Developing a Trustworthy Multilevel Intervention to Improve Equity in Lung Cancer Screening

制定值得信赖的多层次干预措施以提高肺癌筛查的公平性

基本信息

批准号：
10580196
负责人：
Jennifer Ann Richmond
金额：
$ 10.92万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10580196
关键词：
Academic Medical Centers Address Administrator Age American Annual Reports Area Award Awareness Black race Cancer Control Cancer Etiology Cancer Survivor Collaborations Communities Congresses Decision Making Effectiveness Eligibility Determination Environment Equity Ethnic Origin Exclusion Future Goals Health Personnel Health system Healthcare Individual Inequity Intervention Interview Investigation Knowledge Leadership Life Low income Lung Malignant Neoplasms Malignant neoplasm of lung Medical Mentors Methods Nurses Participant Patients Phase Population Population Heterogeneity Process Provider Public Health Race Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Research Resources Scientist Screening for cancer Smoke Smoking History Structure System Training Trust United States United States Preventative Services Task Force cancer prevention career community engaged research design effectiveness evaluation evidence base experience feasibility testing health equity implementation framework implementation science implementation strategy improved innovation low dose computed tomography lung cancer screening mortality patient-level barriers pilot test post implementation provider communication racial diversity racism routine screening screening screening program smoking cessation sociodemographics socioeconomic diversity socioeconomics trustworthiness uptake

项目摘要

PROJECT SUMMARY/ABSTRACT Lung cancer screening using low-dose computed tomography significantly reduces lung cancer mortality, the leading cause of cancer mortality in the United States. Despite its life-saving potential, lung cancer screening uptake remains extremely low among eligible populations (about 5%). Lung cancer screening utilization is even lower among populations that experience a disproportionate burden of lung cancer (e.g., Black and low-income Americans). In November 2021, the U.S. Preventive Services Task Force (USPSTF) called for more evidence to increase equity in lung cancer screening uptake in their Annual Report to Congress. Yet, multilevel barriers to lung cancer screening exist at the patient, provider, and health system levels. However, prior research assessing these barriers is limited by inadequate racial, ethnic, and socioeconomic diversity among participants and exclusion of key health care staff (e.g., nurses) who often champion screening programs. Medical mistrust is another commonly reported screening barrier. Yet, mistrust is often studied as a patient- level barrier, ignoring that mistrust arises from structures, such as racism in health care. Many health care interventions also lack trustworthiness, partly because they are often designed without community input. Little is known about how screening barriers can be addressed through implementation strategies that center equity and have an explicit goal to earn patient trust. Through three specific aims, this study will address these knowledge gaps. These aims are to: 1) identify multilevel barriers and facilitators to the equitable implementation of lung cancer screening (K99 phase), 2) engage with community advisors and key stakeholders to identify multilevel implementation strategies to promote equity in lung cancer screening (K99 phase), and 3) pilot test the feasibility of multilevel implementation strategies designed to equitably improve lung cancer screening uptake (one at the patient level and one at the provider/system level, R00 phase). To complete these research aims, the candidate (Dr. Jennifer Richmond) requires didactic and mentored training in lung cancer leadership, implementation science, and methods for designing/evaluating multilevel health equity interventions. Dr. Richmond has assembled an outstanding mentoring team (Drs. Melinda Aldrich, Consuelo Wilkins, Eric Grogan, and Carolyn Audet) with collective expertise in these areas to help her achieve the research and training goals. Overall, this innovative study will be among the first to respond to the USPSTF call for evidence to increase lung cancer screening equity. It will also lay the groundwork for a R01 application to evaluate the intervention pilot tested in this study. With support from her mentors and the exceptional training and research environment at Vanderbilt University Medical Center, Dr. Richmond will reach her long- term goal of transitioning to independence and becoming a national leader in lung cancer equity research.

项目摘要/摘要使用低剂量计算机断层扫描的肺癌筛查显着降低了肺癌死亡率，美国癌症死亡率的主要原因。尽管具有挽救生命的潜力，但肺癌筛查在合格人群中的吸收仍然极低（约5％）。肺癌筛查的利用甚至是在肺癌负担不成比例的人群中较低（例如，黑人和低收入美国人）。 2021年11月，美国预防服务工作队（USPSTF）呼吁提供更多证据为了增加肺癌筛查吸收的股权，他们的年度报告给国会。但是，多层次障碍患者，提供者和卫生系统水平存在肺癌筛查。但是，先前的研究评估这些障碍受到种族，种族和社会经济多样性不足的限制参与者并排除了经常拥护筛查计划的关键医疗保健人员（例如护士）。医疗不信任是另一个常见的筛查障碍。但是，不信任通常被研究为患者 - 水平障碍，忽略了不信任的原因是结构，例如医疗保健中的种族主义。许多医疗保健干预措施也缺乏可信赖性，部分原因是它们通常是无社区投入的设计。小的知道如何通过中心公平的实施策略来解决筛查障碍并有一个明确的目标来赢得患者信任。通过三个具体目标，本研究将解决这些问题知识差距。这些目的是：1）确定公平的多层次障碍和促进者实施肺癌筛查（K99阶段），2）与社区顾问和关键利益相关者确定多层次实施策略以促进肺癌筛查中的股权（K99）阶段）和3）试验测试旨在公平改进的多级实施策略的可行性肺癌筛查摄取（一个处于患者水平，一个在提供商/系统级别，R00期）。到完成这些研究目的，候选人（Jennifer Richmond博士）需要教学和指导培训在肺癌领导力，实施科学和设计/评估多层次健康的方法中公平干预措施。里士满博士组建了一个杰出的指导团队（梅琳达·奥尔德里奇博士， Consuelo Wilkins，Eric Grogan和Carolyn Audet）在这些领域具有集体专业知识，以帮助她实现研究和培训目标。总体而言，这项创新研究将是最早回应USPSTF的研究之一呼吁有证据以增加肺癌筛查。它还将为R01申请奠定基础评估本研究中测试的干预试验。在她的导师和杰出的支持下范德比尔特大学医学中心的培训和研究环境，里士满博士将达到她的长期过渡到独立并成为肺癌股本研究的国家领导者的任期目标。