School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2022 Dec 1;12(12):e067270. doi: 10.1136/bmjopen-2022-067270.
Delaying cancer treatment following diagnosis impacts health outcomes, including increasing patient distress and odds of mortality. Interventions to promote timely healthcare engagement may decrease patient-reported stress and improve quality of life. Community health workers (CHWs) represent an enabling resource for reducing delays in attending initial oncology treatment visits. As part of an ongoing programme evaluation coordinated by the Merck Foundation, we will implement a pilot navigation programme comprising CHW-conducted needs assessments for supporting patients and their caregivers. We aim to investigate (1) the programme's influence on patients' healthcare utilisation within the period between their first diagnosis and initial treatment visit and (2) the logistic feasibility and acceptability of programme implementation.
We will employ a hybrid implementation design to introduce the CHW navigation programme at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. CHW team members will use a consecutive sampling approach. Participants will complete the Problem-Checklist, Chronic Illness Distress Scale and the Satisfaction with Life Domains instruments. CHWs will provide tailored guidance by sharing information available on the Johns Hopkins Electronic Resource databases. The investigators will evaluate patients' time to initial oncology treatment and healthcare utilisation by reviewing electronic medical records at 3 and 6 months postintervention. Bivariate analyses will be completed to evaluate the relationships between receiving the programme and all outcome measures.
This study's protocol was approved by the Johns Hopkins School of Medicine's institutional review board (IRB00160610). Informed consent will be obtained by phone by the CHW navigator. Dissemination planning is ongoing through regular meetings between members of the investigator team and public members of two community advisory groups. Study plans include collaborating with other experts from the Johns Hopkins Institute for Clinical and Translational Research and the Johns Hopkins Center for Health Equity for ideating dissemination strategies.
诊断后延迟癌症治疗会影响健康结果，包括增加患者的痛苦和死亡几率。促进及时获得医疗保健的干预措施可能会减少患者报告的压力并提高生活质量。社区卫生工作者（CHW）是减少首次肿瘤治疗就诊时延迟的有效资源。作为默克基金会正在进行的计划评估的一部分，我们将实施一项试点导航计划，该计划包括 CHW 进行的需求评估，以支持患者及其照顾者。我们旨在调查（1）该计划对患者在首次诊断和初始治疗就诊之间的医疗保健利用的影响，以及（2）计划实施的逻辑可行性和可接受性。
我们将采用混合实施设计，在约翰霍普金斯 Sidney Kimmel 综合癌症中心引入 CHW 导航计划。CHW 团队成员将采用连续抽样方法。参与者将完成问题清单、慢性疾病困扰量表和生活满意度领域量表。CHW 将通过共享约翰霍普金斯电子资源数据库上提供的信息提供量身定制的指导。研究人员将通过在干预后 3 个月和 6 个月查看电子病历来评估患者接受初始肿瘤治疗和医疗保健的时间和利用情况。将进行双变量分析，以评估接受该计划与所有结果测量之间的关系。
该研究的方案已获得约翰霍普金斯医学院机构审查委员会（IRB00160610）的批准。CHW 导航员将通过电话获得知情同意。通过定期召开调查员团队成员和两个社区咨询小组的公众成员会议，正在进行传播计划。研究计划包括与约翰霍普金斯临床和转化研究研究所和约翰霍普金斯健康公平中心的其他专家合作，为传播策略出谋划策。
