Randomized Controlled Trial of a Remote, Multi-level Intervention to Successfully Transition to Adult Care for Survivors of Childhood and Adolescent Cancers: The BRIDGES-YAS! Study - PROJECT SUMMARY/ABSTRACT Although ~95% of young adult (YA) childhood cancer survivors (CCS) will develop chronic health conditions, suboptimal transition to adult-oriented care leads to <20% receiving recommended lifelong survivorship care. YA CCS survivorship follow-up care at the pediatric cancer treatment center (CTC) is limited by organization- and patient-level barriers. Our proposal overcomes these barriers by transitioning YA CCS to community adult PCPs after orienting PCPs to survivors’ individual survivorship care needs and educating YA CCS regarding health self-management/advocacy. In-person transition programs are resource-intensive with limited generalizability and scalability. Our proposal builds on our prior work and includes a remote transition approach for YA survivorship care that leverages community PCPs, telehealth, and nurse navigators (NNs). BRIDGES-YAS! is a two-arm, pragmatic Hybrid Type 1 Effectiveness-Implementation randomized controlled trial (RCT) that will investigate a novel, remote, multi-level intervention (n=120) to transition YA CCS to community adult PCPs for a survivorship visit vs. comparison (n=120) of usual CTC-based follow-up care (plus educational handout about transition). The 1-year intervention addresses individual (CCS), organizational (CTC), and community (PCP) barriers and includes: 1) tailored telehealth CCS education and resource navigation with self-management and self-advocacy skills training by a CTC NN, 2) brief, structured, interactive phone handoff by CTC NN to the community PCP conveying the CCS’s individualized survivorship care needs, 3) secure electronic storage on CCS’ smartphone (or other device) of Survivorship Care Plan and established health education materials, and 4) ongoing NN support and communication between CCS, CTC, and PCP. The three geographically distinct study sites serve patients with health care limitations (e.g., under/uninsured, rural residence, non-English speaking). At 1-year post-randomization, our Specific Aims are to: Aim 1-Compare quality of survivorship care between arms measured objectively by medical record review based on a standardized composite z-score of rates of completed surveillance/assessments in 5 prioritized categories from the 2024 National Standards for Cancer Survivorship Care (maintenance also assessed at 2-years); Aim 2-Compare change in CCS’s self- management/advocacy skills and trust in provider delivering survivorship care using validated instruments (also assessed at baseline); and Aim 3- Evaluate implementation process and outcomes (feasibility, acceptability, cost, intervention fidelity), crucial for future scalability, using implementation tracking, surveys, and interviews. We hypothesize our intervention will support higher quality survivorship care, greater CCS self- management/advocacy and trust, and will be both feasible and acceptable to CCS, CTCs, and PCPs. Impact: If effective, we will utilize the preliminary implementation findings from our remote, multi-level intervention to further refine the intervention and design a subsequent implementation study focused on reach and effectiveness across broader settings to transition YA CCS to community PCP-led survivorship care.
