Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
JCO Oncol Pract. 2021 Oct;17(10):e1512-e1523. doi: 10.1200/OP.20.00943. Epub 2021 Mar 10.
More than half of patients with head and neck squamous cell carcinoma (HNSCC) experience a delay initiating guideline-adherent postoperative radiation therapy (PORT), contributing to excess mortality and racial disparities in survival. However, interventions to improve the delivery of timely, equitable PORT among patients with HNSCC are lacking. This study (1) describes the development of NDURE (Navigation for Disparities and Untimely Radiation thErapy), a navigation-based multilevel intervention (MLI) to improve guideline-adherent PORT and (2) evaluates its feasibility, acceptability, and preliminary efficacy.
NDURE was developed using the six steps of intervention mapping (IM). Subsequently, NDURE was evaluated by enrolling consecutive patients with locally advanced HNSCC undergoing surgery and PORT (n = 15) into a single-arm clinical trial with a mixed-methods approach to process evaluation.
NDURE is a navigation-based MLI targeting barriers to timely, guideline-adherent PORT at the patient, healthcare team, and organizational levels. NDURE is delivered via three in-person navigation sessions anchored to case identification and surgical care transitions. Intervention components include the following: (1) patient education, (2) travel support, (3) a standardized process for initiating the discussion of expectations for PORT, (4) PORT care plans, (5) referral tracking and follow-up, and (6) organizational restructuring. NDURE was feasible, as judged by accrual (88% of eligible patients [100% Blacks] enrolled) and dropout (n = 0). One hundred percent of patients reported moderate or strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for Black patients.
NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.
超过一半的头颈部鳞状细胞癌（HNSCC）患者在开始接受符合指南的术后放射治疗（PORT）时会出现延迟，这导致死亡率增加，并且生存方面存在种族差异。然而，缺乏改善 HNSCC 患者及时、公平接受 PORT 的干预措施。本研究（1）描述了导航以减少放疗延误（NDURE）的开发，这是一种基于导航的多层次干预（MLI），旨在改善符合指南的 PORT；（2）评估其可行性、可接受性和初步疗效。
NDURE 是使用干预映射（IM）的六个步骤开发的。随后，通过对接受手术和 PORT 的局部晚期 HNSCC 连续患者（n=15）进行单臂临床试验，采用混合方法进行过程评估，对 NDURE 进行了评估。
NDURE 是一种基于导航的 MLI，针对的是患者、医疗团队和组织层面上及时、符合指南的 PORT 的障碍。NDURE 通过三次面对面的导航会议来提供，这些会议以病例识别和手术护理过渡为基础。干预措施包括以下内容：（1）患者教育；（2）旅行支持；（3）发起 PORT 期望讨论的标准化流程；（4）PORT 护理计划；（5）转诊跟踪和随访；（6）组织重构。NDURE 是可行的，这体现在入组率（符合条件的患者中有 88%[100%为黑人]入组）和退出率（n=0）上。100%的患者报告说，NDURE 有助于解决开始 PORT 时的挑战，他们表示同意的程度为中度或强烈；86%的患者非常有可能推荐 NDURE。总体上及时、符合指南的 PORT 率为 86%，黑人患者的这一比例为 100%。
NDURE 是一种基于导航的 MLI，它是可行的、可接受的，并且有可能改善及时、公平、符合指南的 PORT。
