Understanding Rural Patient, and Provider Preferences for Mobile Lung Cancer Screening Clinics

项目概要/摘要 项目1（Hasson）：了解农村患者和提供者对移动的肺癌筛查的偏好 诊所 尽管在肺癌的早期阶段给予治疗的结果是最好的，但在肺癌的早期阶段， 6%符合条件的高危患者参加肺癌筛查（LCS）， 农村人口。数据来自国家肺筛查试验（NLST），一项多机构随机 超过50，000例患者的对照研究，通过比较低剂量计算的 胸部X线断层扫描（CT）。研究发现，低剂量CT的LCS与20%的 肺癌特异性死亡率，以及总死亡率降低6.7%。许多组织已经 随后发布了支持年度LCS的指导方针。然而，10年后，尽管多个 研究证实了NLST的结果，并根据对NLST的持续研究修订了指南。 尽管低剂量CT的有效性很低，但仍然没有得到充分利用，而且不成比例的高风险患者要么没有得到充分利用， 转介或未接受筛查。虽然原因是多方面的，但需要更好地 了解当前农村筛查的现状，以及农村提供者和患者的障碍， 参与是解决这一公共卫生困境的必要条件。此外，考虑到这些难以达到的 在不同地点，采用基于社区的办法对于制定一项得到充分利用的干预措施至关重要。 这项拟议研究的主要目标是确定提供者和患者的障碍和促进因素， 预测农村地区LCS的转诊和使用情况;评估移动的诊所的可行性和可接受性 进行筛查;以及测试移动的单元干预。用于交付LCS的拟议方法旨在 减少后勤和心理障碍。在农村地区，一个移动的单位应该是可行的和可以接受的， 患者和提供者，并可用于补充传统的医院或诊所为基础的筛选。基于 移动的乳腺癌和宫颈癌筛查项目的成功，研究小组试图确定 移动的单位在增加农村地区的筛查方面是否比传统医院更成功- 基于方法。该项目将通过以下方式发展这一假设：（1）确定肺结核发生率高的区域 癌症（以及在后期阶段识别的肺癌）;（2）从社区成员获得输入，以告知 可行的、可接受的移动的LCS干预;以及（3）对移动的LCS诊所进行试点测试。时发现的问题 这项研究将有助于开发一种可扩展的、可行的干预措施， 改善农村生活。此外，通过了解农村社区的需求， 更接近家庭的LCS机会，更早的检测，更好的治疗和改善癌症结果 可以实现。

PROJECT SUMMARY/ABSTRACT Project 1 (Hasson): Understanding Rural Patient and Provider Preferences for Mobile Lung Cancer Screening Clinics Despite the fact that outcomes are best when treatment is given in the early stages of lung cancer, less than 6% of eligible high-risk patients participate in lung cancer screening (LCS), with even lower participation in rural populations. Data from the National Lung Screening Trial (NLST), a multi-institutional randomized controlled study of over 50,000 patients, demonstrated the utility of LCS by comparing low-dose computed tomography (CT) with chest X-ray. It found that LCS with low-dose CT was associated with a 20% reduction in lung cancer-specific mortality, as well as an overall mortality reduction of 6.7%. Many organizations have subsequently published guidelines supporting annual LCS. Nevertheless, 10 years later, despite multiple studies confirming the results of the NLST, and revised guidelines based on continued research into its efficacy, low-dose CT is still underutilized, and a disproportionate number of high-risk patients are either not referred or do not undergo screening. While the reasons for this are multifactorial, the need to better understand the current rural screening landscape, and rural provider and patient barriers leading to low participation, is imperative to resolve this public health dilemma. Additionally, given these hard-to-reach locations, use of a community-based approach is vital to developing an intervention that would be well-utilized. The primary objectives of this proposed study are to identify provider and patient barriers and facilitators that predict referral to, and utilization of, LCS in rural spaces; assess feasibility and acceptability of mobile clinics for screening; and test a mobile unit intervention. The proposed approach used to deliver LCS was designed to reduce logistical and psychosocial barriers. In rural areas, a mobile unit should be feasible and acceptable to patients and providers, and may serve to supplement traditional hospital or clinic-based screening. Based on the success of mobile breast and cervical cancer screening programs, the research team seeks to determine whether a mobile unit will be more successful in increasing screening in rural areas than a traditional hospital- based approach. This project will develop this hypothesis by: (1) identifying regions with high rates of lung cancer (and lung cancer identified at later stages); (2) obtaining input from community members to inform a feasible, acceptable mobile LCS intervention; and then (3) pilot testing a mobile LCS clinic. Findings from this study will aid in the development of a scalable, feasible intervention acceptable to patients and providers in rural areas to improve LCS. Further, by understanding the needs of rural communities and enhancing opportunities for LCS closer to home, earlier detection, prompter treatment, and improved cancer outcomes can be achieved.