The overarching goal of this five-year grant proposal, submitted on behalf of the Beckman Research Institute of City of Hope and the University of California, Riverside, in response to RFA-CA-19-035, is to test the efficacy of an advance-practice nurse (APRN)-driven telehealth Survivor Self-Management (SSM) Intervention in 414 lung and colorectal cancer survivors. This research is critical because lung and colorectal cancer survivors have high post-treatment needs, are older, and suffers from greater co-morbidities and poor quality of life (QOL). Lung and colorectal cancer survivors remain underrepresented in research, leading to significant disparities in post-treatment outcomes. Based on the Chronic Care Self-Management Model (CCM), the SSM Intervention includes the following components: 1) care coordination and communication between oncology and primary care on surveillance/follow-up, health promotion, disease prevention, and comorbidity management; 2) provision of clinician care plan to PCPs; 3) comprehensive patient/geriatric assessment for survivors of all ages; 4) personalized care plan for survivors; and 5) survivor self-management skills building for surveillance/follow-up, late and long-term effects of treatments, comorbidities, and healthy living. It is administered in five telehealth sessions (Zoom videoconferencing) and three subsequent maintenance telehealth sessions for survivors who are four months post-treatment. We will test the efficacy of the SSM Intervention using a randomized design of attention control arm versus an intervention arm to pursue the following specific aims:
Specific Aim 1 (Primary): Determine the efficacy of the intervention on care coordination, communication, and provider knowledge at 4 months post-accrual;
Specific Aim 2 (Primary): Determine the efficacy of the intervention on survivor outcomes at 4 months post-accrual;
and Specific Aim 3 (Exploratory): Assess the reach, efficacy, adoption, implementation, and maintenance (RE-AIM) of the intervention. The RE-AIM Framework informs intervention delivery process, which will set the stage for future large scale implementation for sustainability in real-world care settings. This proposal is innovative because it addresses a critical need to improve care delivery and outcomes for high needs, understudied survivorship populations (lung, colorectal, older survivors), and the telehealth approach promotes scalability. The interdisciplinary team, which includes expertise in nursing science (Sun, Reb, Ferrell), oncology (Fakih), and primary care (Kim) is uniquely suited to conduct this research. The proposal is significant, with high scientific rigor and outcomes that are of critical importance to survivors, clinicians, healthcare systems, the National Cancer Institute, and the Beau Biden Cancer MoonshotSM. The research will address a critical gap in knowledge of how self-management interventions improve care delivery and outcomes during post-treatment transitions to follow-up care.
The overall purpose of this R01 grant application entitled ?Self-Management to Optimize Survivorship Care and Outcomes in Lung and Colorectal Cancer? is to test whether an advanced practice nurse (APRN)-led Survivor Self-Management (SSM) Intervention can improve care coordination, communication, and quality of life in lung and colorectal cancer. In collaboration with the Beckman Research Institute of City of Hope and the University of California, Riverside, we have a unique opportunity to understand whether a self-management and oncology/primary care shared care model can optimize outcomes for lung and colorectal cancer survivors, a growing population that are traditionally underrepresented in cancer research. Completion of the study will improve our understanding on how to best transition lung and colorectal cancer survivors to post-treatment follow-up care.
