Determining organizational structures and processes that improve lung cancer screening adherence among underserved populations

确定提高服务不足人群肺癌筛查依从性的组织结构和流程

• 批准号: 10314581
• 负责人: Eduardo R. Nunez
• 金额: $ 7.27万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2022-06-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10314581
• 关键词: Adherence; Affect; Attention; Award; Cancer Etiology; Caring; Cause of Death; Cessation of life; Data; Development; Ensure; Facility Designs; Foundations; Goals; Grant; Health Services; Health Services Accessibility; Incidence; Inequality; Infrastructure; Insurance; K-Series Research Career Programs; Low income; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Manuscripts; Mental Health; Mentors; Minority Groups; Modeling; Participant; Patients; Population; Population Heterogeneity; Poverty; Process; Recommendation; Research; Research Personnel; Research Project Grants; Research Proposals; Resources; Screening Result; Site; Structure; Subgroup; Surveys; System; Time; Underserved Population; United States National Institutes of Health; Update; Variant; Veterans; Veterans Health Administration; Vulnerable Populations; Work; adherence rate; barrier to care; black men; cancer health disparity; career; career development; cohort; comorbidity; copayment; design; effectiveness evaluation; effectiveness implementation study; ethnic minority population; evidence base; experience; follow-up; hands on research; health care delivery; health disparity; improved; low dose computed tomography; lung cancer screening; lung volume; mortality; organizational structure; pilot trial; predictive modeling; preventable death; racial minority; screening; screening program; skills; treatment disparity

PROJECT SUMMARY/ABSTRACT Lung cancer remains the leading cause of cancer death, with an estimated 1.8 million deaths annually worldwide. Racial and ethnic minorities are disproportionately affected as they are more likely to be impoverished, lack insurance, and suffer disparities in treatment of lung cancer. Lung cancer screening (LCS) can reduce lung cancer mortality by 20% with close follow-up and adherence to management recommendations. Yet, how to optimize LCS adherence in a real-world population with diverse backgrounds and barriers to accessing LCS is unknown. In our recent work, we found that in a national cohort of 28,294 Veterans who underwent initial LCS, only 63% received the recommended next step in the expected time frame, with delayed or absent follow-up more likely in vulnerable populations, including Veterans who were racially Black, had mental health comorbidities, earned lower income or had higher copayments to access care. Encouragingly, Veterans who received care at high-volume LCS or academic facilities were less likely to have delayed or absent follow-up, suggesting that lessons could be learned from these LCS programs. I propose two foundational steps to enhance our understanding of the barriers to lung cancer screening and develop strategies to mitigate disparities: 1) evaluate the current structures and processes at VA facilities performing LCS designed to support equitable adherence to LCS by developing and administering surveys to these facilities and 2) conduct hierarchical multivariable regression models to identify barriers to adherence and strategies that are associated with greater in LCS follow-up overall, and among subgroups of vulnerable populations. This work represents a critical first step to identify best practices to improve adherence to LCS and ultimately mitigate lung cancer disparities among vulnerable population. This work will inform the next step in my career development, in which I will develop a tailored implementation plan and then a pilot implementation / effectiveness study in a site with a diverse population to improve mortality benefits from LCS.

项目总结/摘要 肺癌仍然是癌症死亡的主要原因，估计每年有180万人死亡 国际吧种族和族裔少数群体受到的影响不成比例，因为他们更有可能 贫困，缺乏保险，肺癌治疗不平等。肺癌筛查（LCS） 通过密切随访和坚持治疗，可将肺癌死亡率降低20% 建议.然而，如何在具有不同背景的现实世界人群中优化LCS依从性， 并且访问LCS的障碍是未知的。在我们最近的研究中，我们发现在一个28294人的国家队列中， 接受初始LCS的退伍军人中，只有63%在预期时间内接受了建议的下一步 框架，延迟或缺乏后续行动更可能在弱势群体，包括退伍军人谁是 黑人，有精神健康共病，收入较低或有较高的共付额 在乎令人鼓舞的是，在高容量LCS或学术机构接受护理的退伍军人不太可能 延迟或缺乏后续行动，这表明可以从这些LCS项目中吸取教训。我 提出两个基本步骤，以提高我们对肺癌筛查障碍的理解， 制定战略，以减轻差距：1）评估目前的结构和程序，在VA设施 执行LCS，旨在通过开发和管理调查来支持公平遵守LCS， 这些设施和2）进行分层多变量回归模型，以确定依从性的障碍 和战略，与更大的LCS后续行动的整体，并在亚组的脆弱 人口。这项工作是确定最佳实践以提高LCS依从性的关键第一步 并最终减少弱势人群中的肺癌差异。这项工作将为下一步工作提供信息 在我的职业发展中，我将制定一个量身定制的实施计划， 实施/有效性研究，以提高LCS的死亡率效益。

项目成果

Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans.

• DOI: 10.1001/jamanetworkopen.2022.27126
• 发表时间: 2022-08-01
• 期刊: JAMA network open
• 影响因子: 13.8

Time to Update Lung-RADS v1.1? Incorporating evidence from recent observational studies.

• DOI: 10.1016/j.jacr.2022.06.010
• 发表时间: 2023-09
• 期刊: JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
• 影响因子: 4.5
• 作者: Nunez, Eduardo R.;Gould, Michael K.;Wiener, Renda Soylemez
• 通讯作者: Wiener, Renda Soylemez

National Survey of Lung Cancer Screening Practices in Veterans Health Administration Facilities.

退伍军人健康管理机构肺癌筛查实践全国调查。

• DOI: 10.1016/j.amepre.2023.05.005
• 发表时间: 2023
• 期刊: American journal of preventive medicine
• 影响因子: 5.5
• 作者: Núñez,EduardoR;Slatore,ChristopherG;Tanner,NicholeT;Melzer,AnneC;Crothers,KristinaA;Lewis,JenniferA;Fabbrini,AngelaE;Brown,JamesK;Wiener,RendaS
• 通讯作者: Wiener,RendaS