A Multilevel intervention to address health disparities in lung cancer screening

解决肺癌筛查健康差异的多层次干预

• 批准号: 10746896
• 负责人: Randi M. Williams
• 金额: $ 24.82万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746896
• 关键词: Accounting; Address; Affect; African American population; Award; Awareness; Behavior; Cancer Control; Cancer Etiology; Cessation of life; Clinic; Clinical; Collaborations; Colorectal Cancer; Comprehensive Cancer Center; Computerized Medical Record; Control Groups; Data; Development; Diagnosis; Disease; Disparity; Early Diagnosis; Electronics; Eligibility Determination; Enrollment; Environment; Equity; Ethnic Population; Feasibility Studies; Future; Health; Health Disparities Research; Health Personnel; Health Services Accessibility; Healthcare Systems; Individual; Institution; Insurance Coverage; Intention; Intervention; Interview; Knowledge; Length; Lung; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Mentors; Minority; Minority Groups; Morbidity - disease rate; Notification; Outcome; Participant; Patient Education; Patient Preferences; Patients; Persons; Phase; Physicians; Pre-Post Tests; Primary Care; Printing; Provider; Public Health; Quasi-experiment; Race; Recommendation; Recording of previous events; Reporting; Research; Research Methodology; Resources; Schedule; Scientist; Screening for cancer; Smoker; Smoking History; Specialist; Surveys; System; Telephone; Testing; Thoracic Radiography; Training; United States; United States National Institutes of Health; United States Preventative Services Task Force; Visit; acceptability and feasibility; advanced disease; cancer health disparity; cancer survival; care preference; career; design; disparity reduction; electronic medical record system; ethnic minority; former smoker; health care disparity; health care settings; health disparity; health literacy; high risk; high risk population; improved; intervention participants; low dose computed tomography; lung cancer screening; malignant breast neoplasm; mortality; outreach; patient level intervention; patient-clinician communication; preference; primary care clinic; primary care provider; primary outcome; racial minority; racial population; screening; screening disparities; secondary outcome; systemic barrier; tool; uptake

Abstract Lung cancer is the leading cause of cancer-related mortality in the US, with more than 135,000 deaths expected in 2020. Based on the National Lung Screening Trial, which showed that low-dose computed tomography (lung screening) vs. chest X-ray reduced mortality due to lung cancer by 20%, the US Preventive Services Task Force recommends annual lung screening for asymptomatic high risk individuals. Despite this recommendation, utilization is poor (3%-14%). Lung screening may be particularly beneficial for African Americans (AA), because they are more likely to have advanced disease, lower survival, and lower screening rates compared to whites. The causes of low uptake of lung screening are multifactorial and consistent with evidence from other cancer screening disparities. For example, provider-initiated discussions about cancer screening tests are low overall, and AA and other racial/ethnic minorities are less likely than whites to have these discussions. Another key driver of screening disparities is patients’ lack of knowledge about early detection. Evidence points to the need for multilevel interventions that simultaneously address multiple barriers to increase screening rates and decrease lung cancer morbidity and mortality in minority populations. The proposed study will target two key levels of influence in the healthcare setting: provider and patient behavior in order to address disparities between AA and whites in lung screening awareness and utilization. Guided by NIH’s Health Disparities Research Framework, in the K99 phase, I will receive didactic and mentored training in research methods to address disparities occurring in the healthcare system. I will conduct feasibility studies and formative research to strengthen the content and delivery of the quasi-experimental study (pretest- posttest, with a nonequivalent control group) to be conducted in the R00 phase. The specific aims are to: Aim 1: Evaluate the feasibility and acceptability of implementing a healthcare provider prompt in a primary care network (K99). Aim 2: Develop and pre-test the patient education component (K99). Aim 3: Test the impact of the multilevel intervention on primary (provider-patient communication, screening intentions, and knowledge) and secondary (screening referrals and completion) outcomes (R00). I will explore whether Health Disparities Framework factors (e.g., race, health literacy) moderate these relationships. The proposed multilevel intervention targets important barriers to lung screening that will provide preliminary data to inform a future R01 application designed to measure the independent and overlapping contributions of the provider and patient interventions. This award, along with the institutional environment, training, research resources, and mentoring team available to me through the Georgetown Lombardi Comprehensive Cancer Center, will provide the necessary training to develop approaches to reduce disparities that arise in the clinical setting and will launch my career as an independent cancer control scientist focused on eliminating cancer disparities.

抽象的 肺癌是美国癌症相关死亡的主要原因，有超过 135,000 人死亡 预计 2020 年。基于全国肺部筛查试验，该试验表明低剂量计算 美国预防医学协会称，断层扫描（肺部筛查）与胸部 X 光检查相比，可将肺癌死亡率降低 20% 尽管如此，服务工作组仍建议对无症状的高危人群进行年度肺部筛查。 推荐，利用率较差（3%-14%），肺部筛查可能对非洲特别有益。 美国人（AA），因为他们更有可能患有晚期疾病、较低的生存率和较低的筛查率 与白人相比，肺部筛查率低的原因是多因素的，并且与白人相比。 来自其他癌症筛查差异的证据例如，提供者发起的关于癌症的讨论。 筛查测试总体较低，AA 和其他种族/族裔比白人更不可能获得 这些讨论造成筛查差异的另一个关键因素是患者缺乏早期知识。 证据表明需要同时采取多层次干预措施来解决多种障碍。 提高少数群体的筛查率并降低肺癌发病率和死亡率。 拟议的研究将针对医疗保健环境中的两个关键影响水平：提供者和患者的行为 以解决 AA 和白人在肺部筛查意识和利用方面的差异。 NIH 的健康差异研究框架，在 K99 阶段，我将接受教学和指导培训 我将进行可行性研究，以解决医疗保健系统中出现的差异。 和形成性研究，以加强准实验研究（预测试- 后测试（具有非等效对照组）将在 R00 阶段进行，具体目标是： 目标 1：评估在初级保健中实施医疗保健提供者提示的可行性和可接受性 目标 2：开发并预先测试患者教育部分（K99）。 对初级的多层次干预（医患沟通、筛查意图和知识） 我将探讨是否存在健康差异。 框架因素（例如种族、健康素养）调节这些关系。 干预针对肺部筛查的重要障碍，这将为未来的 R01 提供初步数据 旨在衡量提供者和患者的独立和重叠贡献的应用程序 该奖项以及机构环境、培训、研究资源和指导。 通过乔治敦隆巴迪综合癌症中心为我提供的团队将提供 必要的培训，以制定减少临床环境中出现的差异的方法，并将启动 作为一名独立的癌症控制科学家，我的职业生涯专注于消除癌症差异。