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

项目总结 在此R21应用程序中，我们提出了一项试点随机临床试验，以解决NCI的挑衅性问题#8 测试使用远程保健和双语非专业健康教育者的创新策略，以提供语言和 为拉美裔人提供文化上合适的癌症生存关怀。拉丁裔现在是美国最大的少数民族人口 我们。然而，与非拉丁裔白人相比，他们在癌症方面仍然存在显著差异 护理，包括生还者护理。这些差异可归因于多种制度和文化因素。 并造成与癌症相关的并发症的更大负担和较低的生活质量。可能存在的因素 要服从干预措施，包括部分由于语言造成的患者与提供者沟通方面的差异 医疗保健提供者中的障碍和有限的文化能力。生存护理计划(SCP)可以 提高患者对生存问题的了解，改善肿瘤学专家和 初级保健提供者。它们已被美国国家医学科学院推荐，以及多个 国家和专业组织。然而，全面交付SCP的工作一直是 困难，特别是在资源不足的情况下。总体而言，对拉丁裔癌症生存经验的研究 一直是有限的，很少有研究考察SCP对拉丁裔幸存者的影响。大多数研究都有 只关注乳腺癌幸存者，通常以资源密集型肿瘤学护理或医生指导为特色 干预措施。为了解决这些知识差距，我们建议招募城市和农村的拉丁裔混血 5种最常见癌症组织(乳腺癌、结直肠癌、肺癌、淋巴瘤和前列腺癌)的癌症幸存者 来自华盛顿州的学术和社区肿瘤学诊所。我们的具体目标是确定， 在随机方式下，使用远程蛋鸡健康提供SCP的可行性和初步疗效 教育者单独与SCP进行比较，重点是近期结果(幸存者对其癌症的了解 病史和他们对后续护理需求的自我效能)可以得到改善。该提案利用了NCI的 癌症信息服务中心拥有一批接受过生存培训、双语的非职业健康教育者。我们也 建议使用混合方法从研究参与者(拉丁裔癌症幸存者)那里获得反馈 通过定性的半结构化访谈，评估他们的初级保健提供者的知识和自我效能 关于生存护理的问题。最后，我们将实施健康研究实施促进行动 服务(PARIHS)实施科学框架，为未来的实施战略提供信息，以整合 将对拉美裔癌症幸存者的SCP交付和更全面的生存护理转变为常规护理。结果是 这一多层次的建议将提供关键的初步数据，为更大规模的开发和应用提供参考， 强大的随机临床试验，以及促进发展的补充战略 为拉美裔癌症患者提供有效和可持续的生存护理。

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.