A Pilot CHW Model to Facilitate Shared Decision Making and Lung Cancer Screening for Chinese Taxi Drivers

CHW试点模式促进中国出租车司机的共同决策和肺癌筛查

• 批准号: 9813440
• 负责人: Jennifer CF Leng
• 金额: $ 8.98万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9813440
• 关键词: Address; Adherence; Adopted; Adoption; Adult; Advisory Committees; Age; Air Pollution; Asian Americans; Asians; Automobile Driving; Cancer Etiology; Cancer Patient; Caring; Cessation of life; China; Chinese People; Colorectal Cancer; Communities; Community Health Aides; Counseling; Data; Diffusion of Innovation; Elements; Environment; Exposure to; Face; Health; Health Services Accessibility; Healthcare; Hour; Immigrant; Individual; Insurance; Intervention; Knowledge; Language; Linguistics; Longevity; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Manuals; Mexico; Modeling; Neighborhood Health Center; New York City; Non-Small-Cell Lung Carcinoma; Occupational; Occupations; Outcome; Pacific Island Americans; Population; Prevalence; Preventive service; Process; Publishing; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Resources; Restaurants; Screening for cancer; Smoke; Smoker; Smoking; Stress; Survival Rate; Testing; Training; United States Centers for Medicare and Medicaid Services; Visit; Work; barrier to care; base; cancer diagnosis; cancer health disparity; checkup examination; computed tomography screening; design; evidence base; health care availability; health disparity; high risk; high risk population; improved; innovation; low-dose spiral CT; lung cancer screening; men; mortality; patient oriented; personalized management; primary outcome; recruit; screening; sedentary; shared decision making; smoking prevalence; theories

Project Summary The Chinese population is anticipated to become the largest immigrant group in New York City (NYC) in the next few years. Nationwide, immigrants from China constitute the second largest foreign-born group, after those from Mexico. Chinese immigrants work in a number of occupations that put them at higher risk for lung cancer, including taxi driving. Chinese taxi drivers may be at exceptionally high risk for lung cancer due to the combined impact of high rates of smoking and increased exposure to air pollution. The prevalence of ever smoking among Chinese men in the U.S. is 42.5%. In our preliminary work assessing health needs among foreign-born Chinese livery drivers in NYC, a staggering 73% were current or former smokers. Lung cancer is the second most commonly diagnosed cancer in the U.S., and the leading cause of cancer-related deaths. Results from the National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer with low-dose computed tomography (LDCT) screening. In 2013 the U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) with LDCT in adults age 55-80 years with a 30 pack year history who smoke or quit within the past 15 years. In 2015 the Centers for Medicare and Medicaid Services began providing coverage for a LCS counseling and shared decision making (SDM) visit, and annual LCS with LDCT, if appropriate, for eligible individuals. Previous research describes lower rates of screening for other cancers among foreign-born Asian Americans and Pacific Islanders (AAPIs) compared to U.S. born AAPIs, even after adjusting for insurance-related access to care. A substantial body of research suggests that immigrants face unique barriers to care, including language and cultural factors. Community health worker (CHW) efforts address these barriers, and have led to significant increases in cancer screening rates. In this study, we will conduct a pre-pilot with 10 high risk, previously unscreened Chinese livery drivers eligible for LCS, to refine an adapted, existing Immigrant Health and Cancer Disparities (IHCD) CHW model, Taxi HAILL (Health Access Interventions for Linkages and Longevity), for the multiple levels of influence at which CHWs can articulate, including the individual (drivers), organizations (livery bases), and the environment (health care access/environment). We will then conduct a pilot randomized controlled trial (RCT) to assess the feasibility of the refined CHW model versus written materials to facilitate SDM and LCS (when appropriate) among 50 NYC Chinese livery drivers eligible (by USPSTF criteria) for LCS. The model also incorporates key elements of the Penn Center for Community Health Workers evidence-based CHW model, IMPaCTTM (Individualized Management towards Patient-Centered Targets). Feasibility results will be used to inform the plannning and design of large scale RCTs, targeting Chinese drivers as well as other driver populations in NYC and throughout the U.S., and other high risk Chinese smoking populations in other occupations (e.g. restaurant work, construction).

项目摘要 中国人口预计将成为纽约市最大的移民群体， 未来几年在全国范围内，来自中国的移民构成了第二大外国出生群体，仅次于 那些来自墨西哥。中国移民从事的一些职业使他们面临更高的肺部风险 癌症，包括出租车驾驶。由于中国出租车司机患肺癌的风险可能特别高， 高吸烟率和空气污染暴露增加的综合影响。曾经的流行 在美国，中国男性吸烟率为42.5%。在我们的初步工作中， 在纽约市的外国出生的中国出租车司机中，73%的人现在或曾经吸烟。肺癌是 是美国第二常见的癌症，也是癌症相关死亡的主要原因。 国家肺筛查试验（NLST）的结果显示， 低剂量计算机断层扫描（LDCT）。2013年，美国预防服务工作组 （USPSTF）建议在55-80岁的成年人中进行LDCT年度肺癌筛查（LCS）， 在过去15年内吸烟或戒烟的人。2015年，医疗保险和医疗补助中心 服务开始为LCS咨询和共同决策（SDM）访问提供覆盖， LCS和LDCT（如适用）适用于符合条件的个人。以前的研究描述了较低的筛查率， 与美国出生的亚裔美国人和太平洋岛民（AAPI）相比， AAPI，即使在调整了与保险相关的医疗服务之后。大量研究表明， 移民在获得照料方面面临独特的障碍，包括语言和文化因素。社区卫生工作者 (CHW)这些努力解决了这些障碍，并导致癌症筛查率大幅提高。在这 研究，我们将进行一个预试点与10个高风险，以前未经筛选的中国制服司机有资格 LCS，改进现有的移民健康和癌症差异（IHCD）CHW模型，出租车冰雹 （促进联系和长寿的健康获取干预措施），因为社区卫生工作者在多个层面上具有影响力， 能够清楚地表达，包括个人（驾驶员）、组织（车身基础）和环境（医疗保健 访问/环境）。然后，我们将进行一项试点随机对照试验（RCT），以评估 改进的CHW模型与书面材料，以促进50个纽约市中的SDM和LCS（适当时） 符合LCS条件的中国制服司机（根据USPSTF标准）。该模型还纳入了 宾州社区卫生工作者中心循证CHW模型IMPaCTTM（个体化 以患者为中心的目标）。可行性研究结果将用于规划和 设计大规模随机对照试验，针对中国司机以及纽约市的其他司机人群， 在整个美国，以及其他职业（如餐馆）的中国高危吸烟人群 工作、建设）。