Full Project 2: Supporting High Risk African American Men in Research, Engagement & Decision Making (SHARED)

摘要 支持高风险非洲裔美国人参与肺癌的研究和决策 筛查是芝加哥CHEC外展研究的一个完整项目，旨在减少肺癌的不公平性。 高风险吸烟者的不同人群。少数种族/族裔承担着肺癌的最大负担 发病率和死亡率，非洲裔美国人（AAM）的发病率和死亡率最高。 低剂量螺旋计算机断层扫描（LDCT）肺癌早期发现筛查是推荐的 美国预防服务工作组（USPSTF - B建议）在55-80岁的成年人中， smoking.然而，很少有研究涉及如何使高风险AAM及其临床护理提供者参与其中 在LDCT。我们提出了一个创新的外展干预研究项目，让AAM成为公民科学家 为了提高英里广场健康中心（MSHC）对肺癌筛查的接受率，一个由13个联邦政府组成的小组， 与伊利诺伊大学医院和UIC健康科学系统相关的合格健康中心。 公民科学家指的是没有接受过正式科学家培训，但接受过从事以下工作的非专业人员： 研究工作应符合社区的需要。公民科学家已被证明在增加 社区对研究的知识和认识，建立对科学研究的信任， 研究设计和伦理。由于医疗保险和医疗补助服务中心需要共同决定- 在LDCT筛查之前，我们为医疗保险和医疗补助接受者制定流程， 在这项研究中，我们努力利用他们的社交网络来吸引AAM，并支持和加强一个机构 医疗保健研究和质量（AHRQ）基于证据的决策辅助（DA），促进共同决策 进行肺癌筛查。我们提出以下目标：1）招募和培训8名AAM， 公民科学家; 2）让公民科学家研究相关的知识，态度，障碍和促进者 在AAM吸烟者及其提供者中进行LDCT肺癌筛查; 3）使用目标2中获得的数据， 让公民科学家参与MSHC肺癌筛查中的AAM外展策略 并调整AHRQ DA，为AAM患者及其家属共同创建一个文化靶向的肺癌筛查DA。 提供者;以及4）让公民科学家参与一项试点RCT，比较文化目标的相对功效 公民-科学家告知DA与标准护理AHRQ DA关于知识，决策支持和肺癌的关系 在AAM中筛选。我们假设，与分配给标准护理DA的AAM相比， 接受公民-科学家告知的DA将表明更大的筛查意愿， 根据USPSTF指南进行LDCT筛查，以及更多的知识和感知决策支持。接合 AAM作为公民科学家，预计将改善外展和回应社区的需求， 传统上是“不参与”的研究过程，并提供了一个机会，为集团在最多的 增加肺癌风险，AAM，直接推动循证筛查的采用。

ABSTRACT Supporting High Risk African American Men in Research & Engagement in Decision Making for Lung Cancer Screening is a ChicagoCHEC outreach research full project that aims to reduce lung cancer inequities across diverse populations of high-risk smokers. Racial/ethnic minorities carry the greatest burden of lung cancer morbidity and mortality, with African American men (AAM) carrying the greatest incidence and mortality rates. Low dose helical computed tomography (LDCT) lung cancer early detection screening is recommended by the US Preventive Services Task Force (USPSTF - B recommendation) among adults aged 55-80, with a history of smoking. However, few studies have addressed how to engage high risk AAM and their clinical care providers in LDCT. We propose an innovative outreach intervention research project engaging AAM as Citizen Scientists to improve uptake of lung cancer screening at Mile Square Health Centers (MSHC), a group of 13 Federally Qualified Health Centers associated with the University of Illinois Hospital and Health Sciences System at UIC. Citizen Scientists refer to lay persons who are not formally trained as scientists but who are trained to engage in research efforts responsive to community needs. Citizen Scientists have proven valuable in increasing communities’ knowledge and awareness of research, building trust in scientific research, and informing areas of research design and ethics. As the Centers for Medicare and Medicaid Services requires a shared decision- making process for Medicare and Medicaid recipients prior to LDCT screening, we focus our Citizen Scientists efforts in this study on leveraging their social networks to engage AAM and supporting and enhancing an Agency for Healthcare Research and Quality (AHRQ) evidence-based Decision Aid (DA) that promotes shared decision making and subsequent lung cancer screening. We propose the following aims 1): recruit and train 8 AAM as Citizen Scientists; 2) engage Citizen Scientists to examine knowledge, attitudes, barriers and facilitators related to LDCT lung cancer screening among AAM smokers and their providers; 3) using data obtained in Aim 2, engage Citizen Scientists to refine outreach strategies for engaging AAM in lung cancer screening with MSHC and adapt the AHRQ DA to co-create a culturally targeted lung cancer screening DA for AAM patients and their providers; and 4) engage Citizen Scientists in a pilot RCT comparing the relative efficacy of the culturally targeted Citizen-Scientist informed DA vs the standard care AHRQ DA on knowledge, decisional support, and lung cancer screening among AAM. We hypothesize that compared with AAM assigned to the standard care DA, those receiving the Citizen-Scientist informed DA will demonstrate greater intention to screen, greater utilization of LDCT screening per USPSTF guidelines, and greater knowledge and perceived decisional support. Engaging AAM as Citizen Scientists is expected to improve outreach and respond to the needs communities that may traditionally be “unengaged” in the research process and provides an opportunity for the group at the most increased risk for lung cancer, AAM, to directly drive uptake of evidence based screening.