Assessing Cervical Cancer Healthcare Inequities in Diverse Populations: The ACHIEVE Study

评估不同人群的宫颈癌医疗保健不平等：ACHIEVE 研究

• 批准号: 10599412
• 负责人: Adana A. M. Llanos
• 金额: $ 72.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-05 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10599412
• 关键词: Accreditation; Address; Advocate; Age; Area; Caring; Cervical Cancer Screening; Characteristics; Clinic; Communities; Continuity of Patient Care; Data; Data Collection; Data Set; Development; Diagnosis; Discrimination; Disease; Early Diagnosis; Economics; Equity; Ethnic Origin; Guidelines; Gynecologic Oncology; Health Disparities Research; Health care facility; Health system; Healthcare Systems; Housing; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Immigrant; Incidence; Individual; Inequity; Insurance Coverage; Intervention; Interview; Knowledge; Linguistics; Logic; Los Angeles; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Medical Records; Methods; Modeling; National Cancer Institute; National Institute on Minority Health and Health Disparities; New Jersey; Outcome; Patient Self-Report; Patients; Police; Policies; Population Heterogeneity; Population Study; Poverty; Predictive Factor; Provider; Quality of Care; Questionnaires; Race; Records; Registries; Research; Risk; SEER Program; Sampling Studies; Screening Result; Socioeconomic Status; Specialist; Structural Models; Structural Racism; Surveillance Program; System; Testing; Translating; Underinsured; Uninsured; United States; Violence; Vulnerable Populations; Woman; Work; access disparities; cancer care; cancer survival; cancer therapy; care delivery; cohort; cultural competence; deprivation; ethnic minority; follow-up; food insecurity; health care delivery; health care disparity; health illiteracy; health literacy; implementation research; improved outcome; low socioeconomic status; marginalization; marginalized population; mortality; multi-ethnic; multimodal data; neoplasm registry; optimal treatments; population based; prospective; racial minority; recruit; residence; residential segregation; screening; social; social factors; social structure; structural determinants; survival outcome; survivorship; vaccine acceptance; Accreditation; Address; Advocate; Age; Area; Caring; Cervical Cancer Screening; Characteristics; Clinic; Communities; Continuity of Patient Care; Data; Data Collection; Data Set; Development; Diagnosis; Discrimination; Disease; Early Diagnosis; Economics; Equity; Ethnic Origin; Guidelines; Gynecologic Oncology; Health Disparities Research; Health care facility; Health system; Healthcare Systems; Housing; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Immigrant; Incidence; Individual; Inequity; Insurance Coverage; Intervention; Interview; Knowledge; Linguistics; Logic; Los Angeles; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Medical Records; Methods; Modeling; National Cancer Institute; National Institute on Minority Health and Health Disparities; New Jersey; Outcome; Patient Self-Report; Patients; Police; Policies; Population Heterogeneity; Population Study; Poverty; Predictive Factor; Provider; Quality of Care; Questionnaires; Race; Records; Registries; Research; Risk; SEER Program; Sampling Studies; Screening Result; Socioeconomic Status; Specialist; Structural Models; Structural Racism; Surveillance Program; System; Testing; Translating; Underinsured; Uninsured; United States; Violence; Vulnerable Populations; Woman; Work; access disparities; cancer care; cancer survival; cancer therapy; care delivery; cohort; cultural competence; deprivation; ethnic minority; follow-up; food insecurity; health care delivery; health care disparity; health illiteracy; health literacy; implementation research; improved outcome; low socioeconomic status; marginalization; marginalized population; mortality; multi-ethnic; multimodal data; neoplasm registry; optimal treatments; population based; prospective; racial minority; recruit; residence; residential segregation; screening; social; social factors; social structure; structural determinants; survival outcome; survivorship; vaccine acceptance

PROJECT SUMMARY/ABSTRACT No one should die from cervical cancer—a preventable disease. Up to 93% of invasive cervical cancer cases are preventable through human papillomavirus (HPV) vaccination and early detection, yet over 4,300 individuals die from cervical cancer annually in the United States. HPV vaccines and cervical cancer screening have yielded declining incidence over the past several decades but these advances have not improved survival across all groups. Racial and ethnic minority and low-income women are less likely to receive guideline-concordant cervical cancer treatment, which is associated with increased cervical cancer-specific mortality. Recent research, including ours, indicate a need to examine influences beyond individual-level factors, to better understand social, structural, and health system-level influences on treatment and survivorship outcomes among underserved women. Our prior work (which demonstrates successful recruitment and follow-up of cases through cancer registries, linkage with administrative datasets, and multi-modal data collection), and data from others show that healthcare system characteristics contribute to inequitable access to timely and high-quality care delivery across the cervical cancer care continuum. To address critical gaps in knowledge, the proposed study seeks to examine upstream indicators of structural racism as contributors to inequities in receipt of guideline-concordant cervical cancer treatment and survival in a diverse study sample drawn from population-based cancer registries. Guided by the NIMHD research framework and socio-structural models, this mixed-methods study will leverage two National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program registries (New Jersey State Cancer Registry and Los Angeles Cancer Surveillance Program), to prospectively examine the impact of micro- mezzo-, and macro-level factors on receipt of guideline-concordant treatment for and survival from cervical cancer. We will assemble a multiethnic cohort of individuals diagnosed with cervical cancer between 2021-2024 and obtain retrospective and prospective data (collected 12 months after baseline) from cancer registry records, self-reported questionnaires, medical records, and publicly available datasets to address these specific aims: 1.) Evaluate the association of social and structural factors on receipt of guideline- concordant care for invasive cervical cancer, 2.) Evaluate the association of social and structural factors on cervical cancer outcomes, and 3.) Identify actionable strategies for addressing social and structural risks and health system-level factors to optimize delivery of equitable cervical cancer care through one-on-one depth interviews with key stakeholders. This study will elucidate the multilevel causes of suboptimal cervical cancer treatment and poorer survival outcomes among marginalized groups to develop actionable system-level practice and policy change to address the persistent inequities cervical cancer outcomes.

项目摘要/摘要 没有人应该死于宫颈癌 - 可预防的疾病。最多93％的浸润性宫颈癌病例 可以通过人乳头瘤病毒（HPV）疫苗接种和早期检测来预防，但超过4300个人 每年在美国死于宫颈癌。 HPV疫苗和宫颈癌筛查已产生 在过去的几十年中，事件的下降，但这些进步并没有提高所有人的生存 组。种族和少数民族和低收入妇女不太可能接受准则颈椎 癌症治疗，这与宫颈癌特异性死亡率增加有关。最近的研究， 包括我们在内，表明需要检查超越个人级别因素的影响，以更好地了解社会， 结构和卫生系统水平对服务欠佳的治疗和生存结果的影响 女性。我们先前的工作（证明了通过癌症成功招募和案件随访 注册表，与管理数据集的链接以及多模式数据收集）以及其他数据表明 医疗保健系统的特征有助于无法访问跨越及时和高质量的护理交付 宫颈癌护理仍在继续。为了解决知识的关键差距，拟议的研究试图考试 结构性种族主义的上游指标是对收到指南符合宫颈的不平等的贡献者 从基于人群的癌症登记处获取的潜水员研究样本中的癌症治疗和生存。指导 通过NIMHD研究框架和社会结构模型，这项混合方法将利用两个 国家癌症研究所（NCI）监视，流行病学和最终结果（SEER）计划注册（新的 泽西州癌症注册表和洛杉矶癌症监测计划），前瞻性检查 微膜和宏观因素对接受和生存的指南符合治疗的影响 来自宫颈癌。我们将组装诊断为宫颈癌的个体的多民族队列 在2021 - 2024年之间，从中获得回顾性和前瞻性数据（基线后12个月收集） 癌症注册表记录，自我报告的问卷，病历和公开可用的数据集 这些具体目的：1。）在收到指南时评估社会和结构因素的关联 - 对侵入性宫颈癌的一致护理，2。）评估社会和结构因素的关联 宫颈癌的结局和3.）确定可行的策略，以解决社会和结构性风险以及 通过一对一的深度优化卫生系统级别的因素，以优化公平的宫颈癌护理 与主要利益相关者的访谈。这项研究将阐明次优宫颈癌的多层次原因 边缘化群体之间的治疗和较差的生存结果，以发展可行的系统级实践 和政策变化以解决持续的不平等宫颈癌结果。