Patient Navigation in Gynecologic Oncology: Improving Care among Rural Endometrial Cancer Patients

项目总结 子宫内膜癌(EC)是美国最常见的妇科癌症，农村居民有8- 死亡率比城市同龄人高17%。由于预计新的EC病例数量将 到2030年增加50%，这一城乡差距预计将继续扩大。造成这种差异的原因之一 减少接受符合指南的治疗；特别是农村EC患者不太可能 接受全面的外科治疗，是区域性EC治疗的基石。 该项目的总体目标是确定和瞄准获得指南的多级障碍- 通过开发和试点患者导航干预在农村EC患者中进行协调治疗。 患者导航干预可以解决医疗服务不足的癌症面临的众多障碍 患者，并已被证明缩短了开始治疗的时间，增加了接受和坚持 治疗，提高患者满意度。然而，由于设计和设计上的巨大差异， 提供患者导航干预措施，为新的 背景和人群已成为主要挑战；在与治疗相关的患者导航中 干预措施，大多数集中在乳腺癌和结直肠癌患者身上。与这些癌症患者不同， EC患者有不同的需求，例如需要由妇科肿瘤医生指导治疗， 通常只位于城市地区附近或学术医疗中心。只有10%的妇科肿瘤学家 由于在农村地区有这种做法，因此，农村的EC患者经常长途跋涉接受治疗。在建议的 这项研究，我将确定在患有EC的农村妇女中接受符合指南的治疗的多层次障碍 (目标1)，使用干预地图设计患者导航干预(目标2)，并引导患者 航行干预(目标3)。使用干预地图设计EC导航干预将不会 不仅精确地针对多级治疗障碍，而且还将优化匹配和实施 妇科肿瘤科设置中的导航程序。这种方法很新颖，因为它集成了 在计划的设计中确定适当的实施策略。 该项目将为R01应用程序提供初步数据，以测试开发的患者导航 第1类混合有效性-实施试验中的干预。这项研究的预期结果将 为国家少数民族健康和健康差距研究所的使命做出贡献，利用干预措施 消除医疗服务不足人群中的健康差距。此外，我还将接受(1)的培训 社区参与的研究方法，以了解癌症护理公平的多层次决定因素，(2) 设计适合特定人群和背景的干预措施，以及(3)进行干预研究。这 该项目将有助于我的长期目标，即成为一名独立的调查员，开发和 评估干预措施，以减少服务不足人群在癌症护理和结果方面的差异。

PROJECT SUMMARY Rural residents with endometrial cancer (EC), the most prevalent gynecologic cancer in the US, have 8- 17% higher odds of mortality than their urban counterparts. As the number of new EC cases is expected to increase 50% by 2030, this urban-rural disparity is expected to continue widening. Contributing to this disparity is the reduced receipt of guideline-concordant treatment; in particular, rural patients with EC are less likely to receive comprehensive surgical care, the cornerstone of regional stage EC treatment. The overall objective of this project is to identify and target multilevel barriers to receiving guideline- concordant treatment among rural EC patients by developing and piloting a patient navigation intervention. Patient navigation interventions can address a multitude of barriers faced by medically underserved cancer patients and have been shown to shorten time to initiating treatment, increase receipt of and adherence to treatment, and improve patient satisfaction. However, because of the substantial variation in the design and delivery of patient navigation interventions, developing effective and cost-effective interventions for new contexts and populations has become a major challenge; among treatment-related patient navigation interventions, most have focused on patients with breast and colorectal cancers. Unlike these cancer patients, EC patients have different needs, such as requiring treatment to be directed by a gynecologic oncologist, who often are only located near urban areas or at academic medical centers. Only 10% of gynecologic oncologists practice in rural areas, and as a result, rural EC patients often travel far distances for care. In the proposed study, I will identify multilevel barriers to receiving guideline-concordant treatment among rural women with EC (Aim 1), use intervention mapping to design a patient navigation intervention (Aim 2), and pilot a patient navigation intervention (Aim 3). Using intervention mapping to design an EC navigation intervention will not only precisely target the multilevel barriers to treatment but also will optimize the fit and implementation of the navigation program within the gynecologic oncology setting. This approach is novel in that it integrates the identification of appropriate implementation strategies into the program’s design. This project will provide preliminary data for an R01 application to test the developed patient navigation intervention in a Type 1, hybrid effectiveness-implementation trial. The expected outcomes of this study will contribute to the National Institute on Minority Health and Health Disparities’ mission of using interventions to eliminate health disparities among medically underserved populations. Additionally, I will receive training in (1) community-engaged research methods to understand the multi-level determinants of cancer care equity, (2) designing interventions to fit specific populations and context, and (3) conducting intervention studies. This project will contribute to my long-term goal of becoming an independent investigator who develops and evaluates interventions to reduce disparities in cancer care and outcomes among underserved populations.