A Pilot CHW Model to Facilitate Shared Decision Making and Lung Cancer Screening for Chinese Taxi Drivers

CHW试点模式促进中国出租车司机的共同决策和肺癌筛查

基本信息

批准号：
9813440
负责人：
Jennifer CF Leng
金额：
$ 8.98万
依托单位：
SLOAN-KETTERING INST CAN RESEARCH
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：
2019-07-01 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9813440
关键词：
Address Adherence Adopted Adoption Adult Advisory Committees Age Air Pollution Asian Americans Asians Automobile Driving Cancer Etiology Cancer Patient Caring Cessation of life China Chinese People Colorectal Cancer Communities Community Health Aides Counseling Data Diffusion of Innovation Elements Environment Exposure to Face Health Health Services Accessibility Healthcare Hour Immigrant Individual Insurance Intervention Knowledge Language Linguistics Longevity Lung Malignant Neoplasms Malignant neoplasm of lung Manuals Mexico Modeling Neighborhood Health Center New York City Non-Small-Cell Lung Carcinoma Occupational Occupations Outcome Pacific Island Americans Population Prevalence Preventive service Process Publishing Randomized Randomized Controlled Trials Recording of previous events Research Resources Restaurants Screening for cancer Smoke Smoker Smoking Stress Survival Rate Testing Training United States Centers for Medicare and Medicaid Services Visit Work barrier to care base cancer diagnosis cancer health disparity checkup examination computed tomography screening design evidence base health care availability health disparity high risk high risk population improved innovation low-dose spiral CT lung cancer screening men mortality patient oriented personalized management primary outcome recruit screening sedentary shared decision making smoking prevalence theories

项目摘要

Project Summary The Chinese population is anticipated to become the largest immigrant group in New York City (NYC) in the next few years. Nationwide, immigrants from China constitute the second largest foreign-born group, after those from Mexico. Chinese immigrants work in a number of occupations that put them at higher risk for lung cancer, including taxi driving. Chinese taxi drivers may be at exceptionally high risk for lung cancer due to the combined impact of high rates of smoking and increased exposure to air pollution. The prevalence of ever smoking among Chinese men in the U.S. is 42.5%. In our preliminary work assessing health needs among foreign-born Chinese livery drivers in NYC, a staggering 73% were current or former smokers. Lung cancer is the second most commonly diagnosed cancer in the U.S., and the leading cause of cancer-related deaths. Results from the National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer with low-dose computed tomography (LDCT) screening. In 2013 the U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) with LDCT in adults age 55-80 years with a 30 pack year history who smoke or quit within the past 15 years. In 2015 the Centers for Medicare and Medicaid Services began providing coverage for a LCS counseling and shared decision making (SDM) visit, and annual LCS with LDCT, if appropriate, for eligible individuals. Previous research describes lower rates of screening for other cancers among foreign-born Asian Americans and Pacific Islanders (AAPIs) compared to U.S. born AAPIs, even after adjusting for insurance-related access to care. A substantial body of research suggests that immigrants face unique barriers to care, including language and cultural factors. Community health worker (CHW) efforts address these barriers, and have led to significant increases in cancer screening rates. In this study, we will conduct a pre-pilot with 10 high risk, previously unscreened Chinese livery drivers eligible for LCS, to refine an adapted, existing Immigrant Health and Cancer Disparities (IHCD) CHW model, Taxi HAILL (Health Access Interventions for Linkages and Longevity), for the multiple levels of influence at which CHWs can articulate, including the individual (drivers), organizations (livery bases), and the environment (health care access/environment). We will then conduct a pilot randomized controlled trial (RCT) to assess the feasibility of the refined CHW model versus written materials to facilitate SDM and LCS (when appropriate) among 50 NYC Chinese livery drivers eligible (by USPSTF criteria) for LCS. The model also incorporates key elements of the Penn Center for Community Health Workers evidence-based CHW model, IMPaCTTM (Individualized Management towards Patient-Centered Targets). Feasibility results will be used to inform the plannning and design of large scale RCTs, targeting Chinese drivers as well as other driver populations in NYC and throughout the U.S., and other high risk Chinese smoking populations in other occupations (e.g. restaurant work, construction).

项目概要预计华人人口将成为纽约市最大的移民群体未来几年。在全国范围内，来自中国的移民构成了第二大外国出生群体，仅次于来自墨西哥的。中国移民从事的许多职业使他们患肺病的风险较高癌症，包括出租车驾驶。中国出租车司机患肺癌的风险可能极高高吸烟率和空气污染增加的综合影响。历来盛行在美国的中国男性吸烟率为42.5%。在我们评估健康需求的初步工作中在纽约市外国出生的华人出租车司机中，令人震惊的是，73% 的人现在或曾经吸烟。肺癌是美国第二常见的癌症，也是癌症相关死亡的主要原因。国家肺部筛查试验 (NLST) 的结果显示，肺癌死亡率降低了 20% 低剂量计算机断层扫描 (LDCT) 筛查。 2013 年，美国预防服务工作组 (USPSTF) 建议对 55-80 岁的成人进行年度肺癌筛查 (LCS)，并进行 LDCT 筛查，并进行 30 过去 15 年内吸烟或戒烟的年份记录。 2015 年医疗保险和医疗补助中心服务开始提供 LCS 咨询和共同决策 (SDM) 访问以及年度如果适用，适用于符合资格的个人的 LCS 和 LDCT。先前的研究描述了较低的筛查率与美国出生的亚裔美国人和太平洋岛民 (AAPI) 相比，外国出生的亚裔美国人和太平洋岛民 (AAPI) 的其他癌症 AAPI，即使在调整了与保险相关的护理获取机会之后也是如此。大量研究表明移民在护理方面面临着独特的障碍，包括语言和文化因素。社区卫生工作者 (CHW) 的努力解决了这些障碍，并导致癌症筛查率显着提高。在这个研究中，我们将对 10 名高风险且之前未经筛选的中国出租车司机进行预试点，这些司机有资格获得 LCS，完善现有的移民健康和癌症差异 (IHCD) CHW 模型，Taxi HAILL （针对联系和长寿的健康获取干预措施），针对社区卫生工作者的多层次影响力能够清晰表达，包括个人（驾驶员）、组织（车辆基地）和环境（医疗保健）访问/环境）。然后，我们将进行一项试点随机对照试验（RCT）来评估可行性改进的 CHW 模型与书面材料的对比，以促进 50 个纽约市的 SDM 和 LCS（适当时）中国的出租车司机有资格（根据 USPSTF 标准）参加 LCS。该模型还包含了以下关键要素宾夕法尼亚州社区卫生工作者中心基于证据的 CHW 模型，IMPaCTTM（个性化管理以患者为中心的目标）。可行性结果将用于告知规划和设计大规模随机对照试验，针对中国驾驶员以及纽约市的其他驾驶员群体美国各地以及其他职业（例如餐厅）的中国吸烟高危人群工作、建筑）。