Scaling Social Determinants of Health Screening, Social Support and Anti-Racism Training to Reduce Inequities in Minority Cancer Survivor Health and Wellbeing in Washington, DC

摘要 尽管随着时间的推移，癌症结果有所改善，但黑人和白人之间仍然存在着显著的差异 癌症幸存者。健康的社会决定因素(SDOH)解释了高达80%的健康结果 据估计，医疗保健只解释了20%的健康结果。因此，这项研究的目标是同时 针对不公平的医疗保健系统，加快可扩展的社会决定因素的证据基础 健康筛查和转介，以减少癌症幸存者健康和福祉方面的不平等。这个项目是 旨在建立可持续的临床-社区联系，并改善幸存者的生活质量和社会 联系。了解这一人群的社会需求负担，可用的社区资源， 巩固集成的闭环转诊系统以满足这些需求对于提高 癌症幸存者的生命。这项研究的长期目标是开发可扩展的干预措施，以应对 对癌症幸存者的社会需求和支持。该提案旨在：1)改善护理协调和 通过绘制华盛顿特区和华盛顿特区癌症幸存者可用资源的地图进行信息交流 在DC的三个癌症中心建立统一的筛查和转诊流程；2)确定 社区卫生工作者(CHW)支持乳腺癌和前列腺癌幸存者的健康和福祉 通过生活质量和社会关系衡量；3)确定反种族主义的影响(包括SDOH) 对三个癌症中心的工作人员和临床医生进行关于患者报告的感知歧视的培训。这 建议对RFA-DP-21-003做出回应，以评估以下各项的实施、影响和因果机制 我们建议的干预措施，以减少癌症幸存者中的种族不平等。我们包括创新的 利用系统工程和社会网络分析将诊所和社区联系起来的方法 并得到DC持续努力的支持，以加强卫生信息交流系统，以满足社会需求。 在一个唯一合格的研究团队的领导下，这项研究有可能产生很大的影响，因为 黑人和白人乳腺癌和前列腺癌幸存者在癌症预后方面的显著差异 华盛顿特区。我们的方法还与现有的社区资源相结合，包括关键的社区- 总部设在华盛顿特区地区的组织。本研究的结果将为今后的研究提供基础 研究检查干预措施对其他弱势癌症幸存者的普适性 拟议的筛查和转介系统的可持续性。调查结果还将为进一步 研究社区卫生服务以支援我们的目标人群，以改善支援癌症的资源共享 在不断变化的卫生信息交流环境中，最大限度地发挥影响。

SUMMARY Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Social determinants of health (SDOH) explain up to 80% of health outcomes while clinical care is estimated to explain only 20% of health outcomes. The goal of this research is thus to simultaneously target unequitable health care systems and accelerate the evidence base for scalable social determinants of health screening and referral to reduce inequities in cancer survivor health and well-being. This project is intended to establish sustainable clinical-community linkages and improve survivor quality of life and social connection. Understanding the burden of social needs in this population, the available community resources, and solidifying integrated, closed-loop referral systems to address those needs is critical to improving quality of life for cancer survivors. The long-term goal of this research is to develop scalable interventions to address social needs and support for cancer survivors. The proposal aims to: 1) improve care coordination and information exchange through mapping available resources for cancer survivors across Washington DC and building a universal screening and referral process at three cancer centers in DC; 2) determine impact of Community Health Worker (CHW) support on breast and prostate cancer survivor health and wellbeing as measured through quality of life and social connection; 3) determine impact of anti-racism (inclusive of SDOH) training for staff and clinicians at three cancer centers on patient reported perceived discrimination. This proposal is responsive to RFA-DP-21-003 to evaluate the implementation, impact, and causal mechanisms of our proposed intervention to reduce racial inequities among cancer survivors. We include innovative approaches to linking clinics and communities drawing on systems engineering and social network analyses and supported by ongoing DC efforts to bolster health information exchange systems to address social needs. Led by a uniquely-qualified research team, this research has the potential for high impact because of the significant disparities in cancer outcomes comparing Black and White breast and prostate cancer survivors in Washington DC. Our approach is also integrated with existing community resources including key community- based organizations in the Washington DC region. Results from this study will provide the foundation for future research examining the intervention’s generalizability to other disadvantaged cancer survivors and sustainability of the proposed screening and referral system. Findings will also provide a basis for further research on CHWs to support our target population, to improve shared resources in supporting cancer survivors, and to maximize impact within the evolving health information exchange environment.