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

改善拉丁裔幸存者的癌症生存护理服务：远程医疗

• 批准号: 10603034
• 负责人: Eric Jessen Chow
• 金额: $ 13.7万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10603034
• 关键词: Improving; cancer; survivorship; care; delivery

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.

项目摘要 在此R21应用程序中，我们通过提出一项试点随机临床试验来解决NCI的挑衅性问题＃8 测试使用远程医疗和双语外行健康教育者在语言和 在文化上适合拉丁裔的癌症生存护理。拉丁美洲人现在是最大的少数民族人口 我们。但是，与非拉丁裔白人相比，他们继续在癌症中遇到重大差异 护理，包括生存护理。这些差异归因于多种系统性和文化因素 并有助于更大的癌症合并症和较低的生活质量燃烧。可能的因素 可以接受干预措施包括患者提供者的沟通中的分布，部分是由于语言 医疗保健提供者之间的障碍和有限的文化能力。生存护理计划（SCP）可能 提高患者对生存问题的了解并改善肿瘤学专家和 初级保健提供者。美国国家医学院推荐了它们以及多个 国家和专业组织。但是，以全面的方式交付SCP 困难，尤其是在资源不足的环境中。总体而言，对拉丁裔癌症生存经验的研究 受到限制，很少有研究检查SCP在拉丁裔生存中的影响。大多数研究都有 专注于乳腺癌的存活，通常具有资源密集型肿瘤学护士或身体主导 干预措施。为了解决这些知识的差距，我们建议招募城市和农村拉丁裔的混合 5种最常见的癌症组织学（乳腺癌，结直肠，肺，淋巴瘤和前列腺）的癌症存活率 来自华盛顿州立大学的学术和社区肿瘤学诊所。我们的具体目标是确定， 以随机方式，使用基于远程外行健康的SCP的可行性和初步效率 教育工作者与SCPS仅对SCP，重点是近端结果（幸存者对癌症的了解 历史及其对后续护理需求的自我效能）可以改善。该提案利用了NCI的 癌症信息服务，其生存训练，双语，外行健康教育者。我们也是 提案，使用混合方法方法获得研究参与者（拉丁裔癌症存活）的反馈 通过定性半结构化访谈，并评估其初级保健提供者的知识和自我有效 考虑生存护理。最后，我们将针对健康研究实施采取促进行动 服务（PARIHS）实施科学框架，以告知未来实施策略以整合 SCP分娩和对拉丁裔癌症生存的更全面的生存护理。结果 该多层建议将提供关键的初步数据，以告知大型，更大的， 强大动力的随机临床试验，以及促进发展的完整策略 为拉丁裔癌症患者提供有效且可持续的生存护理。