Culturally Adapted Multilevel Decision Support Navigation Trial to Reduce Colorectal Cancer Disparity among At-Risk Asian American Primary Care Patients

适应文化的多层次决策支持导航试验，以减少高危亚裔美国初级保健患者中结直肠癌的差异

• 批准号: 10308425
• 负责人: SUNMIN LEE
• 金额: $ 74.05万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308425
• 关键词: Address; Adherence; African American population; Area; Asian; Asian Americans; Asian population; Award; Blood Tests; Cancer Control; Cancer Etiology; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chinese American; Clinic; Colonoscopy; Colorectal Adenoma; Colorectal Cancer; Communities; Control Groups; Counseling; Data; Decision Making; Diagnostic Reagent Kits; Disease; District of Columbia; Ethnic group; Feces; Goals; Incidence; Intervention; Interview; Knowledge; Korean American; Language; Linguistics; Malignant Neoplasms; Measures; Medical; Medical Records; Minority Groups; Outcome; Pamphlets; Participant; Patient Care; Patient Recruitments; Patient Self-Report; Patients; Physicians; Population; Primary Care Physician; Primary Health Care; Provider; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Recommendation; Reporting; Research; Risk; Surveys; System; Target Populations; Testing; Time; Woman; aged; base; bilingualism; cancer health disparity; cancer prevention; colorectal cancer screening; cultural competence; design; evidence base; improved; insight; men; metropolitan; mortality; novel; patient oriented; practice setting; primary care setting; primary outcome; process evaluation; programs; racial and ethnic; screening; theories

PROJECT SUMMARY Cancer is the leading cause of death among Asian Americans, and mortality from colorectal cancer (CRC) is ranked as the second most common in cancer deaths among Asian Americans. However, recent data show that CRC screening rates are substantially lower for Chinese and Korean Americans (CKAs) compared with other racial/ethnic groups. To date, a small number of community-based studies have reported on the use of single level (participant level only) interventions to increase CRC screening rates among CKAs; however, very little is known about the impact of multi-level (patient-oriented and provider-oriented) interventions on CRC screening adherence among CKA patients in primary care setting. Furthermore, our preliminary data indicate physician's recommendation as the strongest facilitator of CRC screening among CKAs. Thus, the primary objective of the study is to address this important knowledge gap by conducting a randomized controlled trial to determine the impact of a multi-level culturally-sensitive decision support intervention on CRC screening adherence among 400 CKA primary care patients. Previous studies found that facilitating patient decision-making through decision support and providing patient navigation can increase CRC screening among diverse primary care patients. We will culturally adapt existing evidence- based decision support navigation intervention (CA-DSNI) and test its efficacy among 200 CKA men and 200 CKA women aged 50 to 75 eligible for CRC screening. We will recruit the participants from primary care physicians (PCPs) clinics. The study is designed to compare CRC screening outcomes between the CA-DSNI and the Advanced Control (AC). Those randomized to the AC will receive an informational booklet, a stool blood test kit and a reminder by mail. Those randomized to the CA-DSNI will receive everything the AC receives. Additionally, we will provide decision support and navigation contacts to participants, develop an individualized screening plan using a theory-based online Decision Counseling Program, share the plan with the participants' PCPs, and have PCPs to encourage the screening to participants. Using outcomes data collected by survey and medical record review, we will: (1) determine overall CRC screening adherence in the CA-DSNI vs. the AC; (2) measure change in CRC screening decision stage in the CA-DSNI vs. the AC; and (3) Assess CRC screening test-specific (stool blood test vs. colonoscopy) adherence in the CA-DSNI vs. the AC. Additionally, we will evaluate intervention reach, effectiveness, adoption, implementation, and maintenance using interview data. IMPACT: This study represents the first instance in which CA-DSNI will be used with CKAs in primary care practice settings to address a significant cancer disparity. With growing need for linguistically and culturally competent care, more decision support, language facilitation, and navigation efforts may come into care settings. Therefore, having tested interventions ready for the target population will be timely, and medical systems may benefit from having multilevel best practices known and tested for CKAs.

项目摘要 癌症是亚裔美国人死亡的主要原因，结直肠癌的死亡率（CRC）为 在亚裔美国人中排名第二。但是，最近的数据显示 与中国和韩裔美国人（CKA）相比，CRC筛查率大大降低 其他种族/族裔。迄今为止，已经报告了少数基于社区的研究 单级（仅参与者级别）干预措施，以提高CKA中的CRC筛查率；但是，非常 关于多层次（面向患者和提供者）干预措施的影响知之甚少 在初级保健环境中，CKA患者的CRC筛查依从性。此外，我们的初步 数据表明，医师的建议是CKA中CRC筛查的最强促进者。 因此，该研究的主要目的是通过进行一次来解决这一重要知识差距 随机对照试验以确定多层对文化敏感决策的影响 支持400名CKA初级保健患者中CRC筛查依从性的干预。以前的 研究发现，通过决策支持促进患者决策并提供患者导航 可以增加各种初级保健患者中的CRC筛查。我们将在文化上适应现有证据 - 基于决策支持导航干预措施（CA-DSNI），并测试200名CKA男性和200份的功效 50至75岁的CKA妇女有资格进行CRC筛查。我们将从初级保健中招募参与者 医师（PCP）诊所。该研究旨在比较CA-DSNI之间的CRC筛选结果 和高级控制（AC）。随机分配给AC的人将收到一本信息手册，凳子 血液测试套件和通过邮件提醒。那些随机到CA-DSNI的人将收到AC的所有内容 收到。此外，我们将向参与者提供决策支持和导航联系人，开发 使用基于理论的在线决策咨询计划的个性化筛选计划，与 参与者的PCP，并具有PCP，以鼓励对参与者进行筛查。使用结果数据 通过调查和病历审查收集，我们将：（1）确定CRC筛查的整体遵守 Ca-dsni与AC； （2）测量CA-DSNI与AC中CRC筛选决策阶段的变化； （3） 评估CA-DSNI与AC中的CRC筛查测试特异性（粪便测试与结肠镜检查）的粘附。 此外，我们将评估干预措施，有效性，采用，实施和维护 使用访谈数据。影响：这项研究代表了使用CA-DSNI的第一次实例 在初级保健实践环境中，CKAS可以解决巨大的癌症差异。随着需求越来越多 在语言和文化上有能力的护理，更多的决策支持，语言促进和导航 努力可能会进入护理环境。因此，准备好针对目标人群的干预措施将 请及时，医疗系统可能会受益于拥有CKA的多层次最佳实践和测试。

项目成果

Rural-urban disparities in preventive breast and cervical cancer screening among women with early-onset dementia.

• DOI: 10.1186/s12905-023-02301-7
• 发表时间: 2023-05-11
• 期刊: BMC WOMENS HEALTH
• 影响因子: 2.5
• 作者: Xu, Wendy Y. Y.;Raver, Eli;Jung, Jeah;Li, Yiting;Thai, Gaby;Lee, Sunmin
• 通讯作者: Lee, Sunmin

The Cross-Sectional Association of Sleep Disturbance and Sleep Apnea With Complex Multimorbidity Among Chinese and Korean Americans.

华裔和韩裔美国人的睡眠障碍和睡眠呼吸暂停与复杂多发病的横断面关联。

• DOI: 10.1093/aje/kwac211
• 发表时间: 2023
• 期刊: American journal of epidemiology
• 影响因子: 5
• 作者: Ryu,Soomin;Morey,BrittanyN;Lee,GraceE;Kawachi,Ichiro;Redline,Susan;Lee,Sunmin
• 通讯作者: Lee,Sunmin

Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants.

• DOI: 10.1007/s10900-022-01069-5
• 发表时间: 2022-06
• 期刊: Journal of community health
• 影响因子: 5.9
• 作者: Morey BN;Valencia C;Lee S
• 通讯作者: Lee S

The Mediating Role of Sleep Disturbance on the Association Between Stress and Self-Rated Health Among Chinese and Korean Immigrant Americans.

• DOI: 10.5888/pcd20.220241
• 发表时间: 2023-01-26
• 期刊: Preventing chronic disease
• 影响因子: 5.5
• 作者: Morey BN;Ryu S;Shi Y;Lee S
• 通讯作者: Lee S

Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans.

• DOI: 10.1007/s40615-022-01347-x
• 发表时间: 2023-08
• 期刊: JOURNAL OF RACIAL AND ETHNIC HEALTH DISPARITIES
• 影响因子: 3.9
• 作者: Morey, Brittany N;Ryu, Soomin;Shi, Yuxi;Park, Hye Won;Lee, Sunmin
• 通讯作者: Lee, Sunmin