An Implementation Study to Integrate a Self-Management Support Model Into Routine Cancer Care for Rural Patients

项目摘要。居住在农村地区的近300万美国癌症幸存者的经历比其他地区高出10%。 癌症死亡率低于城市，部分原因是癌症治疗依从性较差。 癌症治疗依从性城乡差异的原因尚不完全清楚。大多数 迄今为止的研究侧重于健康索赔数据和小样本调查数据。此外，现有数据 这往往忽视了农村社区特有的保护性和扶持性因素。更深 有必要了解农村人群中导致癌症治疗不依从性的因素， 有针对性的、以资产为基础的干预措施，以减少农村卫生差距并改善成果。的前提 提出的研究是，多层次的因素有助于观察到的癌症的城乡差异 治疗依从性和结果，包括社会人口不平等和获得 医疗保健、心理社会服务和技术进步。农村文化因素是障碍， 促进治疗依从性，并可能受到数字介导干预的积极影响。的 本研究的目的是阐明农村文化中的社会和行为因素， 与肿瘤治疗非依从性相关，并描述了适合于靶向定制方法的因素 改善农村肿瘤学的结果。这些目标将通过严格的混合方法来实现 利用基于人口的调查、半结构化访谈和生态瞬时评估， 在整个研究阶段得到社区参与的支持，以利用农村文化的优势， 减少障碍。一个高素质的多学科团队已经组装，以支持我的研究， 混合方法和农村社区参与方面的培训目标。建议的F99/K 00应用 针对NCI的农村癌症控制的新兴优先事项，并与目前NCI在农村的资助计划保持一致， 肿瘤学和实施科学。完成这一独特的前博士后奖学金过渡 该奖项将为我提供必要的技能和经验，成为一个训练有素的癌症控制研究人员 在1）农村人口，2）健康差距，3）护理模式和4）护理协调方面具有特定的专业知识 和交付-癌症控制和人口科学的研究领域的七个NCI部门的四个 强调，从而熟练地准备我通过发展农村癌症控制领域， 创新和可扩展的干预措施，满足这一服务不足群体的自我管理支持需求 人口

Project Summary. The nearly 3 million US cancer survivors residing in rural areas experience 10% higher cancer mortality compared to their urban counterparts, in part due to poorer cancer treatment adherence. Reasons for rural-urban disparities in cancer treatment adherence are not fully understood. The majority of research to-date has focused on health claims data and small-sample survey data. Moreover, extant data has often neglected the protective and enabling factors that are characteristic of rural communities. A deeper understanding of factors driving cancer treatment non-adherence in rural populations is necessary to design targeted, asset-based interventions to reduce rural health disparities and improve outcomes. The premise of the proposed research is that multi-level factors contribute to the observed rural-urban differences in cancer treatment adherence and outcomes, including sociodemographic inequities and diminished access to healthcare, psychosocial services, and technological advances. Rural cultural factors serve as barriers and facilitators to treatment adherence and may be positively impacted by digitally-mediated interventions. The purpose of the proposed research is to elucidate social and behavioral factors encompassing rural culture as it relates to oncology treatment non-adherence and delineate factors amenable to targeted, tailored approaches to improve rural oncology outcomes. These goals will be accomplished by a rigorous mixed methods approach utilizing population-based surveys, semi-structured interviews, and ecological momentary assessment, supported by community engagement across study phases to capitalize on strengths of rural culture while minimizing barriers. A highly qualified multi-disciplinary team has been assembled to support my research and training goals in mixed methodology and rural community engagement. The proposed F99/K00 application targets the NCI's emerging priority of rural cancer control and aligns with current NCI funding initiatives in rural oncology and implementation science. Completion of this unique pre to post-doctoral fellowship transition award will provide me with the skills and experience necessary to be a highly trained cancer control researcher with specific expertise in 1) rural populations, 2) health disparities, 3) patterns of care, and 4) care coordination and delivery - four of the seven NCI Division of Cancer Control and Population Sciences areas of research emphasis, thus expertly preparing me to advance the field of rural cancer control through the development of innovative and scalable interventions addressing the self-management support needs of this underserved population.