Reducing health disparities in foregut cancers by using modifiable barriers to predict risk for inequitable care: a novel implementation science-based approach

项目总结

PROJECT SUMMARY Foregut (esophageal, gastric, liver, biliary and pancreatic) cancers account for approximately 20% of new cancer deaths in the United States each year, with an incidence that is projected to increase by almost 70% over the next ten years. These are aggressive malignancies, with complex therapies that require coordinated, specialized multidisciplinary care. There are significant racial and location-based disparities in the utilization of evidence-based guideline concordant therapy (GCT) in foregut cancers. Race and location serve as proxies for multiple, potentially modifiable, barriers along the cancer care continuum, that threaten access to and receipt of care. Identifying these barriers is critical to reduce disparities. Accurate identification of patients at risk for non-GCT is a vital first step to intervene. However, there is no screening tool to identify patients at risk for non-GCT. This project aims to address racial and location-based disparities in foregut cancers by using mixed methods research to develop a risk prediction model and clinic-based screening tool that utilizes modifiable barriers to identify patients at risk for non-receipt of GCT. Together, this clinically applicable and statistically valid model and the high-yield screening instrument will inform an emerging model that identifies patients at risk for non- receipt of care, and facilitates the administration of personalized, solution-focused interventions that can redirect the course of care. My long-term objective is to become an independent researcher focused on identifying, understanding and addressing disparities in access to cancer care. This career development award will help achieve my objective by filling gaps in knowledge and skills through a personalized training program that will include didactics, mini-sabbaticals, experiential training and mentorship in three areas: (1) mixed methods with a focus on patient-oriented research (2) statistical modeling and measure development and (3) implementation science. This training plan will support my proposed project and enable my transition to an independent surgeon-scientist. The specific aims are (1) to identify barriers in access to GCT in patients with foregut cancers through a patient-centric and stakeholder-informed approach (2) to examine the extent to which modifiable barriers predict risk for non-GCT using quantitative modeling and (3) to develop and pilot test a clinic-based screening tool to prospectively identify patients at risk for non-GCT. This proposal is novel in its exploration of underlying modifiable barriers to inform the development of a model that predicts receipt of inferior care, and a clinic-based screening tool to identifiy individuals at risk for disparities in access to oncologic care. While there are currently a range of successful interventions such as patient navigation that have shown promise in decreasing treatment disparities, there is no streamlined way for clinicians to identify patients at risk for non- GCT. This proposal will allow for the identification of patients at risk for health disparities (non-GCT) in a consistent way across providers and embedded in health systems.The results of this study will be used to apply for an R01 to prospectively evaluate the utility of the developed screening tool in a multi-institution study to predict disparities in care and test its invariance by race/ethnicity, location (rural versus urban), socioeconomic status and type of institution.