Pilot Project 1: Creating Bridges to Reproductive Health Care for Rural Adolescent and Young Adult Cancer Survivors

项目摘要/摘要--试点项目 在医疗服务不足的帝国郡，癌症患者的生殖健康保健是一个未得到满足的需求， 农村地区癌症研究和教育促进卫生公平(Create)伙伴关系 主要是西班牙裔人口的集水区。生殖健康是青少年的一个主要问题。 和年轻成人(Aya)癌症幸存者，因为他们可以经历更高的不孕不育风险，不利的 妊娠结局和未得到满足的信息需求。生殖保健有效地降低了风险，但 吸纳率较低，因为没有可扩展的干预措施来支持实施常规生殖 服务不足、地理位置偏远的社区的医疗保健。在癌症生存关怀的指引下 质量框架，这一试点提案寻求适应和试点测试多组件干预以改进 女性Aya癌症幸存者对生殖保健的接受情况。干预措施有三个组成部分 源自我们以前的工作：1)生殖风险总结(RS)和生殖健康护理计划 健康(SCP-R)，2)导航，以及3)远程生殖咨询。在目标1中，我们将调整RS和 SCP-R英文和西班牙文，以回应文化、健康素养和社会生态需求 拉丁裔Aya幸存者通过与Aya幸存者和父母/监护人的焦点小组，并采用半结构化 对医疗保健提供者的采访。我们还将系统地评估障碍和促进者 皇郡的生殖健康保健及如何适应多元干预 背景，通过与幸存者和父母/监护人的焦点小组以及与医疗保健提供者的访谈 和诊所的工作人员。在目标2中，我们将进行单一ARM多组件干预的可行性测试 试点混合类型1试验(评估效果和观察实施情况)。主要结果是 15名新确诊的Aya幸存者和15名治疗后的Aya幸存者参与生殖保健。 其次，我们将对Aya幸存者的有效性、适合性和实施结果进行定性评估， 医疗保健提供者和健康诊所工作人员。该提案直接针对以下人群面临的严重健康差距 我们集水区的女性Aya幸存者和农村社区卫生之间建立伙伴关系的需要 专业人员和城市专家提供高质量的生殖生存护理。我们将创作一部小说， 可扩展的干预和初步数据，以支持未来关于干预有效性的多点试验 在农村、医疗服务不足的肿瘤科环境中增加生殖保健。两国之间的伙伴关系 SDSU、CRCD和UCSD的研究人员将通过协作学习、社区 参与，以及增强受训人员的能力，以支持帝国郡未来的癌症研究。

PROJECT SUMMARY/ ABSTRACT – PILOT PROJECT Reproductive health care in cancer patients is an unmet need in Imperial County, a medically underserved, rural region of the Cancer Research and Education to Advance HealTh Equity (CREATE) Partnership’s catchment area with a predominantly Hispanic population. Reproductive health is a major issue for adolescent and young adult (AYA) cancer survivors because they can experience higher risks of infertility, adverse pregnancy outcomes, and unmet informational needs. Reproductive health care effectively reduces risks, but uptake is low because there are no scalable interventions to support the implementation of routine reproductive health care in underserved, geographically remote communities. Guided by the Cancer Survivorship Care Quality Framework, this pilot proposal seeks to adapt and pilot test a multi-component intervention to improve reproductive health care uptake by female AYA cancer survivors. The intervention has three components derived from our prior work: 1) a reproductive risk summary (RS) and survivorship care plan on reproductive health (SCP-R), 2) navigation, and 3) telehealth reproductive consults. In Aim 1, we will adapt the RS and SCP-R in English and Spanish to be responsive to the cultural, health literacy, and socio-ecological needs of Latina AYA survivors through focus groups with AYA survivors and parents/guardians, and semi-structured interviews with healthcare providers. We will also systematically evaluate barriers and facilitators to reproductive health care in Imperial County and examine how to fit the multi-component intervention to this setting, through focus groups with survivors and parents/guardians and interviews with healthcare providers and clinic staff. In Aim 2, we will conduct feasibility testing of the multicomponent intervention in a single arm pilot hybrid type 1 trial (evaluating effectiveness and observing implementation). The primary outcome is engagement in reproductive health care by 15 newly diagnosed and 15 post-treatment AYA survivors. Secondarily, we will qualitatively assess effectiveness, fit and implementation outcomes with AYA survivors, healthcare providers and health clinic staff. The proposal directly targets a critical health disparity faced by female AYA survivors in our catchment area and need for partnership between rural community health professionals and urban specialists to deliver quality reproductive survivorship care. We will generate a novel, scalable intervention and preliminary data to support a future multi-site trial on intervention effectiveness in increasing reproductive care in rural, medically underserved oncology settings. The partnership between SDSU, CRCD and UCSD researchers will be strengthened with collaborative learning, community engagement, and increased capacity of trainees to support future cancer research in Imperial County.