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

总结 尽管随着时间的推移，癌症的结果有所改善，但黑人和白色之间仍然存在显着差异 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，而临床 据估计，保健只能解释20%的健康结果。因此，本研究的目的是同时 针对不公平的卫生保健系统，加快建立可扩展的社会决定因素的证据基础， 健康检查和转诊，以减少癌症幸存者健康和福祉方面的不平等。这个项目是 旨在建立可持续的诊所-社区联系，提高幸存者的生活质量和社会 连接.了解这一人群的社会需求负担，可用的社区资源， 巩固综合、闭环转诊系统以满足这些需求，对于提高医疗质量至关重要。 癌症幸存者的生活这项研究的长期目标是开发可扩展的干预措施，以解决 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， 通过绘制华盛顿特区癌症幸存者的可用资源来交换信息， 在华盛顿特区的三个癌症中心建立普遍筛查和转诊流程; 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联系衡量; 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 提案响应RFA-DP-21-003，以评估以下内容的实施、影响和因果机制 我们提出的干预措施，以减少癌症幸存者之间的种族不平等。我们包括创新 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正在努力加强卫生信息交换系统以满足社会需求的支持。 在一个合格的研究团队的领导下，这项研究具有很高的影响力，因为 黑人和白色人乳腺癌和前列腺癌幸存者之间的癌症结局差异 华盛顿特区。我们的方法还与现有的社区资源相结合，包括主要的社区- 总部设在华盛顿地区的组织。本研究的结果将为今后的研究奠定基础。 研究检查干预措施对其他弱势癌症幸存者的普遍性， 拟议的筛查和转诊制度的可持续性。调查结果还将为进一步的研究提供基础。 研究社区卫生工作者，以支持我们的目标人群，改善支持癌症的共享资源 幸存者，并在不断变化的卫生信息交流环境中产生最大影响。

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.