Identifying modifiable factors that reduce the burden of late stage melanoma in Hispanics

确定减少西班牙裔晚期黑色素瘤负担的可改变因素

• 批准号: 10612918
• 负责人: MYLES G COCKBURN
• 金额: $ 50.71万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-18 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10612918
• 关键词: Accounting; Acculturation; Acral Lentiginous Malignant Melanoma; Adherence; Awareness; Clinic; Complex; County; Data; Data Sources; Diagnosis; Disease; Disparity; Early Diagnosis; Ensure; Ethnic Origin; Ethnic Population; Etiology; Health Services Accessibility; Health education; Hispanic; Hispanic Populations; Histologic; Histology; Incidence; Intervention; Knowledge; Lesion; Los Angeles; Low income; Neoplasm Metastasis; Not Hispanic or Latino; Outcome; Patients; Pattern; Perception; Phase; Physicians; Population; Predisposition; Primary Care; Prognosis; Reporting; Risk; Role; Rural Population; Self Efficacy; Stage at Diagnosis; Stress; System; Telemedicine; Testing; Time; United States; cancer prevention; cultural competence; cultural values; design; effective intervention; experience; follow-up; health care availability; improved; melanoma; mortality risk; multiple data sources; neoplasm registry; patient-clinician communication; patient-level barriers; population based; primary care setting; response; screening; screening guidelines; skin lesion; therapy design; treatment response; tumor

Project Summary Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. In our recent analysis, while the risk of presenting with a late stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g. ability to access treatment) once they are diagnosed. A later stage of diagnosis among Hispanics could be due to a multitude of factors all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. The key question remaining to be answered is WHY Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test and implement effective interventions to improve earlier detection and reduce melanoma-related disparities for Hispanics. We will investigate modifiable factors related to diagnosis at later stage in Hispanics compared to NHW. Aim 1: Determine the roles of patient-perceived risk and knowledge of melanoma, perceived barriers to melanoma screening and diagnosis, patient access to screening and diagnosis, and cultural factors in determining the later stage at diagnosis of melanoma in Hispanic compared to NHW melanoma patients. Aim 2: Determine how, when and by whom melanomas are diagnosed (among Hispanics and NHW) and what factors are related to time delays in the diagnosis of melanoma. Aim 3: Develop, deliver and test a clinic-based health education telenovela intervention designed to achieve earlier diagnosis of melanoma among Hispanics. We will obtain data from multiple sources for this study in order to minimize the potential impact of selection, response and survival biases all of which would compromise the scientific rigor of our Approach. We will identify the key factors resulting in late diagnosis of melanoma among Hispanics to provide truly population- based data on HOW to develop targeted patient-and-systems level interventions to reduce the melanoma burden among Hispanics. We will then test targeted patient-and-physician level interventions carried out in low income primary care setting ensuring that we intervene at the earliest possible stage.

项目摘要 西班牙裔在后期被诊断出黑色素瘤，而不是他们的非西班牙裔白人（NHW） 导致转移的可能性增加，生存率较差。西班牙裔是最大的族裔 美国，黑色素瘤率上升，尤其是肿瘤的增加 预后。西班牙裔代表着一个服务不足和研究的人群 发生和结果。在我们最近的分析中，虽然出现晚期黑色素瘤的风险是 西班牙裔（OR：1.65 [95％CI：1.52-1.79]）高于NHW，这是黑色素瘤死亡的总体风险 在诊断时考虑阶段的阶段相似，NHW和NHW（HR：0.99 [95％CI：0.94-1.04]），这意味着 整体对西班牙裔的预后较差几乎完全是由于其后来的诊断阶段， 一旦诊断出治疗或其他因素（例如，获得治疗的能力），而不是对治疗或其他因素的反应。一个 西班牙裔诊断的后期阶段可能是由于许多因素都可以改变的： 缺乏适当的筛查，缺乏遵守筛查建议，缺乏 了解初级保健环境中适当的筛查方法（在患者和 医师），或这些因素的组合。尚待回答的关键问题是为什么西班牙裔 在稍后的阶段被诊断出：在不回答这个问题的情况下，我们无法开始设计，测试和实施 有效改善早期检测并减少黑色素瘤相关的西班牙裔差异的有效干预措施。我们 与NHW相比，西班牙裔在后期与诊断有关的可修改因素将研究。 目标1：确定患者感知风险和黑色素瘤知识的作用，感知到的障碍 黑色素瘤筛查和诊断，患者接受筛查和诊断以及文化因素 与NHW黑色素瘤患者相比，西班牙裔黑色素瘤诊断时的后期阶段。 AIM 2：确定如何，何时何地被诊断出黑色素瘤（在西班牙裔和NHW中）以及什么 因素与黑色素瘤诊断的时间延迟有关。 目标3：开发，交付和测试基于诊所的健康教育Telenovela干预旨在实现 西班牙裔中黑色素瘤的早期诊断。 我们将从多个来源获得本研究的数据，以最大程度地减少选择的潜在影响， 反应和生存偏见所有这些都会损害我们方法的科学严谨性。我们将 确定在西班牙裔中诊断出黑色素瘤迟到的关键因素，以提供真正的人群 - 基于如何开发目标患者和系统水平干预措施以减少黑色素瘤的基于数据 西班牙裔的负担。然后，我们将测试以低的为目标的患者和医师水平干预措施 收入初级保健设置，以确保我们尽早干预。