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 在这个R21申请中，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 测试一项创新战略，利用远程保健和双语非专业保健教育工作者， 为拉丁美洲人提供文化上合适的癌症生存护理。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着差异。 护理，包括生存护理。这些差异可归因于多种制度和文化因素 并导致癌症相关合并症的更大负担和更低的生活质量。因素可能 对干预措施的顺从性包括患者与提供者之间的沟通差异，部分原因是语言 卫生保健提供者之间的障碍和有限的文化能力。幸存者护理计划（SCP）可能 提高患者对生存问题的认识，改善肿瘤专家之间的协调， 初级保健提供者。他们已被推荐的国家医学科学院沿着与多个 国家和专业组织。然而，以全面的方式交付SCP已经 困难，特别是在资源不足的情况下。总的来说，对拉丁美洲癌症生存经验的研究 研究的范围有限，很少有研究考察SCP对拉丁裔幸存者的影响。大多数研究 只专注于乳腺癌幸存者，往往具有资源密集型肿瘤护理或医生领导的 干预措施。为了解决这些知识上的差距，我们建议招聘城市和农村的拉丁美洲人， 5种最常见癌症组织学（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诊所。我们的具体目标是确定， 以随机的方式，使用远程的非专业健康服务提供SCP的可行性和初步疗效 教育工作者与单独的SCP，重点是是否近端结果（幸存者对他们的癌症的知识 病史和对后续护理需求的自我效能）。该提案利用了NCI的 癌症信息服务，其生存训练，双语，奠定健康教育工作者池。我们也 建议使用混合方法从研究参与者（拉丁美洲癌症幸存者）获得反馈 通过定性的半结构化访谈，并评估他们的初级保健提供者的知识和自我效能 关于幸存者护理最后，我们将实施卫生研究实施促进行动 服务（PARIHS）执行科学框架，为未来的执行战略提供信息， SCP交付和更全面的生存护理拉丁美洲癌症幸存者纳入常规护理。结果 这一多层次的建议将提供关键的初步数据，以告知开发和应用一个更大的， 强有力的随机临床试验，以及补充战略，以促进发展， 为拉丁美洲癌症患者提供有效和可持续的生存护理。