Prevention Research Center: Category 1--Center Composite

7.项目摘要 肺癌是美国癌症死亡的主要原因。国家肺部筛查试验 最近，研究人员报告说，低剂量CT筛查降低了高危人群的癌症死亡率。 指南支持对符合NATIONAL资格标准的患者进行筛查，但注意到确保 接受筛查的患者可以进入高容量、高质量的筛查和治疗中心。 此外，筛选的绝对效益很小，必须与潜在的下游效益进行权衡。 危害，包括诊断测试的并发症。因此，指南还鼓励临床医生 让患者参与共同决策（SDM），帮助他们澄清自己的价值观， 在这方面，我们呼吁各国政府采取措施，以提高筛查的结果，并将筛查作为解决戒烟问题的一个可教的时刻。的一种方法 实现这一目标的方法是使用决策支持工具（决策辅助工具）， 讲英语，并在文化上适当。少数民族人口在NLST中没有很好的代表性， 比非西班牙裔白人更不可能接受各种癌症筛查测试， 存在局部阶段癌症，并且不太可能接受积极的治疗性治疗。这些差距 被归因于社会经济因素，语言障碍，有限的健康素养，以及特定的 关于筛查和治疗的知识、态度和信念。了解这些因素如何 影响肺癌筛查计划和戒烟努力对发展中国家患者 决策辅助工具和提供者决策支持工具，并用于指导患者-提供者讨论， 共同决策。本项目的目的是进行形成性研究， 和提供者的障碍和促进者参与肺癌筛查的共同决策 以及在服务不足的少数群体中戒烟。我们将利用参与式研究 方法进行定性研究，包括访谈和焦点小组，以确定病人和 与低剂量计算机断层扫描（LDCT）筛查决策相关的提供者因素， 戒烟。这些结果将为肺癌筛查和戒烟的发展提供信息 决策支持工具。我们将在一个以实践为基础的研究网络和一个 学术肺结节诊所，为服务不足的人群提供护理，他们可以获得高质量的 学术癌症诊断和治疗中心。受试者将包括被发现患有以下疾病的当前或既往吸烟者： CT成像显示有肺结节，有风险的当前或以前的吸烟者，以及初级保健提供者。的结果 这项研究可能最终导致减少服务不足人群的肺癌负担。

7. Project Summary Lung cancer is the leading cause of cancer death in the United States. The National Lung Screening Trial (NSLT) recently reported that low-dose CT screening reduced cancer mortality among at-risk populations. Guidelines support screening for patients meeting NSLT eligibility criteria, but note the importance of ensuring that screened patients have access to high-volume, high-quality screening and treatment centers. Furthermore, the absolute benefit of screening is small, and must be weighed against potential downstream harms, including complications from diagnostic testing. Consequently, guidelines also encourage clinicians to engage patients in shared decision-making (SDM), helping them to clarify their values for the potential outcomes of screening and to use screening as a teachable moment for addressing cessation. One way to accomplish this is by using decision support tools (decision aids) that can accommodate low-literacy, non- English speakers, and be culturally appropriate. Minority populations, who were not well represented in NLST, are less likely than non-Hispanic whites to be current with a variety of cancer screening tests, less likely to present with local stage cancer, and less likely to undergo aggressive curative treatment. These disparities have been attributed to socioeconomic factors, language barriers, limited health literacy, and to specific knowledge, attitudes, and beliefs about screening and treatment. Understanding how these factors could impact lung cancer screening programs and smoking cessation efforts is important for developing patient decision aids and provider decision support tools and for guiding patient-provider discussions to enhance shared decision making. The objective of this project is to conduct formative research identifying patient and provider barriers and facilitators to engaging in shared decision making for lung cancer screening and smoking cessation among underserved minority populations. We will utilize participatory research methods to conduct the qualitative research, including interviews and focus groups, to identify patient and provider factors relevant to decision making around low-dose computer tomography (LDCT) screening and smoking cessation. These results will inform development of lung cancer screening and smoking cessation decision-support tools. We will conduct the research within a practice-based research network and an academic lung nodule clinic that provides care to underserved populations who can access a high-quality academic cancer diagnostic and treatment center. Subjects will include current or former smokers found to have lung nodules on CT imaging, at-risk current or former smokers, and primary care providers. Findings from this research could ultimately lead to reducing the burden of lung cancer in underserved populations.