A Paradigm to Examine Cancer Disparities: Limited English Proficient Chinese Patients with Thyroid Nodules

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PROJECT SUMMARY Asian Americans and Pacific Islanders are the only racial/ethnic group in the United States (US) for whom cancer is the leading cause of death for both sexes. Thus, there is an urgent need for research focused on understanding the mechanisms by which cancer disparities occur in this vulnerable patient population. Across the thyroid cancer care continuum, which starts prior to diagnosis and treatment of cancer, Asians experience a disproportionate burden of disease and death. Among Asian women, in particular, thyroid cancer is the second most common cancer and thyroid cancer mortality is the highest of any racial/ethnic group in the US. Differential management of thyroid nodules, a precursor of thyroid cancer, likely contributes to observed downstream disparities in the thyroid cancer continuum. However, Asians continue to be underrepresented in both the cancer disparities and thyroid literature, potentially exacerbated by the high rates of limited English proficiency in this population. Thus, granular data on the quality of medical care received by Asian Americans across the thyroid cancer care continuum is lacking. We propose using the paradigm of limited English proficient (LEP) Chinese patients with thyroid nodules to improve our understanding of linguistic disparities across the thyroid cancer care continuum and to inform the development of interventions that promote equitable care for LEP patients. In Aim 1, we will survey a national sample of physicians to examine variation in medical care delivery to LEP patients with thyroid nodules and thyroid cancer. In Aim 2, we will recruit patients from two sites, the University of Michigan (U-M) and the University of California, San Francisco (UCSF), to conduct virtual focus groups of LEP and English- proficient Chinese patients with thyroid nodules to explore their experiences with thyroid nodule evaluation and treatment. In Aim 3, we will use study findings from Aims 1 and 2 to inform the development and evaluation of a thyroid nodule decision preparation tool prototype for LEP Chinese patients. Data from the subsequent pilot clinical trial to evaluate the feasibility, acceptability, and preliminary effectiveness of this intervention will inform a R01 application to develop and evaluate a more comprehensive, multilevel, personalized thyroid nodule decision preparation tool that is accessible in multiple languages. By tailoring this intervention to the LEP patient population and targeting disparities more upstream of the cancer continuum, we hope to improve downstream cancer outcomes for LEP patients with thyroid cancer. This innovative research proposal fulfills a critically important unmet public health need while serving as a vehicle for Dr. Debbie Chen’s development into an independent health services researcher in the fields of cancer disparities and thyroidology. In addition to didactic learning, she will receive mentoring from her team of committed mentors and advisors who have complementary expertise and are internationally recognized experts in their field. Upon completion of this carefully designed project linking skill acquisition to research aims, Dr. Chen will emerge as an expert in linguistic disparities across the cancer care continuum.