Disparities in Quality Healthcare Among Childhood Cancer Survivors: Role of Medicaid - PROJECT SUMMARY or ABSTRACT Survivors of childhood cancer require life-long healthcare to improve quality of life and health. However, the majority of adult survivors of childhood cancer, including those with public health insurance (e.g., Medicaid), lack long-term healthcare. There are crucial gaps in our current understanding of variations in patient care and the modifiable factors that may influence variability in care among childhood cancer survivors in the Medicaid system. This study will use qualitative and survey research methods to systematically assess survivor experience of care in the Medicaid system and determine sources of variation affecting care experience among adult survivors of childhood cancer. We anticipate contacting for potential recruitment a total of 2,700 adult survivors insured with Medicaid from the Childhood Cancer Survivor Study (CCSS), including: 20 survivors for qualitative survivor interviews (Aim 1), among whom 8 survivors will participate in a Delphi panel (Aim 2); 144 survivors for a pilot survey (Aim 2); and 2,536 survivors for an expanded survey (Aim 3). For Aim 1, we will also include 10 stakeholder participants (care providers and financial navigators) from CCSS participating institutions for qualitative stakeholder interviews. The specific aims are as follows. Aim 1: Use qualitative methods to explore multi-level factors influencing quality healthcare for adult survivors of childhood cancer in the Medicaid system. Aim 2: Develop and validate a survey to quantify survivor experiences with the Medicaid system. Aim 3: Assess variations in survivor experiences with insurance and healthcare in Medicaid, and how these differences are related to survivor-, community-, and state-level characteristics. Data gained from this study will form the foundation for an R01 proposal to survey state-specific cancer survivor cohorts, with the goal of informing interventions that promote high-quality care based on state Medicaid program rules. The candidate’s long-term career goal is to become an independent scientist with a research program focused on examining factors that influence health and healthcare after childhood cancer. Under the mentorship of international experts in health research and cancer survivorship, the candidate will accomplish her short-term goals to 1) develop expertise in implementation science and research on health differences, 2) acquire qualitative and survey research skills, 3) understand patient experience in pediatric oncology and cancer survivorship, and 4) improve research leadership and management skills to complete transition to independence. The integrated training plan includes a mix of didactic courses, hands-on learning activities, and focused multidisciplinary mentorship that will advance the candidate’s research skills and ensure her transition to a fully independent investigator.
