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.

项目概要/摘要 在所有实体瘤中，子宫内膜癌 (EC) 表现出最严重的种族差异之一 - 黑人与白人之间的差异 人口差距从1992-2001年的79.5%上升到2014-2018年的97.8%。接受治疗符合 na- 推荐是一个重要的可修改因素，影响 EC 结果并有助于种族 生存方面的差异。国家综合癌症网络建议首先进行手术分期 符合指南的治疗步骤和从手术中捕获的病理因素为辅助治疗提供信息 建议。我们之前的工作表明，接受符合指南的 EC 治疗可以改善 黑人或白人 EC 患者的生存率。因此，符合指南的 EC 治疗较低 我们观察到的黑人妇女中的疾病令人担忧，并导致了疾病的显着差异 结果。我们对不同指导方针背后的决定因素缺乏全面的了解 一致的 EC 治疗，阻碍了循证干预措施发展的任何有意义的进展。这 现有文献专门关注个体水平因素作为指南一致 EC 的预测因素 治疗。这项工作并没有带来有效的干预，并且忽略了已知的多层次影响 巩固基于种族的健康差异。此外，在符合指南的范例中，可以有 推荐治疗的强度水平差异很大，对生活质量的影响明显不同。 在符合指南的范例中，种族对治疗强度的影响目前尚不清楚。最多 重要的是，没有定性数据可以了解黑人女性或其提供者如何做出决定 加德EC治疗。如果没有这些关键的组成部分，我们就无法推进基于证据的研究。 改善符合指南的 EC 治疗接受情况的干预措施。我们建议确定以下因素的决定因素： 通过结合监测的多级数据分析，得出符合指南的 EC 治疗差异， 流行病学和最终结果 (SEER) - 医疗保险索赔关联数据集（目标 1-2）以及对以下人员的深入访谈 拥有 EC 和 EC 提供者的黑人妇女（目标 3）。目标 1：确定预测黑白表现的多层次因素 符合指南的 EC 治疗中的均等性。目标 2：量化种族差异和潜在的预测因素 与指南一致的 EC 治疗强度，并检查与指南一致的 EC 治疗强度之间的关联 精神强度和生存。目标 3：检查驱动和限制治疗选择的多层次动态 由患有 EC 的黑人女性使用定性方法进行。通过分析高质量的多级数据集 黑人和白人 EC 患者，并获取治疗经历和偏好的第一手资料 黑人女性及其提供者，我们的团队将评估特定种族障碍的重要性，以指导- 一致的EC治疗。我们的研究将确定一组多层次的可修改因素，这些因素可以针对 减少差距并改善对所有妇女的护理。