Multilevel determinants of racial disparities in receipt of guideline-concordant endometrial cancer treatment

接受符合指南的子宫内膜癌治疗中种族差异的多层次决定因素

• 批准号: 10647785
• 负责人: Ashley S. Felix
• 金额: $ 47.61万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647785
• 关键词: Academy; Adjuvant Therapy; Black race; Cancer Patient; Cancer Survivor; Caring; Data; Data Set; Decision Making; Disease Outcome; Disparate; Disparity; Endometrial Carcinoma; Evidence based intervention; Exhibits; Foundations; Future; Guidelines; Health; Health Disparities Research; Healthcare Systems; Individual; Inequity; Intervention; Interview; Knowledge; Link; Literature; Logistic Regressions; Medicare claim; Medicine; Methods; National Comprehensive Cancer Network; National Institute on Minority Health and Health Disparities; Neighborhoods; Operative Surgical Procedures; Outcome; Pathology; Patients; Prediction of Response to Therapy; Predictive Factor; Provider; Qualitative Methods; Quality of life; Race; Recommendation; Research; Respondent; SEER Program; Shapes; Solid Neoplasm; Source; Staging; Variant; Woman; Work; black women; black/white disparity; cancer therapy; comorbidity; disparity reduction; effective intervention; experience; hazard; health definition; health difference; health disparity; improved; mortality; multilevel analysis; preference; prevent; racial determinant; racial disparity; surveillance data; therapy development; treatment choice; treatment disparity; treatment strategy; welfare

PROJECT SUMMARY/ABSTRACT Of all solid tumors, endometrial cancer (EC) exhibits one of the worst racial disparities - the Black-White mor- tality gap has increased from 79.5% in 1992-2001 to 97.8% in 2014-2018. Receipt of treatment in line with na- tional recommendations is an important modifiable factor that influences EC outcomes and contributes to racial disparities in survival. The National Comprehensive Cancer Network recommends surgical staging as the first step of guideline-concordant treatment and pathology factors captured from surgery inform adjuvant treatment recommendations. Our prior work demonstrates that receipt of guideline-concordant EC treatment improves survival among EC patients who are Black or White. Therefore, the lower guideline-concordant EC treatment among Black women that we have observed is concerning and contributes to the marked disparities in disease outcomes. We lack a comprehensive understanding of the determinants that underlie disparate guideline-con- cordant EC treatment, preventing any meaningful progress in evidence-based intervention development. The extant literature has exclusively focused on individual-level factors as predictors of guideline-concordant EC treatment. This work has not led to effective intervention and ignores the multilevel influences that are known to undergird race-based differences in health. In addition, within guideline-concordant paradigms, there can be wide variation in intensity level of recommended treatments, with markedly different impact on quality of life. The impact of race on intensity of treatment within guideline-concordant paradigms is currently unknown. Most important, there are no qualitative data to understand how Black women or their providers make decisions re- garding EC treatment. Absent these critical building blocks, we cannot move forward with evidence-based in- terventions to improve guideline-concordant EC treatment receipt. We propose to identify determinants of guideline-concordant EC treatment disparities by combining analysis of multilevel data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims linked dataset (Aims 1-2) with in-depth interviews of Black women with EC and EC providers (Aim 3). Aim 1: Identify multilevel factors that predict Black-White dis- parities in guideline-concordant EC treatment. Aim 2: Quantify racial disparities and underlying predictors of guideline-concordant EC treatment intensity and examine associations between guideline-concordant EC treat- ment intensity and survival. Aim 3: Examine the multilevel dynamics that drive and constrain treatment choices by and for Black women with EC using qualitative methods. By analyzing a high-quality, multilevel dataset with Black and White EC patients, and capturing first-hand accounts of treatment experiences and preferences of Black women and their providers, our team will assess the importance of race-specific barriers to guideline- concordant EC treatment. Our study will identify the set of multilevel modifiable factors that can be targeted to reduce disparities and improve care for all women.

项目总结/摘要 在所有实体瘤中，子宫内膜癌（EC）表现出最严重的种族差异之一-黑白莫尔， 总体差距从1992-2001年的79.5%增加到2014-2018年的97.8%。接受治疗符合NA- 种族推荐是一个重要的可修改的因素，影响EC结果，并有助于种族 生存的差距。国家综合癌症网络建议手术分期作为第一步。 指南一致治疗步骤和从手术中获取的病理因素告知辅助治疗 建议.我们之前的工作表明，接受指南一致的EC治疗可以改善 黑人或白色人的EC患者的生存率。因此，较低的指南一致EC治疗 在黑人妇女中，我们观察到的是关于并有助于疾病的显着差异， 结果。我们缺乏对不同指导方针背后的决定因素的全面理解， 和谐的EC治疗，阻止任何有意义的进展，以证据为基础的干预发展。的 现有文献仅关注个体水平因素作为指南一致性EC的预测因子 治疗这项工作并没有导致有效的干预，并忽视了多层次的影响，是众所周知的 to undergrid加强the racial种族based基于differences差异in health健康.此外，在与指南一致的范例中， 推荐治疗的强度水平差异很大，对生活质量的影响明显不同。 目前尚不清楚种族对指南一致范式内治疗强度的影响。最 重要的是，没有定性数据来了解黑人妇女或她们的供应商如何做出决定， 进行EC处理。如果没有这些关键的基石，我们就无法推进基于证据的-- 干预，以改善指南一致的EC治疗接收。我们建议确定 指南一致的EC治疗差异，结合监测的多层次数据分析， 流行病学和最终结果（SEER）-与医疗保险索赔相关的数据集（目标1-2），包括对 黑人妇女与欧共体和欧共体提供者（目标3）。目标1：识别预测黑白色差异的多层次因素 在指南一致的EC治疗中的奇偶性。目标2：量化种族差异和潜在的预测因素 指南一致的EC治疗强度，并检查指南一致的EC治疗之间的关联， 影响强度和生存。目的3：检查驱动和约束治疗选择的多层次动态 使用定性方法对患有EC的黑人妇女进行评估。通过分析高质量的多层次数据集， 黑人和白色EC患者，并捕捉治疗经验和偏好的第一手资料， 黑人妇女和他们的供应商，我们的团队将评估种族特定的障碍，以指导的重要性- 一致EC处理。我们的研究将确定一组多层次的可修改的因素，可以针对 减少差距，改善对所有妇女的护理。