Community Services Navigation to Advance Health Equity in Breast Cancer Screening

社区服务导航促进乳腺癌筛查健康公平

基本信息

批准号：
10719957
负责人：
Tracy Onega
金额：
$ 63.81万
依托单位：
UNIVERSITY OF UTAH
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：
2023-07-25 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10719957
关键词：
Accident and Emergency department Address Breast Cancer Detection Cancer Control Caring Cervical Cancer Screening Clinical Trials Community Services Disease Disparity Equity Food Goals Grant Health Promotion Housing Inequity Intervention Longevity Mammographic screening Mammography Methods Outcome Participant Patient Self-Report Patients Population Heterogeneity Preventive care Preventive service Process Randomized, Controlled Trials Recommendation Reduce health disparities Resources Role Screening Result Services Social Work Testing Time Transportation United States Preventative Services Task Force Visit Woman Work World Health Organization acceptability and feasibility breast imaging cancer health disparity cancer prevention care episode disadvantaged women economic disparity effectiveness evaluation evidence base experience falls follow-up health disparity health equity health equity promotion health inequalities health information technology implementation intervention improved improved outcome interest malignant breast neoplasm mortality outreach patient screening point of care preventable death programs referral services remediation routine screening screening screening program service providers social social disparities social health determinants treatment as usual uptake

项目摘要

Project Abstract Community Services Navigation to Advance Health Equity in Breast Cancer Screening Persistent inequities in breast cancer outcomes can be traced in large part to inequities in breast cancer screening follow-up care among underserved women. While U.S. breast cancer mortality rates have decreased approximately 2% per year since 1990, socially and economically disadvantaged women have experienced increasing breast cancer mortality over that time. Many of these deaths are preventable. Mammography is evidence-based screening that, when fully implemented with appropriate follow-up care, improves outcomes for millions of women who are screened each year. Many services, including financial coverage, exist to improve breast screening rates among underserved women. Now, to address health disparities and promote health equity we must remove persistent barriers to appropriate follow-up of abnormal screening exams – the point of care with the most potential impact to decrease late-stage disease and mortality. Women with a higher burden of social needs (e.g., for food, housing, utilities, transportation), are about half as likely to follow-up after an abnormal mammogram than women who experience minimal social needs. There is a critical need to implement programs that will help women overcome barriers to follow-up, including access to community service resources, which is a known barrier. The SINCERE intervention, a validated screener and referral process for social needs (e.g., for transportation, housing, utilities, food), was found in our prior studies to be feasible and acceptable in Emergency Department settings. Building on this prior work, we now propose to adapt and extend the implementation of this intervention by adding community services navigation – an active outreach intervention to connect breast screening patients with social services. We aim to address the needs of underserved women that act as barriers to follow-up of abnormal breast screening and reduce breast cancer disparities. Our overarching objective is to improve health equity, and the goal of this study is to evaluate if adding community services navigation to the standard referral process for social needs is an effective and scalable strategy for addressing disparities in follow-up to abnormal breast cancer screening results. With statewide community service providers, existing health information technology, and validated methods, we will determine the effectiveness of social needs referrals combined with a community services navigation intervention in the screening mammography setting to improving breast screening outcomes in underserved women. We expect that outreach to underserved women, who represent a large proportion of late-stage and higher mortality breast cancers, will improve breast cancer screening follow-up and outcomes for underserved women.

项目摘要社区服务导航促进乳腺癌筛查健康公平乳腺癌结果的持续不平等在很大程度上可以追溯到乳腺癌的不平等在服务不足的女性中进行筛查后续护理，而美国乳腺癌死亡率有所下降。自 1990 年以来，每年约 2% 的社会和经济弱势妇女经历了在此期间，乳腺癌死亡率不断上升，其中许多死亡是可以预防的。基于证据的筛查，如果充分实施并采取适当的后续护理，可以改善结果每年有数百万接受筛查的女性。包括财务保险在内的许多服务旨在提高服务不足的人群的乳腺筛查率现在，为了解决健康差距并促进健康公平，我们必须消除持续存在的障碍。对异常筛查检查进行适当的后续行动——对患者最有潜在影响的护理点降低社会需求负担较高的妇女的晚期疾病和死亡率（例如，食物、住房、公用事业、交通），在异常乳房 X 光检查后进行随访的可能性大约是乳房 X 光检查后的一半缺乏社会需求的女性迫切需要实施能够提供帮助的计划。妇女克服了后续行动的障碍，包括获得社区服务资源，这是众所周知的障碍。 SINCERE 干预、针对社会需求（例如交通、我们之前的研究发现，在急诊科是可行且可以接受的在先前工作的基础上，我们现在建议调整并扩展此实施。通过添加社区服务导航进行干预——连接乳房的积极外展干预我们的目标是满足服务不足的女性的需求。消除异常乳腺筛查随访的障碍并减少乳腺癌差异。我们的首要目标是改善健康公平，本研究的目标是评估是否添加社区服务导航到满足社会需求的标准转介流程是一种有效且可扩展的方法解决异常乳腺癌筛查结果随访差异的策略。社区服务提供商、现有的健康信息技术和经过验证的方法，我们将确定社会需求转介与社区服务导航干预相结合的有效性筛查乳房X光检查设置，以改善服务不足的女性的乳房筛查结果。我们期望将服务范围扩大到服务不足的女性，她们在晚期及更高阶段中占很大比例死亡率乳腺癌，将改善乳腺癌筛查随访和服务不足的结果女性。