Understanding Rural Patient, and Provider Preferences for Mobile Lung Cancer Screening Clinics

了解农村患者和提供者对流动肺癌筛查诊所的偏好

• 批准号: 10555009
• 负责人: Rian M. Hasson
• 金额: $ 20.51万
• 依托单位: DARTMOUTH-HITCHCOCK CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555009
• 关键词: Accreditation; Address; Age; Area; Breast Cancer Detection; Cervical Cancer Screening; Clinic; Clinics and Hospitals; Collaborations; Communities; Community Outreach; County; Data; Development; Disease; Early Diagnosis; Electronic Health Record; Eligibility Determination; Emotional Stress; Enrollment; Family member; Guidelines; Health; Health Services Accessibility; Home; Hospitals; Human Resources; Improve Access; Incidence; Informatics; Institution; Intervention; Interview; Knowledge; Location; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Marketing; Medical center; Methods; Modeling; New England; New Hampshire; Outcome; Patient Participation; Patients; Population; Provider; Psychologist; Psychosocial Assessment and Care; Public Health; Publishing; Qualitative Methods; Reproducibility; Research; Risk; Rural; Rural Community; Rural Health Centers; Rural Population; Science; Screening for cancer; Site; Smoking; Social Marketing; Structure; Surveys; Testing; Thoracic Radiography; Tobacco use; Transportation; Vermont; Work; acceptability and feasibility; cancer diagnosis; cancer risk; community engagement; community partnership; design; effectiveness trial; health care delivery; health literacy; high risk; implementation strategy; improved; low dose computed tomography; lung cancer screening; member; mortality; neoplasm registry; novel strategies; patient-level barriers; pilot test; preference; provider-level barriers; psychosocial; randomized, controlled study; rural area; rural health disparities; rural patients; screening; screening program; sex; social stigma; statistics; success; successful intervention; underserved area; uptake

PROJECT SUMMARY/ABSTRACT Project 1 (Hasson): Understanding Rural Patient and Provider Preferences for Mobile Lung Cancer Screening Clinics Despite the fact that outcomes are best when treatment is given in the early stages of lung cancer, less than 6% of eligible high-risk patients participate in lung cancer screening (LCS), with even lower participation in rural populations. Data from the National Lung Screening Trial (NLST), a multi-institutional randomized controlled study of over 50,000 patients, demonstrated the utility of LCS by comparing low-dose computed tomography (CT) with chest X-ray. It found that LCS with low-dose CT was associated with a 20% reduction in lung cancer-specific mortality, as well as an overall mortality reduction of 6.7%. Many organizations have subsequently published guidelines supporting annual LCS. Nevertheless, 10 years later, despite multiple studies confirming the results of the NLST, and revised guidelines based on continued research into its efficacy, low-dose CT is still underutilized, and a disproportionate number of high-risk patients are either not referred or do not undergo screening. While the reasons for this are multifactorial, the need to better understand the current rural screening landscape, and rural provider and patient barriers leading to low participation, is imperative to resolve this public health dilemma. Additionally, given these hard-to-reach locations, use of a community-based approach is vital to developing an intervention that would be well-utilized. The primary objectives of this proposed study are to identify provider and patient barriers and facilitators that predict referral to, and utilization of, LCS in rural spaces; assess feasibility and acceptability of mobile clinics for screening; and test a mobile unit intervention. The proposed approach used to deliver LCS was designed to reduce logistical and psychosocial barriers. In rural areas, a mobile unit should be feasible and acceptable to patients and providers, and may serve to supplement traditional hospital or clinic-based screening. Based on the success of mobile breast and cervical cancer screening programs, the research team seeks to determine whether a mobile unit will be more successful in increasing screening in rural areas than a traditional hospital- based approach. This project will develop this hypothesis by: (1) identifying regions with high rates of lung cancer (and lung cancer identified at later stages); (2) obtaining input from community members to inform a feasible, acceptable mobile LCS intervention; and then (3) pilot testing a mobile LCS clinic. Findings from this study will aid in the development of a scalable, feasible intervention acceptable to patients and providers in rural areas to improve LCS. Further, by understanding the needs of rural communities and enhancing opportunities for LCS closer to home, earlier detection, prompter treatment, and improved cancer outcomes can be achieved.

项目摘要/摘要 项目1（Hasson）：了解移动肺癌筛查的农村患者和提供者的偏好 诊所 尽管在肺癌早期进行治疗时，最好的结果是最好的 6％的合格高危患者参加了肺癌筛查（LCS），甚至较低参与 农村人口。来自国家肺筛查试验（NLST）的数据，这是一个多机构随机的 超过50,000名患者的对照研究通过比较计算的低剂量来证明LCS的实用性 带有胸部X射线的断层扫描（CT）。它发现低剂量CT的LCS与降低20％有关 肺癌特异性死亡率以及总体死亡率降低6.7％。许多组织都有 随后发布了支持年度LCS的准则。然而，十年后，尽管有多个 研究确认了NLST的结果，并基于继续研究的准则修订了指南 功效，低剂量CT仍未充分利用，高风险患者数量不成比例 推荐或不进行筛选。虽然这样做的原因是多因素，但需要更好 了解当前的农村筛查格局，以及乡村提供者和患者障碍，导致低 参与必须解决这一公共卫生困境。此外，考虑到这些难以触及的 位置，使用基于社区的方法对于开发将充分利用的干预措施至关重要。 这项拟议的研究的主要目标是确定提供者和患者障碍和促进者 预测农村空间中LC的转介和利用；评估移动诊所的可行性和可接受性 进行筛选；并测试移动单位干预。用于输送LCS的建议方法旨在 减少后勤和社会心理障碍。在农村地区，移动单元应该是可行的，可以接受 患者和提供者，可以补充传统医院或基于诊所的筛查。基于 移动乳房和宫颈癌筛查计划的成功，研究小组试图确定 与传统医院相比，移动部门在增加农村地区的筛查方面是否更成功 - 基于方法。该项目将通过：（1）确定肺率高的区域。 癌症（在后期确定的肺癌）； （2）获得社区成员的意见以告知 可行的，可接受的移动LCS干预；然后（3）试点测试移动LCS诊所。从中的发现 研究将有助于开发患者和提供者可以接受的可扩展，可行的干预措施 改善LCS的农村地区。此外，通过了解农村社区的需求并增强 LCS更靠近家中的LC的机会 可以实现。