Although advances in cancer treatment have improved patient survival overall, cancer mortality rates in rural populations remain disproportionately higher than urban populations. Rural-urban disparities in cancer mortality rates are thought to, in part, reflect suboptimal care coordination in rural areas. Cancer patients residing in rural areas experience greater care coordination challenges including limited or lack of access to medical care, travel burdens, shortages of specialists, and delays in receiving diagnosis and post-diagnosis intervention. Delays in diagnosis and treatment initiation have been shown to adversely impact patient survival; such delays have been associated with a three-fold cancer mortality risk. However, little is known about rural cancer patients? perception of care coordination, rural-urban differences in specific cancer care coordination processes, and the impact of rural cancer care coordination on specific care delivery outcomes. The proposed research will address these knowledge gaps and accomplish the following aims:
Aim 1) To compare rural and urban cancer patients? perception of care coordination and Aim 2) To examine the associations between rural cancer patients? perception of care coordination and specific care delivery outcomes (time from first symptoms to diagnosis, time from diagnosis to treatment initiation).
These aims will inform specific care coordination processes that disproportionately impact rural cancer patients and ways to improve rural cancer care delivery. Findings will guide the development of future interventions focused on improving rural cancer care delivery and may contribute to improved quality and value of cancer care, reduce burdens related to care delivery for rural cancer patients, and address rural cancer health disparities. The proposed research advances the Agency for Healthcare Research and Quality (AHRQ)?s focus on research and evaluation of health care delivery in a priority population residing in rural areas. The proposed fellowship is designed to enhance the applicant?s knowledge and skills in health services research under expert mentorship and a mentoring committee, and includes a larger training plan developed to prepare the applicant for the next step in her career toward becoming an independent investigator. Training and research will be conducted at one of the 70 National Cancer Institute-designated cancer centers. Upon completion of the proposed research and training, the applicant will be ideally poised to submit a complete K01 application focused on developing and testing an intervention aimed to improve cancer care coordination in rural areas. Her current and future research aims will advance AHRQ?s mission by focusing on the delivery of health care in a high priority population residing in rural areas.
This proposed research is relevant to public health as improving rural cancer care coordination results in better quality and value of care, reduced burdens of cancer, and lower cancer mortality rates specifically in rural areas. To effectively identify specific targets for improvement in cancer care coordination in rural areas, evaluation of rural cancer patients? perceptions of care coordination is needed. Results will advance patient- centered cancer care delivery research and understanding of rural cancer care coordination to reduce health disparities in rural areas and improve health care delivery in a high priority population residing in rural areas.