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

项目总结 亚裔美国人和太平洋岛民是美国唯一罹患癌症的种族/民族 是导致两性死亡的首要原因。因此，迫切需要以理解为重点的研究 在这一脆弱的患者群体中发生癌症差异的机制。横跨甲状腺癌 在癌症诊断和治疗之前开始的护理连续体，亚洲人经历了不成比例的 疾病和死亡的负担。尤其是在亚洲女性中，甲状腺癌是第二常见的癌症。 癌症和甲状腺癌的死亡率是美国所有种族/民族中最高的。差异化管理 甲状腺结节是甲状腺癌的先兆，这可能是观察到的下游差异的原因 甲状腺癌连续体。然而，亚洲人在癌症差异和癌症方面的代表性仍然不足。 甲状腺文献，潜在地加剧了这一人群中有限英语熟练程度的高比率。因此， 关于亚裔美国人在甲状腺癌治疗中接受的医疗服务质量的细粒度数据 缺乏连续体。我们建议使用有限英语熟练程度(LEP)中国患者的范式 甲状腺结节，以提高我们对整个甲状腺癌治疗过程中语言差异的理解 并为促进对LEP患者公平护理的干预措施的发展提供信息。在目标1中，我们将 对全国医生进行抽样调查，以检验LEP甲状腺患者医疗服务的差异 结节和甲状腺癌。在目标2中，我们将从两个地点招募患者，密歇根大学(U-M) 和加州大学旧金山分校(UCSF)，开展LEP和英语的虚拟焦点小组- 精通中国甲状腺结节患者探讨甲状腺结节评估和治疗经验 治疗。在目标3中，我们将利用目标1和目标2的研究结果，为制定和评估 适用于中国LEP患者的甲状腺结节决策准备工具原型。来自后续试验的数据 评估这种干预措施的可行性、可接受性和初步有效性的临床试验将告知 用于开发和评估更全面、多层次、个性化的甲状腺结节的R01应用程序 可使用多种语言访问的决策准备工具。通过为LEP患者量身定做这种干预 人口和目标差异更上游的癌症连续体，我们希望改善下游 患有甲状腺癌的LEP患者的癌症转归。这一创新的研究提案实现了一项批判性的 重要的未得到满足的公共卫生需求，同时成为黛比·陈博士发展成为 癌症差异和甲状腺学领域的独立卫生服务研究员。除了说教之外 学习，她将得到来自她的团队的忠诚的导师和顾问的指导，他们有互补的 拥有专业知识，是各自领域内国际公认的专家。在完成这个精心设计的 将技能获得与研究目标联系起来的项目，陈博士将成为跨语言差异方面的专家 癌症护理连续体。

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.