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

其他种族/民族的肺脏、前列腺癌、 乳腺癌和结直肠癌，但美洲印第安人/阿拉斯加原住民(AI/AN)人口没有。外科手术 介入治疗是肺癌、乳腺癌和结直肠癌的唯一根治方法，通常用于 前列腺癌。癌症进展过程中越早进行治疗，患癌症的几率就越大 生死存亡。一些研究人员将AI/AN中的高癌症死亡率归因于在 疾病晚期、地理障碍和另类信仰体系阻碍接受 有效的标准癌症。尽管癌症存活率存在显著的不平等，但造成这些不平等的因素 人们对差异的理解仍然很少，对差异的描述也不完整。在我们的第一组研究中，我们检查了 使用两个数据集研究影响全国外科护理差异的不同因素：全国癌症 研究所的监测流行病学和最终结果(SEER)，以及SEER与联邦医疗保险A部分的联系 和B部分文件。在第二组研究中，我们描述了BEST使用在社区层面的变化 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得出 来自外科护理和结果评估计划(SCOAP)。这一努力是全州范围内的一项新颖的 外科医生的监测和基准系统，将绩效数据与旨在进行的积极干预联系起来 在提高质量方面。在第三项人种学研究中，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)描述全国范围内的流程和 应用SEER对AI/AN和非西班牙裔白人癌症患者进行外科治疗的结果 和SEER-Medicare数据集；2)比较收到的“最佳做法”和阶段特定结果 通过华盛顿州的SCOAP网络在这两组患者之间提供手术护理。3) 描述AI/AN患者对外科癌症护理的看法、态度和信念，并评估 外科医生的文化能力和对向AI/AN患者提供癌症护理的障碍的看法。 这一努力将突出在AI/AN癌症患者的护理中发生故障的点，以及 通过人种学数据，建议根据文化定制的干预措施如何减少不平等。

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..