Reducing health disparities in foregut cancers by using modifiable barriers to predict risk for inequitable care: a novel implementation science-based approach

通过使用可修改的障碍来预测不公平护理的风险来减少前肠癌症的健康差异：一种基于科学的新颖实施方​​法

• 批准号: 10633373
• 负责人: Annabelle L Fonseca
• 金额: --
• 依托单位: UNIVERSITY OF SOUTH ALABAMA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-09 至 2023-09-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10633373
• 关键词: Address; Advocate; Alabama; Appointment; Area; Biliary; Cancer Patient; Caregivers; Caring; Cessation of life; Clinic; Code; Communities; Community Health; Complex; Continuity of Patient Care; Data; Development; Disparity; Educational workshop; Electronic Health Record; Esophagus; Ethnic Origin; Excision; Failure; Focus Groups; Funding; Future; Goals; Guidelines; Health Disparities Research; Health Services Accessibility; Health system; Healthcare Systems; Hospital Administrators; Incidence; Individual; Inequity; Inferior; Institution; Intervention; Interview; K-Series Research Career Programs; Knowledge; Literature; Liver; Location; Malignant Neoplasms; Measurable; Measures; Mediating; Mediation; Medical; Medicine; Mentorship; Methods; Modeling; National Comprehensive Cancer Network; National Institute on Minority Health and Health Disparities; Oncologist; Oncology; Pancreas; Patient Care; Patients; Primary Care Physician; Primitive foregut structure; Process; Prognosis; Provider; Proxy; Race; Reduce health disparities; Research; Research Methodology; Research Personnel; Resource Allocation; Risk; Risk Factors; Rural; Scientist; Screening procedure; Site; Socioeconomic Status; Statistical Models; Stomach; Structure; Surgeon; System; Testing; Training; Training Programs; United States; United States National Institutes of Health; Universities; access disparities; cancer care; cancer health disparity; career; clinical application; disparity reduction; evidence base; evidence based guidelines; experience; health care disparity; health disparity; implementation science; improved; individual patient; instrument; longitudinal, prospective study; modifiable risk; multidisciplinary; novel; patient navigation; patient oriented research; pilot test; predictive modeling; prospective; risk prediction; risk prediction model; rurality; sabbatical; screening; skills; sociodemographic disparity; sociodemographic factors; sociodemographic predictors; sociodemographics; successful intervention; survival disparity; system-level barriers; tool; treatment disparity

PROJECT SUMMARY Foregut (esophageal, gastric, liver, biliary and pancreatic) cancers account for approximately 20% of new cancer deaths in the United States each year, with an incidence that is projected to increase by almost 70% over the next ten years. These are aggressive malignancies, with complex therapies that require coordinated, specialized multidisciplinary care. There are significant racial and location-based disparities in the utilization of evidence-based guideline concordant therapy (GCT) in foregut cancers. Race and location serve as proxies for multiple, potentially modifiable, barriers along the cancer care continuum, that threaten access to and receipt of care. Identifying these barriers is critical to reduce disparities. Accurate identification of patients at risk for non-GCT is a vital first step to intervene. However, there is no screening tool to identify patients at risk for non-GCT. This project aims to address racial and location-based disparities in foregut cancers by using mixed methods research to develop a risk prediction model and clinic-based screening tool that utilizes modifiable barriers to identify patients at risk for non-receipt of GCT. Together, this clinically applicable and statistically valid model and the high-yield screening instrument will inform an emerging model that identifies patients at risk for non- receipt of care, and facilitates the administration of personalized, solution-focused interventions that can redirect the course of care. My long-term objective is to become an independent researcher focused on identifying, understanding and addressing disparities in access to cancer care. This career development award will help achieve my objective by filling gaps in knowledge and skills through a personalized training program that will include didactics, mini-sabbaticals, experiential training and mentorship in three areas: (1) mixed methods with a focus on patient-oriented research (2) statistical modeling and measure development and (3) implementation science. This training plan will support my proposed project and enable my transition to an independent surgeon-scientist. The specific aims are (1) to identify barriers in access to GCT in patients with foregut cancers through a patient-centric and stakeholder-informed approach (2) to examine the extent to which modifiable barriers predict risk for non-GCT using quantitative modeling and (3) to develop and pilot test a clinic-based screening tool to prospectively identify patients at risk for non-GCT. This proposal is novel in its exploration of underlying modifiable barriers to inform the development of a model that predicts receipt of inferior care, and a clinic-based screening tool to identifiy individuals at risk for disparities in access to oncologic care. While there are currently a range of successful interventions such as patient navigation that have shown promise in decreasing treatment disparities, there is no streamlined way for clinicians to identify patients at risk for non- GCT. This proposal will allow for the identification of patients at risk for health disparities (non-GCT) in a consistent way across providers and embedded in health systems.The results of this study will be used to apply for an R01 to prospectively evaluate the utility of the developed screening tool in a multi-institution study to predict disparities in care and test its invariance by race/ethnicity, location (rural versus urban), socioeconomic status and type of institution.

项目概要 前肠癌（食管癌、胃癌、肝癌、胆道癌和胰腺癌）约占全球新增癌症死亡人数的 20% 美国每年都会出现这种情况，预计未来 10 年发病率将增加近 70%。这些 是侵袭性恶性肿瘤，治疗方法复杂，需要协调、专业的多学科护理。有 在使用基于证据的指南一致治疗（GCT）方面存在显着的种族和地区差异 预示癌症。种族和地点可以作为癌症治疗过程中多个可能可改变的障碍的代表 连续体，威胁获得和接受护理。识别这些障碍对于减少差距至关重要。 准确识别有非 GCT 风险的患者是干预的重要第一步。但是没有筛选工具 识别有非 GCT 风险的患者。该项目旨在解决前肠中的种族和地域差异 通过使用混合方法研究来开发风险预测模型和基于临床的筛查工具，利用 可修改的障碍，用于识别有未接受 GCT 风险的患者。总之，这具有临床适用性和统计学意义 有效的模型和高产筛查工具将为新兴模型提供信息，该模型可识别处于非非遗传性疾病风险中的患者 接受护理，并促进个性化、以解决方案为中心的干预措施的管理，这些干预措施可以重新引导 护理过程。 我的长期目标是成为一名独立研究员，专注于识别、理解和解决 获得癌症护理的机会存在差异。该职业发展奖将通过填补以下方面的空白来帮助实现我的目标 通过个性化培训计划获取知识和技能，其中包括教学、迷你休假、体验式培训 三个领域的培训和指导：(1) 注重以患者为中心的研究的混合方法 (2) 统计 建模和测量开发以及（3）实施科学。该培训计划将支持我提出的项目 并使我能够转变为一名独立的外科医生兼科学家。具体目标是 (1) 查明获取途径的障碍 通过以患者为中心和利益相关者知情的方法对前肠癌患者进行 GCT (2)，以检查 可修改障碍在多大程度上使用定量模型预测非 GCT 风险，以及 (3) 开发和试点测试 一种基于临床的筛查工具，用于前瞻性识别有非 GCT 风险的患者。 该提案的新颖之处在于它探索了潜在的可修改障碍，为模型的开发提供了信息 预测接受的劣质护理，并使用基于诊所的筛查工具来识别有可能在获得服务方面存在差异的个人 肿瘤护理。虽然目前有一系列成功的干预措施，例如患者导航，已经表明 虽然有望减少治疗差异，但临床医生没有简化的方法来识别有非非遗传性疾病风险的患者。 GCCT。该提案将允许以一致的方式识别面临健康差异风险（非 GCT）的患者 跨提供者并嵌入卫生系统。这项研究的结果将用于申请 R01 前瞻性评估所开发的筛查工具在多机构研究中的效用，以预测护理差异 并通过种族/民族、地点（农村与城市）、社会经济地位和机构类型来测试其不变性。