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.

美国不到40％的卵巢癌（OC）患者接受适合阶段的指南遵守。 手术和化学疗法；黑色OC患者接受此类治疗的可能性较小。而5年 在1975年至2009年之间，白人OC患者的相对生存率提高了47％，下降了27％ 黑人患者在同一时期。在癌症存活中，还观察到黑人患者有 这些种族差异可能是由于 在很大程度上要与医疗保健访问的差异 - 特别是，获得高质量初始治疗和之后 治疗支持护理。医疗保健访问是一个复杂的主题；但是，Penchansky Healthcare 访问框架提出，它包括五个特定维度：可用性，可负担性， 卫生保健服务的可及性，住宿和可接受性。我们的研究将全面 评估黑白患者中医疗保健访问（HCA）的所有五个维度，以识别和 量化导致OC护理和生存中罢工赛车差异的特定因素。更多的 具体而言，我们将利用Seer-Medicare（8,060名OC患者）的数据以及主要的调查数据 来自1,010名OC患者的基于人群的样本，与几个现有数据集有关（例如，美国 社区调查，地区医疗保健资源文件），以表征协会的种族差异 在每个HCA维度和三个结果之间：初始治疗的质量和支持性护理，质量 基于患者报告的符号的结果和生存的生命。我们将 评估患者，邻里，提供者和医院级别的HCA维度，并利用层次结构 具有随机效果的回归模型可以说明聚类，以及多级结构方程模型 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。我们的 初步研究表明，某些研究不足的维度（例如，可接受性）可能超过其他 确定护理质量的维度（例如，可用性）。而且，各种HCA的影响 尺寸可能因种族而异。通过分析黑白患者的高质量多层数据集 我们可以充分表征种族分布的性质，评估特定种族的相对重要性 护理的障碍，并确定种族特定的可修改因素。我们的研究将提供新颖，经验和 关于HCA维度对OC结果的独特和集体影响的可概括见解。 这些见解将有助于识别和优先考虑特定的可修改因素，然后将这些因素定为目标以减少 差异并改善所有患者的护理。