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Zhou L, Li Y, Zhang Y, Chen X, Zhang S, Hu X. Perceptions of Telehealth Services Among Rural Lung Cancer Patients in China: A Qualitative Study Using the Technology Acceptance Model. Semin Oncol Nurs 2024:151710. [PMID: 39117510 DOI: 10.1016/j.soncn.2024.151710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/25/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To describe the perceptions of telehealth services among lung cancer patients in rural areas of China, as well as to explore the potential of telemedicine to improve long-term health recovery at home for rural lung cancer patients. METHODS A qualitative descriptive study design was used in this study and we conducted semi-structured interviews with 14 rural Chinese lung cancer patients between December 2022 and March 2023. Interview content was analyzed using Nvivo software and a framework analysis was performed using the Technology Acceptance Model to identify meaningful themes. RESULTS Participants identified perceptual and technical factors related to perceived ease of use, benefits and drawbacks related to perceived usefulness, and facilitators and barriers related to intention to use. However, regional and disease features including literacy barriers, medical insurance condition, symptom burden, and rural cultural health seeking behavior conduct must be taken into account. CONCLUSIONS Lung cancer patients in rural China believe that telehealth services could be an alternative solution for addressing health and care needs, but various aspects, such as user interface design, cost-effectiveness, and technological anxiety, need to be optimized. IMPLICATIONS FOR NURSING PRACTICE More highly specialized nursing team, friendly telecare lung function modules, and media technology training courses should be developed for rural lung cancer patients to enhance the quality of their home care, meet their information needs and better control their disease progression.
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Affiliation(s)
- Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, China.
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Lizalek JM, Reames BN. Time, Space, and Place: Can Geospatial Information Systems Clarify the Tension Between Regionalization and Access for Complex Cancer Surgery? Ann Surg Oncol 2023; 30:7915-7917. [PMID: 37684367 DOI: 10.1245/s10434-023-14292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Jason M Lizalek
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bradley N Reames
- Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
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Logan CD, Nunnally SEA, Valukas C, Warwar S, Swinarska JT, Lee FT, Bentrem DJ, Odell DD, Elaraj DM, Sturgeon C. Association between travel distance and overall survival among patients with adrenocortical carcinoma. J Surg Oncol 2023; 128:749-763. [PMID: 37403612 PMCID: PMC10997292 DOI: 10.1002/jso.27387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Regionalization of care is associated with improved perioperative outcomes after adrenalectomy. However, the relationship between travel distance and treatment of adrenocortical carcinoma (ACC) is unknown. We investigated the association between travel distance, treatment, and overall survival (OS) among patients with ACC. METHODS Patients diagnosed with ACC between 2004 and 2017 were identified with the National Cancer Database. Long distance was defined as the highest quintile of travel (≥42.2 miles). The likelihood of surgical management and adjuvant chemotherapy (AC) were determined. The association between travel distance, treatment, and OS was evaluated. RESULTS Of 3492 patients with ACC included, 2337 (66.9%) received surgery. Rural residents were more likely to travel long distances for surgery than metropolitan residents (65.8% vs. 15.5%, p < 0.001), and surgery was associated with improved OS (HR 0.43, 95% CI 0.34-0.54). Overall, 807 (23.1%) patients received AC with rates decreasing approximately 1% per 4-mile travel distance increase. Also, long distance travel was associated with worse OS among surgically treated patients (HR 1.21, 95% CI 1.05-1.40). CONCLUSIONS Surgery was associated with improved overall survival for patients with ACC. However, increased travel distance was associated with lower likelihood to receive adjuvant chemotherapy and decreased overall survival.
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Affiliation(s)
- Charles D. Logan
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Sara E. A. Nunnally
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Catherine Valukas
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Samantha Warwar
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Joanna T. Swinarska
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Frances T. Lee
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J. Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D. Odell
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Dina M. Elaraj
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
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Logan CD, Feinglass J, Halverson AL, Durst D, Lung K, Kim S, Bharat A, Merkow RP, Bentrem DJ, Odell DD. Rural-Urban Disparities in Receipt of Surgery for Potentially Resectable Non-Small Cell Lung Cancer. J Surg Res 2023; 283:1053-1063. [PMID: 36914996 PMCID: PMC10289009 DOI: 10.1016/j.jss.2022.10.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Access to cancer care, especially surgery, is limited in rural areas. However, the specific reasons rural patient populations do not receive surgery for non-small cell lung cancer (NSCLC) is unknown. We investigated geographic disparities in reasons for failure to receive guideline-indicated surgical treatment for patients with potentially resectable NSCLC. METHODS The National Cancer Database was used to identify patients with clinical stage I-IIIA (N0-N1) NSCLC between 2004 and 2018. Patients from rural areas were compared to urban areas, and the reason for nonreceipt of surgery was evaluated. Adjusted odds of (1) primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery were determined. RESULTS The study included 324,785 patients with NSCLC with 42,361 (13.0%) from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery (P < 0.001). Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]: 1.05-1.23), (2) surgery being deemed contraindicated due to risk (aOR: 1.19, 95% CI: 1.07-1.33), (3) surgery being recommended but not performed (aOR: 1.13, 95% CI: 1.01-1.26), and (4) overall failure to receive surgery (aOR: 1.21, 95% CI: 1.13-1.29; all P < 0.001). CONCLUSIONS There are geographic disparities in the management of NSCLC. Rural patient populations are more likely to fail to undergo surgery for potentially resectable disease for every reason examined.
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Affiliation(s)
- Charles D Logan
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Joe Feinglass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Amy L Halverson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Dalya Durst
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Kalvin Lung
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Samuel Kim
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ankit Bharat
- Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David J Bentrem
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611; Canning Thoracic Institute, Department of Surgery, Northwestern University, Feinberg School of Medicine, 420 East Superior Street, Chicago, Illinois 60611.
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Chaiyachati KH, Krause D, Sugalski J, Graboyes EM, Shulman LN. A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients' Transportation Insecurity. J Natl Compr Canc Netw 2023; 21:21-26. [PMID: 36634609 PMCID: PMC9888481 DOI: 10.6004/jnccn.2022.7073] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Addressing patients' social determinants of health is a national priority for cancer treatment centers. Transportation insecurity is one major challenge for patients undergoing active cancer treatment, and missing treatments can result in worse cancer treatment outcomes, including worse morbidity and mortality. How cancer treatment centers are addressing transportation insecurity is understudied. METHODS In January and February 2022, the NCCN Best Practices Committee conducted a survey of NCCN's 31 Member Institutions (currently 32 member institutions as of April 2022) to assess how centers were addressing patient transportation insecurity: how they screen for transportation insecurity, coordinate transportation, and fund transportation initiatives, and their plans to address transportation insecurity in the future. RESULTS A total of 25 of 31 (81%) NCCN Member Institutions responded to the survey, of which 24 (96%) reported supporting the transportation needs of their patients through screening, coordinating, and/or funding transportation. Patients' transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%). Few centers (33%) used routine screening approaches (eg, universal screening of social risk factors) to systematically identify transportation needs, and 54% used the support of technology platforms or a vendor to coordinate transportation. Transportation was predominantly funded via some combination of philanthropy (88%), grants (63%), internal dollars (63%), and reimbursement from insurance companies (58%). Over the next 12 months, many centers were either going to continue their current transportation programs in their current state (60%) or expand existing programs (32%). CONCLUSIONS Many NCCN Member Institutions are addressing the transportation needs of their patients. Current efforts are heterogeneous. Few centers have systematic, routine screening approaches, and funding relies on philanthropy more so than institutional dollars or reimbursement from insurers. Opportunities exist to establish more structured, scalable, and sustainable programs for patients' transportation needs.
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Affiliation(s)
| | - Diana Krause
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | | | - Lawrence N. Shulman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Logan CD, Feinglass J, Halverson AL, Lung K, Kim S, Bharat A, Odell DD. Rural-urban survival disparities for patients with surgically treated lung cancer. J Surg Oncol 2022; 126:1341-1349. [PMID: 36115023 PMCID: PMC9710511 DOI: 10.1002/jso.27045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Nonsmall-cell lung cancer (NSCLC) is a common diagnosis among patients living in rural areas and small towns who face unique challenges accessing care. We examined differences in survival for surgically treated rural and small-town patients compared to those from urban and metropolitan areas. METHODS The National Cancer Database was used to identify surgically treated NSCLC patients from 2004 to 2016. Patients from rural/small-town counties were compared to urban/metro counties. Differences in patient clinical, sociodemographic, hospital, and travel characteristics were described. Survival differences were examined with Kaplan-Meier curves and Cox proportional hazards models. RESULTS The study included 366 373 surgically treated NSCLC patients with 12.4% (n = 45 304) categorized as rural/small-town. Rural/small-town patients traveled farther for treatment and were from areas characterized by lower income and education(all p < 0.001). Survival probabilities for rural/small-town patients were worse at 1 year (85% vs. 87%), 5 years (48% vs. 54%), and 10 years (26% vs. 31%) (p < 0.001). Travel distance >100 miles (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.07-1.16, vs. <25 miles) and living in a rural/small-town county (HR = 1.04, 95% CI: 1.01-1.07) were associated with increased risk for death. CONCLUSIONS Rural and small-town patients with surgically treated NSCLC had worse survival outcomes compared to urban and metropolitan patients.
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Affiliation(s)
- Charles D. Logan
- Department of SurgerySurgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Joe Feinglass
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Amy L. Halverson
- Department of SurgerySurgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Kalvin Lung
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Samuel Kim
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - David D. Odell
- Department of SurgerySurgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Division of Thoracic Surgery, Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Herb J, Wolff R, McDaniel P, Holmes M, Lund J, Stitzenberg K. Rural representation of the surveillance, epidemiology, and end results database. Cancer Causes Control 2021; 32:211-220. [PMID: 33392903 DOI: 10.1007/s10552-020-01375-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/21/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE SEER data are widely used to study rural-urban disparities in cancer. However, no studies have directly assessed how well the rural areas covered by SEER represent the broader rural United States. METHODS Public data sources were used to calculate county level measures of sociodemographics, health behaviors, health access and all cause cancer incidence. Driving time from each census tract to nearest Commission on Cancer certified facility was calculated and analyzed in rural SEER and non-SEER areas. RESULTS Rural SEER and non-SEER counties were similar with respect to the distribution of age, race, sex, poverty, health behaviors, provider density, and cancer screening. Overall cancer incidence was similar in rural SEER vs non-SEER counties. However, incidence for White, Hispanic, and Asian patients was higher in rural SEER vs non-SEER counties. Unadjusted median travel time was 53 min (IQR 34-82) in rural SEER tracts and 54 min (IQR 35-82) in rural non-SEER census tracts. Linear modeling showed shorter travel times across all levels of rurality in SEER vs non-SEER census tracts when controlling for region (Large Rural: 13.4 min shorter in SEER areas 95% CI 9.1;17.6; Small Rural: 16.3 min shorter 95% CI 9.1;23.6; Isolated Rural: 15.7 min shorter 95% CI 9.9;21.6). CONCLUSIONS The rural population covered by SEER data is comparable to the rural population in non-SEER areas. However, patients in rural SEER regions have shorter travel times to care than rural patients in non-SEER regions. This needs to be considered when using SEER-Medicare to study access to cancer care.
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Affiliation(s)
- Joshua Herb
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Rachael Wolff
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip McDaniel
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Holmes
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jennifer Lund
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn Stitzenberg
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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