Improving the Timeliness and Quality of Care for Rural Lung and Head-and-Neck Cancer Patients

摘要： 提高肺癌（LC）和头颈癌（HNC）患者护理的及时性和质量， 最重要的是，因为治疗开始的延迟与癌症复发，较低的存活率， 以及患者结果不佳（例如，危难）。农村LC和HNC患者经历显著的治疗延迟。 与城市患者相比，农村地区的患者面临更多挑战，例如需要长途旅行 获得医疗服务的距离远，社会经济地位较低，癌症治疗的可用性较低。 本研究的目的是提高LC和HNC患者的及时性和护理质量， 服务不足（例如，低收入、保险不足）以及落基山脉各州的农村和边境县， 由科罗拉多大学卫生系统治疗，该系统为来自科罗拉多和怀俄明州的患者提供服务， 莱文沃思卫生系统慈善机构的姐妹篇，为来自科罗拉多、犹他州和蒙大拿州的农村病人提供服务。 我们将CARES（癌症宣传、资源教育和支持）干预应用于目标因素 具体到服务不足的农村LC和HNC患者，以及由于他们的统计和临床 显著性与这些患者的次优治疗开始和较差的护理质量相关。的 CARES干预的特点是在LC和HNC治疗期间的关键点实施， 从而比目前的常规护理实践更有效和更高效地增强其对结果的影响。 使用随机对照临床试验（RCT）设计，我们将比较CARES干预效果与 常规护理实践对：（a）治疗开始时间和（B）治疗完成时间的影响。的 CARES干预还针对（c）护理结果的质量（例如，患者沟通，护理协调， 向患者提供信息）和（d）患者报告的结果（例如，应对、苦恼、生活质量）。 将招募约440名LC和HNC患者，并随机分配至任一干预组 （n=220）或常规护理条件（n=220）。我们将采用线性混合模型的意向治疗分析 （LIFE）分析治疗开始时间的主要结局和次要结局。我们预测 那些接受CARES干预的人在所有研究结果中的改善程度将大于那些接受CARES干预的人。 接受常规护理。我们的最终目标是传播和实施CARES干预措施 * 纳入农村临床实践，以提高农村和得不到充分服务的病人的护理的及时性和质量， 减少LC和HNC发病率和死亡率的差异。因此，我们将评估 和CARES干预的可扩展性，通过评估干预策略的总体有效性， 以及“如何以及为什么”它们在现实世界的实践中起作用。

ABSTRACT: Improving the timeliness and quality of care for lung cancer (LC) and head and neck cancer (HNC) patients is of utmost importance because delays in treatment initiation are associated with cancer recurrence, lower survival, and poor patient outcomes (e.g., distress). Rural LC and HNC patients experience significant treatment delays. Compared to urban patients, patients in rural areas face added challenges such as needing to travel long distances to access care, having lower socio-economic status, and having less availability of cancer treatment. The objective of this study is to improve the timeliness and quality of care for LC and HNC patients who are underserved (e.g., low-income, underinsured) and from rural and frontier counties in the Rocky Mountain States, treated by the University of Colorado Health System that serves patients from Colorado and Wyoming and the Sisters of Charity of Leavenworth Health System that serves rural patients from Colorado, Utah, and Montana. We will apply the CARES (Cancer Advocacy, Resources Education, and Support) intervention to target factors specific to rural LC and HNC patients who are underserved and factors that due to their statistical and clinical significance are associated with suboptimal initiation of treatment and poor quality of care for these patients. The hallmark of the CARES intervention is implementing it at key points during LC and HNC treatment, likely augmenting its effects on the outcomes more effectively and more efficiently than current usual care practices. Using a randomized controlled clinical trial (RCT) design, we will compare the CARES intervention effects to the effects of usual care practice on the: (a) time to treatment initiation and (b) time to treatment completion. The CARES intervention also targets (c) quality of care outcomes (e.g., patient communication, coordination of care, providing information to patients) and (d) patient-reported outcomes (e.g., coping, distress, quality of life). Approximately 440 LC and HNC patients will be recruited and randomly assigned to either the intervention (n=220) or to the usual care condition (n=220). We will employ intent-to-treat analyses with linear mixed models (LMMs) to analyze the primary outcome of time to treatment initiation and the secondary outcomes. We predict that those who receive the CARES intervention will improve in all study outcomes to a greater degree than those who received usual care. Our ultimate goal is the dissemination and implementation of the CARES intervention into rural clinical practice to improve the timeliness and quality of care for rural and underserved patients and reduce disparities in LC and HNC morbidity and mortality. Thus, we will assess the pragmatic implementation and scalability of the CARES intervention by evaluating the overall effectiveness of the intervention's strategies, as well as "how and why" they work in real-world practice.