Community Oriented Tool for Reducing Melanoma Health Disparities

描述(申请人提供)：黑色素瘤是一种经常致命的癌症，如果及早发现，相对容易治愈。这种疾病的频率正在迅速增加，最近被国家卫生统计中心健康差距研究确定为一种引人注目的健康差距。此外，人们注意到，现在在年轻人和西班牙裔人口中发生这种情况的频率都有所增加。我们已经开发了一种独特的、专有的和创新的自我筛选成像技术(DermAlert)，通过更充分地让有黑色素瘤风险的人参与他们自己的医疗保健，并使之能够更早地检测到可能是早期黑色素瘤的新的和变化的色素病变，从而有可能显著减轻不同的黑色素瘤结果。这项NIH赠款计划的目标是解决将这项技术转化到高危社区以实现减少黑色素瘤差异的关键问题(与患者相关的差异原因以及疗效演示的医生/保险要求)。我们提出了一项计划，以研究DermAlert成像自我筛查对新的和变化的色素性皮损的有效性，并提供有助于在受影响人群中克服使用DermAlert系统的障碍的教育。第一阶段的活动将包括：“将DermAlert转换为西班牙语资源”，分析患有黑色素瘤健康差异的群体使用成像的具体障碍，“开发教育和推广工具，以帮助克服使用自我成像筛查的障碍，”初步评估使用DermAlert对健康结果的影响，以及“准备在第二阶段进行扩大的大规模疗效研究。随着通过成像系统检测到变化的色素病变进行活组织检查，这些活组织检查的结果将被列表，并与成像不是激励因素的对照活组织检查进行统计比较。使用这种方法，不仅可以调查患者在使用成像系统时的依从性，而且可以调查其在帮助指导更有效的活检决策方面的效用。该项目的这一部分将讨论其疗效和由此产生的医疗结果。第一阶段中可衡量的里程碑包括以下内容，可用于帮助评估进入第二阶段研究的可行性：“定性和定量确定造成健康差距的成像的具体障碍”，为帮助患者和医生克服使用这项技术的障碍准备教育视频，以及“为评估使用DermAlert的疗效建立和初步分析后续活检数据档案”。该项目的成功完成将提高人们的认识，减少使用完全独特的成像方案的障碍，这将使患者更深入地参与他们的个人保健，有助于更早地发现潜在的黑色素瘤，并最终能够减少不必要的活检数量，降低由于严重健康差距而导致的患者死亡率。 与公共健康相关：黑色素瘤是一种严重的、不断扩大的公共健康差距；为了帮助对抗它，医生敦促人们寻找皮肤上新的和变化的色素痣。这目前对人们来说是一项非常具有挑战性的任务；然而，该项目将寻求减少使用可靠的家庭数字摄影工具的障碍，以帮助人们发现这些变化。这项技术的广泛应用可以减少黑色素瘤的健康差距。

DESCRIPTION (provided by applicant): Melanoma is a frequently fatal cancer that, if detected early, is relatively easily cured. This disease is rapidly increasing in frequency and has recently been identified by the National Center for Health Statistics Health Disparities Study as a high profile health disparity. Further it has been noted to occur more frequently now in both young people and Hispanic populations. We have developed a unique, proprietary and innovative self-screening imaging technology (DermAlert) that has the potential to significantly mitigate disparate melanoma outcomes by more fully involving people at-risk of melanoma in their own healthcare, and by enabling much earlier detection of new and changed pigmented lesions that may be early melanomas. The goal of this NIH grant program is to address key issues (patient related causes for the disparity and physician/insurance requirements for efficacy demonstration) for the translation of this technology into the at- risk community to realize reduction in melanoma disparity. We propose a program to research the efficacy of DermAlert imaging self screening for new and changed pigmented lesions, and to provide education that will be useful in overcoming barriers to use of the DermAlert system in affected populations. Phase I activities will include: " Conversion of DermAlert to a Spanish language resource, " Analysis of specific classes of barriers to use of imaging by groups suffering melanoma health disparities, " Development of education and outreach tools to help overcome barriers to use of self imaging screening, " Preliminary evaluation of the effect of DermAlert use on health outcomes, and " Preparation for an expanded, large scale efficacy study during Phase II. As pigmented lesions, for which change was detected by the imaging system, are biopsied, the results of those biopsies will be tabulated and statistically compared with control set of biopsies for which imaging was not a motivating factor. Using this approach it will be possible to investigate not only patient compliance in the use of the imaging system, but also its utility in helping to guide more effective biopsy decisions. This part of the project will address its efficacy and the resultant medical outcomes Measureable milestones during Phase I include the following, which can be used to help assess the viability of progressing to Phase II research: " Qualitative and quantitative identification of specific barriers to imaging that contribute to the health disparity " Preparation of an educational video for helping patients and physicians overcome barriers to use of this technology, and " Foundation and preliminary analysis of an archive of follow-up biopsy data for evaluation of efficacy of using DermAlert. Successful completion of the project will result in enhanced awareness and reduced barriers to use of a completely unique imaging protocols which will more deeply involve patients in their personal health care, contribute to earlier detection of potential melanomas, and have the power to ultimately reduce the number of unnecessary biopsies and reduce patient mortality at the hands of a serious health disparity. PUBLIC HEALTH RELEVANCE: Melanoma is a serious, and growing, public health disparity; to help combat it physicians urge people to look for new and changed pigmented moles on their skin. This is presently a very challenging task for people; however, this project will seek to reduce barriers to use of a reliable, at-home digital photography tool to assist people in finding these changes. Wide use of this technology can reduce the health disparities of melanoma.