are attributable to a multitude of systemic and cultural factors and contribute to a greater burden of cancer-related comorbidities and a lower quality of life. Factors that may be amenable to interventions include disparities in patient-provider communication, due in part to language barriers and limited culture competence among healthcare providers. Survivorship care plans (SCPs) may improve patient knowledge of survivorship issues and improve coordination between oncology specialists and primary care providers. They have been recommended by the National Academy of Medicine along with multiple national and professional organizations. However, the delivery of SCPs in a comprehensive fashion has been difficult, especially in under-resourced settings. Overall, research into the Latino cancer survivorship experience has been limited, with few studies examining the impact of SCPs among Latino survivors. Most studies have focused only on breast cancer survivors, and often feature resource-intensive oncology nursing or physician-led interventions. To address these gaps in knowledge, we propose to recruit a mixture of urban and rural Latino cancer survivors of the 5 most common cancer histologies (breast, colorectal, lung, lymphoma, and prostate) from academic- and community-based oncology clinics in Washington State. Our specific goals are to determine, in randomized fashion, the feasibility and preliminary efficacy of SCPs delivered using remote-based lay health educators vs SCPs alone, with a focus on whether proximal outcomes (survivors’ knowledge of their cancer history and their self-efficacy towards their follow-up care needs) can be improved. The proposal leverages NCI’s Cancer Information Service, with its pool of survivorship-trained, bilingual, lay health educators. We also propose, using a mixed-method approach, to obtain feedback from study participants (Latino cancer survivors) via qualitative semi-structured interviews, and to assess their primary care providers’ knowledge and self-efficacy regarding survivorship care. Finally, we will apply the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework to inform future implementation strategies to integrate SCP delivery and more comprehensive survivorship care for Latino cancer survivors into routine care. The results of this multi-level proposal will provide key preliminary data to inform the development and application of a larger, robustly powered randomized clinical trial, as well as complementary strategies to facilitate the development of effective and sustainable survivorship care for Latino cancer patients.