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

项目摘要/摘要 项目1(Hasson)：了解农村患者和提供者对流动肺癌筛查的偏好 诊所 尽管在肺癌的早期阶段给予治疗是最好的结果，但不到 6%的符合条件的高危患者参加了肺癌筛查(LCS)，参与肺癌筛查的比例更低 农村人口。数据来自国家肺部筛查试验(NLST)，这是一项多机构随机试验 对50,000多名患者进行的对照研究，通过比较低剂量计算机显示了LCS的有效性 胸部X光体层摄影术(CT)。研究发现，使用低剂量CT的LCS与20%的 肺癌特有的死亡率，以及总体死亡率下降6.7%。许多组织都有 随后发布了支持年度LCS的指导方针。然而，10年后，尽管有多个 确认NLST结果的研究，以及基于对其持续研究的修订指南 疗效，低剂量CT仍未得到充分利用，而且不成比例的高危患者要么不是 转诊或未接受筛查。虽然原因是多方面的，但需要更好地 了解当前农村筛查情况，以及农村提供者和患者的门槛较低 参与是解决这一公共卫生困境的当务之急。此外，考虑到这些难以触及的因素 在不同地点，使用以社区为基础的方法对于制定一种将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之间的障碍和促进者 预测农村地区社区卫生服务的转介和使用情况；评估流动诊所的可行性和可接受性 用于筛查；并测试移动单元干预。用于交付LCS的拟议方法旨在 减少后勤和心理社会障碍。在农村地区，流动单位应该是可行的和可以接受的 患者和提供者，并可补充传统的医院或诊所为基础的筛查。基于 移动乳腺癌和宫颈癌筛查项目的成功，研究小组试图确定 在增加农村地区的筛查方面，移动单位是否会比传统医院更成功- 基于策略的方法。该项目将通过以下方式发展这一假设：(1)确定肺脏发病率高的区域 癌症(和后期确诊的肺癌)；(2)从社区成员那里获得信息，以告知 可行、可接受的移动LCS干预；然后(3)对移动LCS诊所进行试点测试。由此得出的结论 这项研究将有助于开发可扩展的、可行的干预措施，患者和提供者可以接受 完善农村土地流转服务体系。此外，通过了解农村社区的需求和加强 离家更近的LC的机会、更早的检测、更快的治疗和改善癌症预后 是可以实现的。

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.