Enhancing Cancer Care Of Rural Dwellers Through Telehealth and Engagement (ENCORE)

建议的项目是根据RFA-CA-18-026的要求提交的，提供了一种基于IT的、基于团队的护理 交付模式…为农村低收入者提供全面、协调、高质量的癌症相关护理 和/或未得到充分服务的人群。农村癌症患者的死亡率差距正在扩大， 特别是那些生活在持续贫困的县的人，因此制定干预措施以改善 这些患者的结果。因此，这项拟议的研究是基于田纳西州和 密西西比州，拥有大量农村人口的州分别占人口的三分之一和一半。 在医疗系统、提供者和患者层面存在障碍的多层次远程提供的干预措施 使农村患者和提供者能够获得综合癌症中心Hold的专业知识 巨大的希望。通过拟议的研究，我们将采用类型1混合有效性-实施 设计，包括传统的临床有效性试验以及干预的过程评估 交付和实施。具体地说，我们将评估1)基于多层次远程医疗的临床效果 对乡村医院的干预，包括提供者级别的分子肿瘤委员会和患者级别的 获得支持性护理的机会；和2)未来更大规模传播和 实施这一多层次干预措施，旨在提高农村癌症护理服务的质量。这个 干预包括非随机化的提供者级别对合并了疾病的肿瘤委员会的访问， 患者和分子肿瘤的特点，以增强治疗选择，以及随机患者水平 获得自我管理干预与注意力控制。综合框架，用于 将利用执行研究来确定障碍和促进者。这些努力之所以可能，是因为 现有的社区伙伴关系已经到位，将利用这种伙伴关系提供全面的护理 在我们的癌症中心，通过远程医疗向农村癌症患者和提供者提供服务。为了进一步强调 我们努力的重要性，我们的学术癌症中心所在的美国南部 最高的癌症死亡率，是这一应用的重点领域。我们的短期目标是 探索通过广泛和远程的方式加强农村癌症患者的癌症护理 与我们地区服务不足的农村社区分享我们癌症中心提供的专业知识。我们的长期合作 目标是传播循证战略，以改善农村癌症患者的预后。

The proposed project is submitted in response to RFA-CA-18-026, providing an “IT-enabled, team-based care delivery models … to deliver comprehensive, coordinated, high-quality cancer-related care to rural low-income and/or underserved populations.” There are widening mortality disparities among rural cancer patients, particularly those who live in counties with persistent poverty, making it critical to develop interventions to improve outcomes for these patients. Therefore, the proposed study is based at seven rural hospitals in Tennessee and Mississippi, states with large rural populations encompassing a third and a half of the population, respectively. With barriers at the health system, provider and patient level, multi-level remotely-delivered interventions that enable rural patients and providers to access expertise housed at a comprehensive cancer center hold tremendous promise. Through the proposed study, we will employ a Type 1 Hybrid Effectiveness-Implementation design, which includes a traditional clinical effectiveness trial along with a process evaluation of the intervention delivery and implementation. Specifically, we will evaluate the 1) clinical effectiveness of a multi-level telehealthbased intervention for rural hospitals consisting of provider-level access to a molecular tumor board and patientlevel access to supportive care; and 2) facilitators and barriers to future larger scale dissemination and implementation of this multilevel intervention, designed to enhance quality of rural cancer care delivery. The intervention consists of non-randomized provider-level access to a tumor board which incorporates disease, patient and molecular tumor characteristics to enhance treatment options, together with randomized patient-level access to a self-management intervention versus attention control. The Consolidated Framework for Implementation Research will be used to identify barriers and facilitators. These efforts are possible due to existing community partnerships already in place, which will be leveraged to bring comprehensive care available at our cancer center to rural cancer patients and providers through telehealth. To further underscore the importance of our efforts, the Southern United States in which our academic cancer center is based has amongst the highest cancer mortality rates, and is the region of focus for this application. Our short-term goals are to explore means by which to enhance cancer care among rural cancer patients through broadly and remotely sharing expertise available at our cancer center with rural underserved communities in our region. Our long-term goals are to disseminate evidence-based strategies to improve outcomes among rural cancer patients.