A Role of Multilevel Healthcare Access Dimensions in Ovarian Cancer Disparities

多层次医疗保健获取维度在卵巢癌差异中的作用

• 批准号: 10394858
• 负责人: Tomi F Akinyemiju
• 金额: $ 49.46万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394858
• 关键词: Address; Adjuvant; Aftercare; American; Area; Attitude; Black race; Cancer Patient; Cancer Survivor; Caring; Community Surveys; Complex; Cost Sharing; Data; Data Set; Databases; Development; Dimensions; Equation; Fatigue; Financial Hardship; Guidelines; Health Personnel; Health Services Accessibility; Healthcare; Hospitals; Knowledge; Link; Location; Malignant Neoplasms; Malignant neoplasm of ovary; Mediating; Medicare; Mental Depression; Modeling; National Cancer Institute; Nature; Neighborhoods; Operative Surgical Procedures; Outcome; Pain; Patient Outcomes Assessments; Patients; Patterns of Care; Perception; Pharmaceutical Preparations; Platinum; Population; Poverty; Provider; Quality of Care; Quality of life; Race; Reporting; Research Personnel; Resources; Role; Rural; SEER Program; Sampling; Social support; Source; Specialist; Subgroup; Supportive care; Surveys; Survival Rate; Survivors; Symptoms; Time; Travel; Trust; Tumor Debulking; Woman; barrier to care; base; black patient; black women; cancer care; cancer health disparity; cancer survival; cancer therapy; chemotherapy; cohort; differences in access; disparity reduction; health care availability; health care service; health care service organization; health literacy; healthcare acceptability; improved; insight; neoplasm registry; novel; patient-clinician communication; population based; preference; racial difference; racial disparity; recruit; socioeconomics; surveillance data; symptom management; theories; treatment strategy; trend

Less than 40% of ovarian cancer (OC) patients in the US receive stage-appropriate guideline- adherent surgery and chemotherapy; Black OC patients are even less likely to receive such treatment. While 5-year relative survival for White OC patients improved by 47% between 1975 and 2009, it declined by 27% for Black patients during this same period. Among cancer survivors, Black patients are also observed to have significantly higher depression, pain, and fatigue than White survivors. These racial disparities are likely due largely to differences in healthcare access – specifically, access to high quality initial treatment and post- treatment supportive care. Healthcare access is a complex subject; however, the Penchansky healthcare access framework proposed that it comprises of five specific dimensions: availability, affordability, accessibility, accommodation and acceptability of health care services. Our study will comprehensively evaluate all five dimensions of healthcare access (HCA) among Black and White patients to identify and quantify the specific factors contributing to the striking racial differences in OC care and survival. More specifically, we will utilize data from SEER-Medicare (8,060 OC patients) along with primary survey data from a population-based sample of 1,010 OC patients, linked with several existing datasets (e.g., American Community Survey, Area Healthcare Resource File), to characterize racial differences in associations between each HCA dimension and three outcomes: quality of initial treatment and supportive care, quality of life based on patient-reported outcomes in prevalent yet manageable symptoms, and survival. We will evaluate HCA dimensions across patient, neighborhood, provider and hospital levels, and utilize hierarchical regression models with random effects to account for clustering, and multilevel structural equation models to estimate the total, direct and indirect effect of race on treatment mediated through HCA dimensions. Our preliminary studies suggest that certain under-studied dimensions (e.g., acceptability) may outweigh other dimensions (e.g., availability) in determining quality of care. Moreover, the impact of the various HCA dimensions may vary by race. By analyzing high-quality multilevel datasets with Black and White patients, we can fully characterize the nature of racial disparities, assess the relative importance of race-specific barriers to care, and identify race-specific modifiable factors. Our study will provide novel, empirical, and generalizable insights regarding the distinct and collective influence of HCA dimensions on OC outcomes. These insights will help identify and prioritize specific modifiable factors that can then be targeted to reduce disparities and improve care for all patients.

美国只有不到 40% 的卵巢癌 (OC) 患者接受了符合分期的指南 手术和化疗；黑人 OC 患者接受此类治疗的可能性更小 5 年。 1975 年至 2009 年间，白人 OC 患者的相对生存率提高了 47%，而白人 OC 患者的相对生存率下降了 27%。 在同一时期的黑人患者中，也观察到黑人患者患有癌症。 这些种族差异可能是由于白人幸存者的抑郁、疼痛和疲劳程度明显更高。 主要是医疗保健获取方面的差异——具体来说，获得高质量的初始治疗和后期治疗的机会 治疗支持性护理。然而，Penchansky 医疗保健是一个复杂的主题； 准入框架建议由五个具体维度组成：可用性、可负担性、 我们的研究将全面评估医疗保健服务的可及性、住宿性和可接受性。 评估黑人和白人患者医疗保健获取 (HCA) 的所有五个维度，以识别和 量化导致 OC 护理和生存方面显着种族差异的具体因素。 具体来说，我们将利用 SEER-Medicare（8,060 名 OC 患者）的数据以及主要调查数据 来自 1,010 名 OC 患者的基于人群的样本，与多个现有数据集（例如 American 社区调查、地区医疗保健资源文件），以描述协会中的种族差异 每个 HCA 维度与三个结果之间的关系：初始治疗和支持性护理的质量、治疗的质量 我们将根据患者报告的普遍但可控制的症状和生存结果来确定生活。 跨患者、社区、提供者和医院级别评估 HCA 维度，并利用分层结构 具有随机效应的回归模型可解释聚类，多级结构方程模型可解释聚类 估计种族对通过 HCA 维度介导的治疗的总体、直接和间接影响。 初步研究表明，某些未充分研究的维度（例如可接受性）可能比其他维度更重要 此外，还包括各种 HCA 的影响。 通过分析黑人和白人患者的高质量多级数据集，维度可能因种族而异。 我们可以充分描述种族差异的本质，评估特定种族的相对重要性 我们的研究将提供新颖的、经验性的和可改变的因素。 关于 HCA 维度对 OC 结果的独特和集体影响的普遍见解。 这些见解将有助于识别和优先考虑特定的可修改因素，然后可以有针对性地减少 差异并改善对所有患者的护理。