Tribally Engaged Approaches to Lung Screening (TEALS)

部落参与式肺部筛查方法 (TEALS)

基本信息

批准号：
10411909
负责人：
ZSOLT J NAGYKALDI
金额：
$ 47.33万
依托单位：
UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10411909
关键词：
Address Administrator Affect Alaska Alaska Native American Indians Attention Authorization documentation Behavior Therapy Breast Cancer Detection Cancer Center Cancer Etiology Caring Cessation of life Choctaw Nation of Oklahoma Collaborations Communities Community Health Systems Community Healthcare Complex Consultations Control Groups Country Coupling Detection Development Diagnosis Disparity Dissemination and Implementation Eligibility Determination Evaluation Evidence based intervention Feedback Focus Groups Foundations Future General Population Goals Guidelines Health Health Professional Health Sciences Health Services Health Status Health system Healthcare Systems Incidence Individual Infrastructure Intervention Interview Knowledge Link Location Lung Malignant Neoplasms Malignant neoplasm of lung Mammography Measures Names Native Americans Native-Born Oklahoma Outcome Participant Patient Care Patients Persons Population Preventive service Primary Care Process Protocols documentation Randomized Recommendation Research Research Personnel Resource-limited setting Running Rural Services Stage at Diagnosis Structure System Testing Tribes United States Centers for Medicare and Medicaid Services United States Preventative Services Task Force Universities Woman Work aged authority cancer health disparity care coordination care delivery cigarette smoke clinical practice community based participatory research community center community involvement community setting comparison control design dissemination science early screening experience group intervention health care delivery health care settings implementation evaluation implementation process implementation science implementation trial improved low dose computed tomography lung cancer screening member men mortality novel patient navigation pilot test preference primary care practice programs randomized, clinical trials screening screening guidelines screening participation screening program smoking cessation system-level barriers theories tribal community tribal health tribal member uptake

项目摘要

Project Summary Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and AI/AN have worse lung cancer incidence rates, survival, and death compared to the general population. Because lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality by roughly 20%, the United States Preventive Services Task Force now recommends LCS for men and women aged 55-80 years who meet specific eligibility criteria (grade-B evidence), and subsequently the Center for Medicare and Medicaid Services (CMS) opted to cover this test. However, the uptake of LCS implementation has been slow in most healthcare systems, and LCS implementation among AI/AN has never been studied. To address this knowledge and implementation gap, we prose the “Tribally Engaged Approaches to Lung Screening (TEALS)” study, which is a collaborative effort between the Choctaw Nation of Oklahoma, the Stephenson Cancer Center, and the University of Oklahoma Health Sciences Center that directly addresses the low uptake of LCS in tribal settings through the development of a theory-driven LCS implementation program within the Choctaw Nation Health Services Authority (CNHSA). Over the course of 5 years, TEALS will: 1) Conduct focus groups and semi-structured interviews with CNHSA patients, clinicians, and health administrators to elucidate individual- and system-level barriers and facilitators that affect the implementation of LCS; 2) Develop, and iteratively refine an LCS care coordination intervention that will identify eligible persons for LCS, help these patients navigate the screening process, and link them with smoking cessation services, when applicable; 3) Measure the impact of the TEALS intervention on the receipt of screening and a set of patient- and practice-level outcomes by conducting a cluster-randomized clinical trial of LCS implementation; and 4) Disseminate the TEALS program to other researchers and healthcare systems that serve AI/AN patients. TEALS will bridge the gap between evidence and clinical practice for LCS in a high- need, low-resource setting by intervening at the level of the healthcare system. System-level interventions for guideline implementation tend to be understudied compared to those evaluating individual-level, behavioral interventions. However, the careful development and evaluation of an LCS screening program at the level of the healthcare system would be critical to ensure that more patients can receive LCS when appropriate. Through TEALS, our research will create a critically needed platform from which future studies could be launched that will examine how to tailor the application of the LCS guideline to the individual preferences of AI/AN patients. TEALS will establish an effective LCS program in a tribal system and thus provide a direct benefit to the Choctaw Nation by increasing LCS participation. TEALS will serve as a blueprint for establishing a sustainable and accessible infrastructure for LCS in AI/AN and other community health systems. By increasing screening for early stage lung cancer, TEALS could ultimately reduce lung cancer mortality in AI/AN communities, many of which are in great need of effective strategies to reduce longstanding cancer disparities.

项目摘要肺癌是美国印第安人和阿拉斯加原住民（AI/AN）的主要原因，以及与普通人群相比，AI/A的肺癌发病率，生存率和死亡较差。由于具有低剂量计算机断层扫描（LDCT）的肺癌筛查（LCS）已显示可减少肺癌死亡率约为20％，美国预防服务工作队现在建议符合特定资格标准（B级证据）的55-80岁男性和女性的LCS和随后，医疗保险和医疗补助服务中心（CMS）选择涵盖此测试。但是，在大多数医疗保健系统中，LCS实施的吸收速度很慢，而LCS实施 AI/AN从未研究过。为了解决这一知识和实施差距，我们散文“部落参与肺部筛查的方法（蓝绿色）”研究，这是Choctaw之间的合作努力俄克拉荷马州，斯蒂芬森癌症中心和俄克拉荷马大学健康科学中心通过开发理论驱动的LCS，直接解决了部落环境中LC的摄取量。 Choctaw国家卫生服务局（CNHSA）内的实施计划。在5个课程中多年，蓝绿色将：1）与CNHSA患者，临床医生，进行焦点小组和半结构化访谈，以及卫生管理员阐明影响障碍的个人和系统级别的障碍和促进者实施LCS； 2）开发并迭代地完善LCS护理协调干预措施，以确定合格的LC人员，帮助这些患者浏览筛查过程，并将其与吸烟联系起来戒烟服务，如果适用； 3）测量蓝绿色干预对收到的影响筛查以及一组患者和练习水平的结果，通过进行集群随机临床试验 LCS实施； 4）将蓝绿色计划传播给其他研究人员和医疗保健系统为AI/A/A的患者服务。蓝绿色将弥合LCS在高位的证据和临床实践之间的差距需求，通过介入医疗保健系统级别来进行低资源设置。系统级干预措施与评估个人级别的行为的人相比，指南实施往往可以理解干预措施。但是，对LCS筛查计划的仔细开发和评估医疗保健系统至关重要，确保更多的患者在适当的情况下可以接受LC。通过蓝绿色，我们的研究将创建一个急需的平台启动将研究如何量身定制LCS指南的应用 AI/A A A/A。蓝绿色将在部落系统中建立有效的LCS计划，从而直接提供通过增加LCS参与来对Choctaw Nation有利。蓝绿色将作为建立的蓝图 AI/AN和其他社区卫生系统中LCS的可持续且可访问的基础设施。经过提高早期肺癌的筛查，蓝绿色最终可以降低AI/AN中的肺癌死亡率社区非常需要有效的策略来减少长期存在的癌症差异。