SURGICAL DISPARITIES IN LUNG, PROSTATE, BREAST AND COLORECTAL CANCER IN AI/ANS

AI/ANS 中肺癌、前列腺癌、乳腺癌和结直肠癌的手术差异

基本信息

批准号：
8376098
负责人：
David R Flum
金额：
$ 30.04万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-05-01 至 2015-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8376098
关键词：
Address Alaska Native American Indian and Alaska Native American Indians Area Attitude Belief Belief System Benchmarking Breast Cancer Death Rates Cancer Patient Caregivers Caring Cause of Death Characteristics Clinical Clinical Data Colorectal Colorectal Cancer Communities Complement Data Data Set Data Sources Databases Death Rate Diagnosis Disease Distal Early treatment Employee Strikes Ethnic group Ethnography Family Focus Groups Health Healthcare Hospitals Individual Intervention Interview Lead Link Lung Malignant Neoplasms Malignant neoplasm of lung Malignant neoplasm of prostate Medicaid Medical Surveillance Medicare Part A National Cancer Institute Native-Born Navajo Not Hispanic or Latino Operative Surgical Procedures Outcome Outcome Assessment Patients Perception Performance Population Process Prostate Provider Qualitative Research Records Research Research Personnel Resources Services Site Staging Subgroup Surgeon System Treatment outcome Tribes Variant Washington Woman Work base cancer care cancer surgery cancer therapy care delivery cultural competence ethnographic method experience health care service utilization health disparity improved informant malignant breast neoplasm mortality novel population health programs racial and ethnic trend tumor progression

项目摘要

Other racial/ethnic groups have seen consistent declines in the rates of deaths from these lung, prostate, breast, and colorectal cancers, but American Indian/Alaska Native (AI/AN) populations have not. Surgical intervention is the only curative treatment for lung, breast, and colorectal cancers, and commonly used for prostate cancer. The earlier that treatment occurs in the progression of cancer, the greater the chance for survival. Some investigators have attributed the high rates of cancer mortality among AI/ANs to diagnosis at late stages of disease, geographic barriers, and alternative belief systems that impede the receipt of effective, standard cancer. Despite striking inequities in cancer survival, the factors producing these disparities remain poorly understood and incompletely described. In our first set of studies, we examine diverse factors influencing national disparities in surgical care by using 2 datasets: the National Cancer Institute's Surveillance Epidemiology and End Results (SEER), and a linkage of SEER to Medicare's Part A and Part B files. In the second set of studies, we describe community-level variation in the use of best practices related to surgical cancer care, using a detailed, prospectively gathered clinical dataset derived from the Surgical Care and Outcomes Assessment Program (SCOAP). This effort is a novel statewide surveillance and benchmarking system for surgeons, linking performance data to active interventions aimed at improving quality. In the third ethnographic study, we interview cancer patients, and surgeons about their perceptions of cancer care. Thus, our specific aims are to 1) Describe nationwide variation in processes and outcomes of surgical cancer care between AI/AN and non-hispanic White cancer patients by using SEER and SEER-Medicare datasets; 2) Compare receipt of "best practices" and stage-specific outcomes in the delivery of surgical care between these 2 groups of patients across Washington State's SCOAP network. 3) Describe the perceptions, attitudes, and beliefs of AI/AN patients related to surgical cancer care, and assess surgeons' cultural competence and perceptions about barriers to providing cancer care to AI/AN patients. This effort will highlight the points where breakdowns in the care of AI/AN cancer patients occur, and along with the ethnographic data, suggest how culturally tailored intervention can reduce inequities..

其他种族/族裔群体在这些肺，前列腺，前列腺的死亡率中持续下降乳房和结直肠癌，但美洲印第安人/阿拉斯加本地人（AI/AN）人群没有。外科干预是肺，乳房和结直肠癌的唯一治疗方法，通常用于前列腺癌。治疗发生在癌症的进展中越早，生存。一些研究人员已将AI/ANS癌症死亡率高的诊断归因于疾病，地理障碍和替代信念系统的晚期阶段，阻碍了收到的有效的标准癌。尽管癌症生存中的不平等令人不安，但产生这些的因素差异仍然很少理解和不完全描述。在我们的第一组研究中，我们检查了通过使用2个数据集影响国家手术护理中民族差异的各种因素：国家癌症研究所的监视流行病学和最终结果（SEER），以及Seer与Medicare的A部分的联系和B部分文件。在第二组研究中，我们描述了最佳使用中社区级别的变化与手术癌症护理有关的实践，使用详细的，前瞻性收集的临床数据集得出根据手术护理和结果评估计划（SCOAP）。这项努力是全州范围内的新颖外科医生的监视和基准测试系统，将绩效数据与针对主动干预措施联系起来提高质量。在第三项民族志研究中，我们采访了癌症患者和外科医生对癌症护理的看法。因此，我们的具体目的是1）描述全国性的过程中的变化和通过使用SEER，AI/AN和非西班牙裔白色癌症患者的手术癌症护理结果和Seer-Medicare数据集； 2）比较收到“最佳实践”和特定于阶段的结果在华盛顿州的SCOAP网络中，这2组患者之间提供手术护理。 3）描述与手术癌症护理有关的AI/A/A的患者的看法，态度和信念，并评估外科医生对为AI/A/A的患者提供癌症护理的障碍的文化能力和看法。这项努力将突出显示AI/A A A/A A A AN癌症患者的细分的点以及沿着借助人种志数据，提出了文化量身定制的干预措施如何减少不平等。