Advancing cancer care and equity through telehealth, communication science, and behavioral economics

项目总结/摘要（总体） 宾夕法尼亚大学癌症护理远程医疗研究中心（Penn TRC）将应用 从通信科学和行为经济学到设计和测试创新的远程医疗战略， 提高癌症护理连续体的有效性和公平性，重点是了解 行动机制。COVID-19大流行导致远程医疗用于癌症护理的使用急剧增长 交付，由临床需要和临时豁免促进。远程保健战略既包括 同步通信（实时视频或电话会议）和异步通信 （通过文本消息或安全门户的顺序健康信息交换）。然而， 知识差距包括远程保健在多大程度上上级非远程保健服务 获取、质量和结果的策略;远程医疗如何增强或削弱实现健康 在数字鸿沟和持续存在的癌症差异的背景下， 远程保健对保健效率的影响。宾夕法尼亚大学TRC将解决一个总体研究主题：应用 从通信科学和行为经济学的见解来设计和测试同步远程医疗 以异步要素为支持的战略，以改善获取、质量、成果、公平和效率 在癌症治疗的连续体中。我们专注于肺癌作为远程医疗的模式， 从筛查到治疗再到生存。我们汇集了一个国际专家团队， 通信科学，行为经济学，癌症护理交付，远程医疗，医疗保健创新，混合 方法和健康公平，以实现以下具体目标：1）应用概念，战略，工具， 从通信科学和行为经济学的方法来设计和测试同步远程医疗 以异步要素为支持的战略，以改善获取、质量、成果、公平和效率 2）进行一项实用的随机临床试验， 远程保健战略的有效性，以增加肺癌筛查的共同决策， 序贯多重分配随机试验（SMART）设计; 3）开展两个快速循环试点项目， 方法和措施与务实的试验，设计和测试远程保健的有效性 改善癌症护理，确定多层次的作用机制，并为未来奠定基础， 明确的务实试验;以及4）建设能力，以推进国家远程医疗研究议程，并培训 在癌症护理、远程保健和健康公平方面具有专门知识的下一代调查人员。连接在一起 跨学科的教师在宾夕法尼亚州，宾夕法尼亚州TRC将导致新的，可扩展的，和推广 传播战略，推动癌症护理和健康公平的持久改善。佩恩有一个 无与伦比的环境，使这些领域的研究。

PROJECT SUMMARY/ABSTRACT (OVERALL) The University of Pennsylvania Telehealth Research Center in Cancer Care (Penn TRC) will apply insights from communication science and behavioral economics to design and test innovative telehealth strategies to improve effectiveness and equity across the cancer care continuum, with an emphasis on understanding mechanisms of action. The COVID-19 pandemic led to dramatic growth in the use of telehealth for cancer care delivery, fostered by both clinical need and temporary waivers. Telehealth strategies have included both synchronous communication (real-time video or telephone conferencing) and asynchronous communication (sequential health information exchange through text messaging or secure portals). Yet, fundamental knowledge gaps include the extent to which telehealth may be superior to non-telehealth care delivery strategies for access, quality, and outcomes; how telehealth may enhance or detract from achieving health equity in cancer care in the context of the digital divide and persistent cancer disparities; and the impact of telehealth on health care efficiency. The Penn TRC will address an overarching research theme: to apply insights from communication science and behavioral economics to design and test synchronous telehealth strategies, supported by asynchronous elements, to improve access, quality, outcomes, equity, and efficiency across the cancer care continuum. We focus on lung cancer as a model for telehealth across the care continuum, from screening to treatment to survivorship. We bring together a team of international experts in communication science, behavioral economics, cancer care delivery, telehealth, health care innovation, mixed methods, and health equity to achieve the following specific aims: 1) Apply concepts, strategies, tools, and methods from communication science and behavioral economics to design and test synchronous telehealth strategies, supported by asynchronous elements, to improve access, quality, outcomes, equity, and efficiency for patients across the care continuum; 2) Conduct a pragmatic randomized clinical trial to compare the effectiveness of telehealth strategies to increase shared decision making for lung cancer screening using a Sequential Multiple Assignment Randomized Trial (SMART) design; 3) Conduct two rapid-cycle pilot projects, with methods and measures aligned with the pragmatic trial, to design and test the effectiveness of telehealth to improve cancer care, identify multilevel mechanisms of action, and lay the foundation for future, more definitive pragmatic trials; and 4) Build capacity to advance a national telehealth research agenda and train the next generation of investigators with expertise in cancer care, telehealth and health equity. By joining together interdisciplinary faculty across Penn, the Penn TRC will result in novel, scalable, and generalizable disseminated strategies to drive lasting improvements in cancer care and health equity. Penn has an unparalleled environment in which to bring together these areas of study.