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).

项目摘要预计中国人口将成为纽约市最大的移民群体（纽约市）接下来的几年。在全国范围内，来自中国的移民构成第二大外国群体，仅次于来自墨西哥的人。中国移民从事许多职业，使他们面临更高的肺风险癌症，包括出租车驾驶。中国出租车司机可能会因肺癌而异常高吸烟率和增加空气污染的综合影响。永远美国中国男性吸烟为42.5％。在我们评估健康需求的初步工作中纽约市外国出生的中国涂装司机是目前或以前的吸烟者惊人的73％。肺癌是在美国第二常见的癌症，也是与癌症相关死亡的主要原因。国家肺筛查试验（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）筛选。 2013年，美国预防服务工作队（USPSTF）建议的年度肺癌筛查（LCS），成人55-80岁的LDCT，30岁在过去15年中吸烟或戒烟的年度历史。 2015年，医疗保险和医疗补助中心服务开始提供LCS咨询和共享决策（SDM）访问和年度覆盖范围适合符合条件的人的LCS具有LDCT。先前的研究描述了较低的筛查率外国出生的亚裔美国人和太平洋岛民（AAPI）中的其他癌症与美国出生 AAPI，即使调整了与保险有关的护理访问之后。大量研究表明移民面临着独特的护理障碍，包括语言和文化因素。社区卫生工作者（CHW）努力解决这些障碍，并导致癌症筛查率的大幅提高。在这个研究，我们将进行一个具有10个高风险，以前未经审查的中国涂装驱动程序的前行李杆菌。 LCS，以完善适应的，现有的移民健康和癌症差异（IHCD）CHW模型，出租车Haill （有关联系和寿命的健康访问干预措施），对于CHW的多种影响可以阐明，包括个人（驱动程序），组织（涂装基地）和环境（医疗保健访问/环境）。然后，我们将进行一项飞行员随机对照试验（RCT），以评估精制的CHW模型与书面材料，以促进50 NYC中的SDM和LC（在适当的情况下）符合LCS的中国涂装司机（按USPSTF标准）。该模型还包含了宾夕法尼亚州社区卫生工作者中心循证基于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策划和大规模RCT的设计，针对中国驾驶员以及纽约市的其他驾驶员人口在美国以及其他职业中的其他高风险中国吸烟人群（例如餐厅工作，施工）。