Overcoming Racial Disparities in Curative Therapies for Hepatocellular Carcinoma

克服肝细胞癌治疗中的种族差异

• 批准号: 10572610
• 负责人: Lauren Nephew
• 金额: $ 15.25万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572610
• 关键词: Active Learning; Address; Alcohols; Behavior Therapy; Behavioral trial; Black race; Cancer Center; Cancer Prognosis; Caring; Characteristics; Chronic; Clinic; Clinical Sciences; Complement; Complex; Consent; Continuity of Patient Care; Data; Disease; Education; Educational Status; Enrollment; Environment; Epidemiology; Evidence based intervention; Excision; Failure; Funding; Gastroenterologist; Goals; Grant; Health; Health Services Accessibility; Health Services Research; Health system; Healthcare; Hospitals; Improve Access; Indiana; Individual; Institutes; Intervention; Knowledge; Liver; Liver diseases; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of liver; Mentors; Mentorship; Methods; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Participant; Patients; Poverty; Primary carcinoma of the liver cells; Prospective cohort study; Provider; Randomized; Randomized Controlled Trials; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Research Training; Services; Social Conditions; Social Work; Surveys; System; Testing; Time; Training; Training Programs; Translational Research; Universities; Vulnerable Populations; Waiting Lists; Work; behavior test; behavioral health; black patient; cancer care; cancer health disparity; career; chronic liver disease; cohort; curative treatments; design; disparity reduction; experience; health disparity; high school; human centered design; implementation intervention; implementation science; improved; intervention effect; liver transplantation; medically underserved population; mortality; mortality disparity; multidisciplinary; patient screening; pilot test; programs; racial disparity; randomized trial; safety net; skills; social; social determinants; social health determinants; social structure; standard of care; substance use; therapy design; therapy development; tumor; usability

ABSTRACT Lauren D. Nephew MD, MA, MSCE's long-term career goal is to become an independent, externally funded researcher and leader in developing multilevel interventions to reduce disparities in access to treatments for liver disease and gastrointestinal malignancies. She has identified improving access to curative therapies for hepatocellular carcinoma (HCC) as a critical issue to address to achieve this goal. This proposal describes a 4-year comprehensive program of training and mentored research for an academic career in health services research with a special focus on advancing health care equity. This is in line with NIDDK's commitment to combating health disparities. While Dr. Nephew has a strong background in epidemiology, this K23 will provide key training in using human centered design research methods for intervention development, randomized controlled behavioral trials, and implementation of interventions within health systems. Black patients with chronic liver disease are approximately 50% less likely than White patients to receive curative therapies for hepatocellular carcinoma (HCC) even when presenting with early stage disease. Reasons for disparities in mortality are in part related to failure to progress through the complex HCC care continuum to access curative therapies as a result of the unequal distribution of social and structural determinants of health (SSDOH). The HCC-EduLink intervention we propose to develop is designed to: a) improve patients' HCC-related knowledge; b) screen patients for social needs and substance use and refer to social work for linkage to local services; and c) use our multidisciplinary HCC tumor board to facilitate linkage to subspecialty HCC cancer care. The objectives of this application are to develop the education program component of the HCC-EduLink intervention and pilot test the full multi-level intervention designed to address patient- and system-level SSDOH variables and facilitate access to HCC curative therapies in a cohort of Black patients HCC. Dr. Nephew's multidisciplinary mentorship team including a world-renowned gastroenterologist, an expert in interventions to reduce cancer disparities, and a behavioral health statistician will provide expert guidance to complement her course work and experiential learning. The environment including the Indiana University Simon Cancer Center, Clinical and Translational Science Institute, the Eskenazi Safety-net Hospital and the Indiana University Academic Health Center, make this an ideal environment for her training and to complete the proposed aims. Upon completion of the proposed research and training, Dr. Nephew will submit a competitive R-level grant to test the pilot intervention in a larger randomized trial and will possess the skills and experience needed to make a sustained and impactful contribution to reduce HCC mortality through evidenced-based interventions in other vulnerable populations.

抽象的 Lauren D. Nephew MD、MA、MSCE 的长期职业目标是成为一名独立的、外部的 资助研究人员和领导者制定多层次干预措施，以减少获得资源方面的差异 肝脏疾病和胃肠道恶性肿瘤的治疗。她发现改善获得治疗的机会 肝细胞癌（HCC）的治疗是实现这一目标需要解决的关键问题。这个提议 描述了一个为期 4 年的学术生涯综合培训和指导研究计划 卫生服务研究，特别关注促进卫生保健公平。这与 NIDDK 的规定一致 致力于消除健康差距。虽然 Nephew 博士拥有深厚的流行病学背景，但 K23 将提供使用以人为本的设计研究方法进行干预开发的关键培训， 随机对照行为试验以及在卫生系统内实施干预措施。 黑人患者患有慢性肝病的可能性比白人患者低约 50% 即使处于早期疾病阶段，也能接受肝细胞癌 (HCC) 的治愈性治疗。 死亡率差异的部分原因在于未能通过复杂的 HCC 护理取得进展 由于社会和结构性分配不平等，人们继续获得治疗 健康的决定因素（SSDOH）。我们建议开发的 HCC-EduLink 干预措施旨在：a) 提高患者HCC相关知识； b) 筛查患者的社交需求和物质使用情况，并参考 与当地服务联系起来的社会工作； c) 使用我们的多学科 HCC 肿瘤委员会来促进联系 专科 HCC 癌症护理。该应用程序的目标是开发教育计划 HCC-EduLink 干预措施的组成部分，并试点测试旨在解决的全面多层次干预措施 患者和系统级 SSDOH 变量，并促进黑人群体获得 HCC 治疗 肝癌患者。 Nephew 博士的多学科导师团队包括世界著名的胃肠病学家、 减少癌症差异干预措施的专家和行为健康统计学家将提供专家 指导以补充她的课程作业和体验式学习。环境包括印第安纳州 西蒙大学癌症中心、临床和转化科学研究所、埃斯肯纳齐安全网医院 和印第安纳大学学术健康中心，使这里成为她训练和学习的理想环境 完成拟议的目标。完成拟议的研究和培训后，Nephew 博士将提交 具有竞争性的 R 级拨款，用于在更大的随机试验中测试试点干预，并将拥有技能 以及通过以下方式为降低 HCC 死亡率做出持续和有影响力的贡献所需的经验： 对其他弱势群体采取循证干预措施。