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Investigating the Roles of Patient Beliefs, Stigma, and Physician Implicit Bias on Disparities in Lung Cancer Screening

调查患者信念、耻辱和医生隐性偏见对肺癌筛查差异的影响

基本信息

批准号：
10491361
负责人：
Minal S Kale
金额：
$ 82.98万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10491361
关键词：
Address Adoption Advisory Committees Affect Agreement Americas Attitude Behavioral Belief Black Populations Black race Cervical Cessation of life Colorectal Communication Data Development Discrimination Evaluation Health system Healthcare Systems Hispanic Hispanic Populations Incidence Informal Social Control Institute of Medicine (U.S.)Intervention Malignant Neoplasms Malignant neoplasm of lung Measures Mediating Medical Minority Minority Groups Modeling New York City Outcome Patients Physicians Preventive service Primary Health Care Process Prostate Pulmonary Challenge Radiation exposure Randomized Controlled Trials Reporting Research Research Personnel Risk Role Sampling Scanning Screening Result Screening for cancer Smoker Smoking Stage at Diagnosis Stigmatization Survival Rate Testing Unconscious State United States cancer health disparity cancer risk cancer therapy care providers cigarette smoking cohort computed tomography screening cultural competence early screening ethnic difference ethnic diversity ethnic minority falls health belief health care delivery health care disparity health communication high risk implicit bias improved low dose computed tomography lung cancer screening malignant breast neoplasm mortality multidisciplinary pain relief provider factors psychologic racial and ethnic disparities racial difference racial disparity racial diversity racial minority recruit response screening screening disparities screening program shared decision making social culture social stigma

项目摘要

Lung cancer is particularly aggressive, lethal, and stigmatized by its strong association with cigarette smoking, with a 5-year survival rate <15%. The burden of lung cancer in the United States falls disproportionally on minorities. Blacks have the highest incidence of lung cancer and both Black and Hispanic patients have worse outcomes than their white counterparts. Lung cancer screening, consisting of an annual low-dose computed tomography (LDCT) scan, is currently recommended by the United States Preventive Services Task Force to the 8 million smokers who are at high risk of developing lung cancer, and is poised to substantially reduce lung cancer deaths. Alarmingly, emerging national data demonstrates that only 3% of black eligible smokers received screening compared to 12% of white smokers in 2017. Prior research on cancer disparities fails to address issues that are specific to lung cancer (stigma, high mortality, and fatalism) and LDCT screening (new test, increased radiation exposure) and greatly limits the generalizability of the findings from these studies to lung cancer screening. In this project, we plan to assess modifiable health beliefs as well as examine psychological responses to discrimination, such as stigma and medical mistrust that may influence lung cancer screening use among minority smokers. We also plan to evaluate the role of implicit bias among physicians. Given the newness and unique challenges of lung cancer screening, efforts to accurately identify barriers and engage Black and Hispanics in LDCT screening early in its adoption are imperative to achieving an early correction to this disparity. The Specific Aims of the study are to: 1) Assess racial and ethnic differences in beliefs about lung cancer and LDCT screening and their association with lower rates of agreement to undergo screening and LDCT completion; 2) Evaluate if racial and ethnic differences in stigma and medical mistrust are associated with lower rates of agreement to undergo screening and LDCT completion and underlie screening disparities; and 3) Assess the association of implicit bias with racial and ethnic disparities in lung cancer screening referral and LDCT completion. To achieve these aims, we will recruit lung cancer screening-eligible smokers and their primary care providers from a vast network of primary care practices in New York City. We plan to measure patient’s beliefs about lung cancer and LDCT screening, stigma, and medical mistrust, as well as measure physicians’ bias and test associations with lung cancer screening referral and completion. The results of the study will directly guide the development of targeted strategies to improve lung cancer screening rates among minorities.

肺癌具有特别的侵袭性、致命性，并因其与癌症的密切联系而被污名化