Multilevel determinants of racial disparities in receipt of guideline-concordant endometrial cancer treatment

接受符合指南的子宫内膜癌治疗中种族差异的多层次决定因素

• 批准号: 10647785
• 负责人: Ashley S. Felix
• 金额: $ 47.61万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647785
• 关键词: Academy; Adjuvant Therapy; Black race; Cancer Patient; Cancer Survivor; Caring; Data; Data Set; Decision Making; Disease Outcome; Disparate; Disparity; Endometrial Carcinoma; Evidence based intervention; Exhibits; Foundations; Future; Guidelines; Health; Health Disparities Research; Healthcare Systems; Individual; Inequity; Intervention; Interview; Knowledge; Link; Literature; Logistic Regressions; Medicare claim; Medicine; Methods; National Comprehensive Cancer Network; National Institute on Minority Health and Health Disparities; Neighborhoods; Operative Surgical Procedures; Outcome; Pathology; Patients; Prediction of Response to Therapy; Predictive Factor; Provider; Qualitative Methods; Quality of life; Race; Recommendation; Research; Respondent; SEER Program; Shapes; Solid Neoplasm; Source; Staging; Variant; Woman; Work; black women; black/white disparity; cancer therapy; comorbidity; disparity reduction; effective intervention; experience; hazard; health definition; health difference; health disparity; improved; mortality; multilevel analysis; preference; prevent; racial determinant; racial disparity; surveillance data; therapy development; treatment choice; treatment disparity; treatment strategy; welfare

PROJECT SUMMARY/ABSTRACT Of all solid tumors, endometrial cancer (EC) exhibits one of the worst racial disparities - the Black-White mor- tality gap has increased from 79.5% in 1992-2001 to 97.8% in 2014-2018. Receipt of treatment in line with na- tional recommendations is an important modifiable factor that influences EC outcomes and contributes to racial disparities in survival. The National Comprehensive Cancer Network recommends surgical staging as the first step of guideline-concordant treatment and pathology factors captured from surgery inform adjuvant treatment recommendations. Our prior work demonstrates that receipt of guideline-concordant EC treatment improves survival among EC patients who are Black or White. Therefore, the lower guideline-concordant EC treatment among Black women that we have observed is concerning and contributes to the marked disparities in disease outcomes. We lack a comprehensive understanding of the determinants that underlie disparate guideline-con- cordant EC treatment, preventing any meaningful progress in evidence-based intervention development. The extant literature has exclusively focused on individual-level factors as predictors of guideline-concordant EC treatment. This work has not led to effective intervention and ignores the multilevel influences that are known to undergird race-based differences in health. In addition, within guideline-concordant paradigms, there can be wide variation in intensity level of recommended treatments, with markedly different impact on quality of life. The impact of race on intensity of treatment within guideline-concordant paradigms is currently unknown. Most important, there are no qualitative data to understand how Black women or their providers make decisions re- garding EC treatment. Absent these critical building blocks, we cannot move forward with evidence-based in- terventions to improve guideline-concordant EC treatment receipt. We propose to identify determinants of guideline-concordant EC treatment disparities by combining analysis of multilevel data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims linked dataset (Aims 1-2) with in-depth interviews of Black women with EC and EC providers (Aim 3). Aim 1: Identify multilevel factors that predict Black-White dis- parities in guideline-concordant EC treatment. Aim 2: Quantify racial disparities and underlying predictors of guideline-concordant EC treatment intensity and examine associations between guideline-concordant EC treat- ment intensity and survival. Aim 3: Examine the multilevel dynamics that drive and constrain treatment choices by and for Black women with EC using qualitative methods. By analyzing a high-quality, multilevel dataset with Black and White EC patients, and capturing first-hand accounts of treatment experiences and preferences of Black women and their providers, our team will assess the importance of race-specific barriers to guideline- concordant EC treatment. Our study will identify the set of multilevel modifiable factors that can be targeted to reduce disparities and improve care for all women.

项目摘要/摘要 在所有实体瘤中，子宫内膜癌（EC）均表现出最严重的种族差异之一 - 黑白疾病 隆起差距从1992-2001的79.5％增加到2014 - 2018年的97.8％。收到与NA-一致的治疗 主题建议是影响EC成果并有助于种族的重要修改因素 生存的差异。国家综合癌症网络建议手术分期作为第一次 手术捕获的指导方案治疗和病理因素的步骤 建议。我们先前的工作表明，收到指导方案的EC治疗有所改善 黑色或白色的EC患者的生存。因此，较低的指南协调EC治疗 在我们观察到的黑人妇女中，与疾病的明显差异有关 结果。我们对决定因素的决定因素缺乏全面的理解，这些决定因素是不同的指南 - Cordant EC的治疗，防止基于证据的干预发展中任何有意义的进展。这 现有的文献专门集中于个人级别因素，作为指导方案ec的预测指标 治疗。这项工作并未导致有效的干预，而忽略了已知的多层次影响 为基于种族的健康差异。此外，在指南符合范式中，可以有 推荐治疗的强度水平的广泛差异，对生活质量的影响明显不同。 目前尚不清楚种族对指南符合范式中治疗强度的影响。最多 重要的是，没有定性数据可以理解黑人妇女或其提供者如何做出决定 园艺EC治疗。没有这些关键的构建块，我们无法继续前进 改善准则contercordant ec治疗收据的服务。我们建议确定 指南符合EC治疗差异通过结合监视的多级数据分析， 流行病学和最终结果（SEER）-Medicare索赔链接的数据集（AIMS 1-2）与深入的访谈 具有EC和EC提供者的黑人妇女（AIM 3）。目标1：确定预测黑白疾病的多层次因素 指南符合EC治疗中的平等。目标2：量化种族差异和基本预测指标 指南符合的EC治疗强度并检查指南符合的EC治疗之间的关联 - 强度和生存。目标3：检查驱动和限制治疗选择的多级动力学 使用定性方法的黑人妇女和患有EC的黑人妇女。通过分析具有高质量的多级数据集 黑白EC患者，并捕获有关治疗经验和偏好的第一手说明 黑人妇女及其提供者，我们的团队将评估特定种族障碍对准则的重要性 - 一致的EC治疗。我们的研究将确定一组可以针对的多层次修改因素 减少差异并改善所有妇女的护理。