Overcoming Racial Disparities in Curative Therapies for Hepatocellular Carcinoma

克服肝细胞癌治疗中的种族差异

• 批准号: 10710051
• 负责人: Lauren Nephew
• 金额: $ 15.25万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710051
• 关键词: Active Learning; Address; Alcohols; Behavior Therapy; Behavioral trial; Black race; Cancer Center; Cancer Prognosis; Caring; Characteristics; Clinic; Clinical Sciences; Complement; Complex; Consent; Continuity of Patient Care; Data; Disease; Education; Educational Status; Enrollment; Environment; Epidemiology; Equitable healthcare; Evidence based intervention; Excision; Failure; Funding; Gastroenterologist; Goals; Grant; Health; Health Services Accessibility; Health Services Research; Health system; Hospitals; Improve Access; Indiana; Individual; Inequity; Intervention; Knowledge; Liver diseases; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of liver; Mentors; Mentorship; Methods; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Participant; Patients; Poverty; Primary carcinoma of the liver cells; Prospective, cohort study; Provider; Randomized; Randomized, Controlled Trials; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Services; Social Conditions; Social Work; Surveys; System; Testing; Time; Training; Training Programs; Translational Research; Universities; Vulnerable Populations; Waiting Lists; Work; access disparities; behavior test; behavioral health; black patient; cancer care; cancer health disparity; career; chronic liver disease; cohort; curative treatments; design; disparity reduction; experience; health difference; health disparity; high school; human centered design; implementation intervention; implementation science; improved; information gathering; intervention effect; liver transplantation; medically underserved population; mortality; mortality disparity; multidisciplinary; patient screening; pilot test; programs; racial disparity; randomized trial; safety net; skill acquisition; skills; social; social determinants; standard of care; structural health determinants; substance use; therapy design; therapy development; tumor; usability

ABSTRACT Lauren D. Nephew MD, MA, MSCE's long-term career goal is to become an independent, externally funded researcher and leader in developing multilevel interventions to reduce disparities in access to treatments for liver disease and gastrointestinal malignancies. She has identified improving access to curative therapies for hepatocellular carcinoma (HCC) as a critical issue to address to achieve this goal. This proposal describes a 4-year comprehensive program of training and mentored research for an academic career in health services research with a special focus on advancing health care equity. This is in line with NIDDK's commitment to combating health disparities. While Dr. Nephew has a strong background in epidemiology, this K23 will provide key training in using human centered design research methods for intervention development, randomized controlled behavioral trials, and implementation of interventions within health systems. Black patients with chronic liver disease are approximately 50% less likely than White patients to receive curative therapies for hepatocellular carcinoma (HCC) even when presenting with early stage disease. Reasons for disparities in mortality are in part related to failure to progress through the complex HCC care continuum to access curative therapies as a result of the unequal distribution of social and structural determinants of health (SSDOH). The HCC-EduLink intervention we propose to develop is designed to: a) improve patients' HCC-related knowledge; b) screen patients for social needs and substance use and refer to social work for linkage to local services; and c) use our multidisciplinary HCC tumor board to facilitate linkage to subspecialty HCC cancer care. The objectives of this application are to develop the education program component of the HCC-EduLink intervention and pilot test the full multi-level intervention designed to address patient- and system-level SSDOH variables and facilitate access to HCC curative therapies in a cohort of Black patients HCC. Dr. Nephew's multidisciplinary mentorship team including a world-renowned gastroenterologist, an expert in interventions to reduce cancer disparities, and a behavioral health statistician will provide expert guidance to complement her course work and experiential learning. The environment including the Indiana University Simon Cancer Center, Clinical and Translational Science Institute, the Eskenazi Safety-net Hospital and the Indiana University Academic Health Center, make this an ideal environment for her training and to complete the proposed aims. Upon completion of the proposed research and training, Dr. Nephew will submit a competitive R-level grant to test the pilot intervention in a larger randomized trial and will possess the skills and experience needed to make a sustained and impactful contribution to reduce HCC mortality through evidenced-based interventions in other vulnerable populations.

抽象的 MSCE的长期职业目标是劳伦·D·侄子医学博士，马萨诸塞州的长期目标是成为独立的，外部的 资助的研究人员和制定多层次干预措施的领导者，以减少差异的差异 肝病和胃肠道恶性肿瘤的治疗方法。她已经确定了改善治疗的机会 肝细胞癌（HCC）的疗法是实现这一目标的关键问题。这个建议 描述了一项为期4年的培训综合计划，并为学术职业提供了指导研究 卫生服务研究特别关注促进医疗保健公平。这与Niddk的 致力于打击健康差异。尽管侄子博士在流行病学方面具有很强的背景 K23将提供关键的培训，以使用以人为中心的设计研究方法进行干预开发， 随机对照行为试验以及卫生系统内干预措施的实施。 黑人慢性肝病患者的可能性比白人患者低约50％ 即使出现早期疾病，也可以接受肝细胞癌（HCC）的治疗疗法。 死亡率差异的原因部分与未能通过复杂的HCC护理进步有关 由于社会和结构的不平等分配而导致获得治疗疗法的连续性 健康决定因素（SSDOH）。我们建议开发的HCC-Edulink干预措施旨在：a） 改善患者与HCC相关的知识； b）筛选患者的社会需求和物质使用，并参考 与当地服务联系的社会工作； c）使用我们的多学科HCC肿瘤板来促进联系 致敬HCC癌症护理。该应用程序的目标是制定教育计划 HCC-Edulink干预和试点测试的组成部分旨在解决 患者和系统级的SSDOH变量，促进黑色队列中的HCC治疗疗法 患者HCC。 Nephew博士的多学科指导团队，包括世界知名的肠胃科医生， 降低癌症差异的干预措施的专家，行为健康统计学家将为专家提供 补充她的课程工作和体验学习的指导。包括印第安纳州在内的环境 埃斯基纳济安全网医院临床和转化科学研究所大学西蒙癌症中心 印第安纳大学学术健康中心，使其成为她培训和进行的理想环境 完成建议的目标。拟议的研究和培训完成后，Nephew博士将提交 在更大的随机试验中测试飞行员干预的竞争​​性R级赠款，并将拥有技能 以及为减少HCC死亡率而持续且有影响力的贡献所需的经验 基于其他脆弱人群的基于基于的干预措施。

项目成果

Correction to: Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care.

• DOI: 10.1007/s13187-023-02279-8
• 发表时间: 2023-04
• 期刊: JOURNAL OF CANCER EDUCATION
• 影响因子: 1.6
• 作者: Kasting, Monica L.;Laily, Alfu;Nephew, Lauren D.;Shields, Cleveland G.;Shedd-Steele, Rivienne;Rawl, Susan M.
• 通讯作者: Rawl, Susan M.

Let's take 2 steps forward.

让我们向前迈出两步。

• DOI: 10.1097/lvt.0000000000000217
• 发表时间: 2023
• 期刊: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
• 作者: Nephew,LaurenD

Hepatic Ischemia/Reperfusion Injury After Liver Transplantation Is Not Associated with Early Impairment of Left Ventricular Ejection Fraction.

• DOI: 10.12659/aot.938105
• 发表时间: 2022-12-13
• 期刊: ANNALS OF TRANSPLANTATION
• 影响因子: 1.1
• 作者: Rokop, Zachary P.;Frick, Kyle;Zenisek, Joseph;Kroepfl, Elizabeth;Mihaylov, Plamen;Patidar, Kavish R.;Nephew, Lauren;Mangus, Richard S.;Kubal, Chandrashekhar
• 通讯作者: Kubal, Chandrashekhar