Improving adherence to posttreatment follow-up care for rural lung cancer survivors through a community-clinical survivorship care team model

农村肺癌生存率几十年来一直落后于全国平均水平。一个关键 造成最近生存差距的一个因素是零散的生存护理，使农村幸存者得不到支持 以促进生存护理和坚持后续护理。农村的幸存者往往从 专家位于远端，城市中心，那里的旅行，社会和经济负担威胁到坚持 后续护理。此外，城市卫生保健专业人员不了解农村资源， 寻找农村社区所需的资源，以克服保健方面的障碍。因此，社区临床生存率 护理小组是一项很有前途的战略，可以改善及时的后续护理，并提供与社区资源的联系。 农村社区卫生工作者（CHW），了解当地资源和社会经济 生存障碍护理是社区临床团队中合适的社区代理人。的成功 社区临床护理团队，以改善护理协调和健康结果是有据可查的，但很少 这些研究调查农村生存护理或在团队模式中整合CHW。此外， 现有文献关于实施CHW-临床生存护理团队模式，以改善 农村生存状况。为了解决这一关键差距，研究审查了CHW- 临床幸存者护理团队，以提高农村肺癌幸存者的后续护理的依从性。目标 本项目的目的是1）评估期望的CHW角色及其与临床互动的过程的观点 社区-临床生存护理团队中的护理团队成员; 2）测试可行性和初步可接受性 3）评估CENTRAL的实施情况，以确定影响其持续的因素 用于多中心有效性-实施试验设计R 01。CENTRAL将从现有的 患者导航研究计划，并与关键利益相关者进行访谈，以告知CHW的角色和流程 与临床护理团队合作（目标1）。Lewis-Thames博士将试验CENTRAL（N=60）治疗农村肺癌 评估其可接受性和可行性（目标2）。目标3将提供关于促进者和障碍的见解 通过EPIS（探索、准备、实施、维持）实施CENTRAL 通过分析实施成本和与中央参与者、CHW和 提供商本K 01涉及培训计划，包括课程作业、研讨会、体验式学习， 由一个成熟的专家团队提供指导。该研究由西北大学进行， 附属的农村服务癌症中心，提供上级设施和资源， 干预发展和适应，实施科学，成本分析和农村生存护理。的 概述的培训计划将使刘易斯-泰晤士博士能够实现她的长期职业目标，成为一名 独立的癌症差异实施。该项目与NCI的癌症部门有关 控制和人口科学研究重点是农村癌症控制和健康差距。

Project/Summary: Rural lung cancer survival rates have lagged behind the national average for decades. A key contributor to recent survival disparities is fragmented survivorship care, leaving rural survivors without supports to facilitate survivorship care and adherence to follow-up care. Rural survivors often receive their care from specialists located in distal, urban centers, where travel, social, and financial burdens threaten adherence to follow-up care. Further, urban healthcare professionals are unaware of rural resources and encumbered by finding rural community resources needed to overcome barriers to care. Thus, a community-clinical survivorship care team is a promising strategy to improve timely follow-up care and provide linkages to community resources. A rural community health worker (CHW) that is knowledgeable about local resources and the socio-economic barriers to survivorship care is a fitting community agent on a community-clinical team. The success of community-clinical care teams to improve care coordination and health outcomes is well documented, but few of these studies investigate rural survivorship care or the integration of a CHW in the team model. Also, a gap in the literature exists regarding the implementation of a CHW-clinical survivorship care team model to improve rural survivorship outcomes. To address this critical gap, the research examines the implementation of a CHW- clinical survivorship care team to improve adherence to follow-up care for rural lung cancer survivors. The aims of this project are to 1) assess perspectives on desired CHW roles and their processes for interacting with clinical care team members in a community-clinical survivorship care team; 2) test the feasibility and initial acceptability of CENTRAL, and 3) evaluate the implementation of CENTRAL to identify factors that influence its sustained use in a multi-site effectiveness-implementation trial design R01. CENTRAL will be adapted from an existing patient navigation research program, and interviews with key stakeholders to inform CHW roles and processes for working with clinical care teams (Aim 1). Dr. Lewis-Thames will pilot CENTRAL (N=60) with rural lung cancer survivors to assess its acceptability and feasibility (Aim 2). Aim 3 will provide insights on facilitators and barriers of implementing CENTRAL via the EPIS (exploration, preparation, implementation, sustainment) implementation framework through an analysis of implementation costs and interviews with CENTRAL participants, CHWs and providers. This K01 involves a training plan consisting of coursework, seminars, experiential learning, and mentorship by an established team of experts. The research is conducted at Northwestern University and affiliated rural-serving Cancer Centers which offer superior facilities and resources to provide training in intervention development and adaption, implementation science, cost-analysis, and rural survivorship care. The outlined training plan will enable Dr. Lewis-Thames to accomplish her long-term career goal to become an independent cancer disparities implementation. The proposed project is relevant to the NCI's Division of Cancer Control and Population Science research emphasis on rural cancer control and health disparities.