Evan M Graboyes1,2,3, Katherine R Sterba2,3, Hong Li2,3, Graham W Warren2,4,5, Anthony J Alberg6, Elizabeth A Calhoun7, Brian Nussenbaum8, Jessica McCay1, Courtney H Marsh1, Nosayaba Osazuwa-Peters9,10, David M Neskey1,2, John M Kaczmar11, Anand K Sharma4, Jennifer Harper4, Terry A Day1, Chanita Hughes-Halbert2,12. 1. Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC. 2. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC. 3. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 4. Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC. 5. Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC. 6. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC. 7. Department of Population Health, University of Kansas, Kansas City, KS. 8. American Board of Otolaryngology - Head and Neck Surgery, Houston, TX. 9. Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, NC. 10. Department of Population Health Sciences, Duke University, Durham, NC. 11. Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC. 12. Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: NDURE is a navigation-based MLI that is feasible, is acceptable, and has the potential to improve the timely, equitable, guideline-adherent PORT.
Authors: Evan M Graboyes; Jennifer Gross; Dorina Kallogjeri; Jay F Piccirillo; Maha Al-Gilani; Michael E Stadler; Brian Nussenbaum Journal: JAMA Otolaryngol Head Neck Surg Date: 2016-05-01 Impact factor: 6.223
Authors: Stephen H Taplin; Rebecca Anhang Price; Heather M Edwards; Mary K Foster; Erica S Breslau; Veronica Chollette; Irene Prabhu Das; Steven B Clauser; Mary L Fennell; Jane Zapka Journal: J Natl Cancer Inst Monogr Date: 2012-05
Authors: Evan M Graboyes; Elizabeth Garrett-Mayer; Mark A Ellis; Anand K Sharma; Amy E Wahlquist; Eric J Lentsch; Brian Nussenbaum; Terry A Day Journal: Cancer Date: 2017-08-25 Impact factor: 6.860
Authors: K K Ang; A Trotti; B W Brown; A S Garden; R L Foote; W H Morrison; F B Geara; D W Klotch; H Goepfert; L J Peters Journal: Int J Radiat Oncol Biol Phys Date: 2001-11-01 Impact factor: 7.038
Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Donald J Dudley; Kevin Fiscella; Electra Paskett; Peter C Raich; Richard G Roetzheim Journal: Cancer Date: 2008-12-15 Impact factor: 6.860
Authors: Elizabeth A Calhoun; Elizabeth M Whitley; Angelina Esparza; Elizabeth Ness; Amanda Greene; Roland Garcia; Patricia A Valverde Journal: Health Promot Pract Date: 2008-12-30
Authors: Jeremy P Harris; Michelle M Chen; Ryan K Orosco; Davud Sirjani; Vasu Divi; Wendy Hara Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-04-01 Impact factor: 6.223