SURGICAL DISPARITIES IN LUNG, PROSTATE, BREAST AND COLORECTAL CANCER IN AI/ANS

其他种族/族裔群体的死亡率也在持续下降，这些死亡率包括肺部、前列腺、 乳腺癌和结肠直肠癌，但美国印第安人/阿拉斯加原住民（AI/AN）人群没有。手术 介入是肺癌、乳腺癌和结直肠癌的唯一治愈性治疗，通常用于 前列腺癌在癌症进展中越早进行治疗， 生存一些研究人员将AI/AN中的高癌症死亡率归因于诊断， 疾病的晚期阶段，地理障碍和其他信仰体系，阻碍了接受 有效的标准癌症尽管在癌症存活率方面存在着惊人的不平等，但产生这些不平等的因素 对差异的了解仍然很少，描述也不完整。在我们的第一组研究中，我们检查 通过使用2个数据集影响国家外科护理差异的各种因素：国家癌症 研究所的监测流行病学和最终结果（SEER），以及SEER与医疗保险A部分的联系 和部分B文件。在第二组研究中，我们描述了使用最佳 与外科癌症护理相关的实践，使用详细的，前瞻性收集的临床数据集， 外科护理和结果评估计划（SCOAP）。这一努力在全州范围内是一种创新 外科医生的监测和基准系统，将性能数据与旨在 提高质量。在第三个民族志研究中，我们采访了癌症患者和外科医生， 对癌症护理的看法。因此，我们的具体目标是：1）描述全国范围内的过程变化， 使用SEER评估AI/AN和非西班牙裔白色癌症患者之间的外科癌症护理结果 和SEER-Medicare数据集; 2）比较“最佳实践”的接收情况和 通过华盛顿州的SCOAP网络在这两组患者之间提供外科护理。第三章 描述AI/AN患者对手术癌症护理的看法、态度和信念，并评估 外科医生的文化能力和对AI/AN患者提供癌症护理的障碍的看法。 这项工作将突出AI/AN癌症患者护理中出现故障的点，并沿着 与人种学数据，建议如何文化定制的干预可以减少不平等。

Other racial/ethnic groups have seen consistent declines in the rates of deaths from these lung, prostate, breast, and colorectal cancers, but American Indian/Alaska Native (AI/AN) populations have not. Surgical intervention is the only curative treatment for lung, breast, and colorectal cancers, and commonly used for prostate cancer. The earlier that treatment occurs in the progression of cancer, the greater the chance for survival. Some investigators have attributed the high rates of cancer mortality among AI/ANs to diagnosis at late stages of disease, geographic barriers, and alternative belief systems that impede the receipt of effective, standard cancer. Despite striking inequities in cancer survival, the factors producing these disparities remain poorly understood and incompletely described. In our first set of studies, we examine diverse factors influencing national disparities in surgical care by using 2 datasets: the National Cancer Institute's Surveillance Epidemiology and End Results (SEER), and a linkage of SEER to Medicare's Part A and Part B files. In the second set of studies, we describe community-level variation in the use of best practices related to surgical cancer care, using a detailed, prospectively gathered clinical dataset derived from the Surgical Care and Outcomes Assessment Program (SCOAP). This effort is a novel statewide surveillance and benchmarking system for surgeons, linking performance data to active interventions aimed at improving quality. In the third ethnographic study, we interview cancer patients, and surgeons about their perceptions of cancer care. Thus, our specific aims are to 1) Describe nationwide variation in processes and outcomes of surgical cancer care between AI/AN and non-hispanic White cancer patients by using SEER and SEER-Medicare datasets; 2) Compare receipt of "best practices" and stage-specific outcomes in the delivery of surgical care between these 2 groups of patients across Washington State's SCOAP network. 3) Describe the perceptions, attitudes, and beliefs of AI/AN patients related to surgical cancer care, and assess surgeons' cultural competence and perceptions about barriers to providing cancer care to AI/AN patients. This effort will highlight the points where breakdowns in the care of AI/AN cancer patients occur, and along with the ethnographic data, suggest how culturally tailored intervention can reduce inequities..