Community Services Navigation to Advance Health Equity in Breast Cancer Screening

社区服务导航促进乳腺癌筛查健康公平

• 批准号: 10719957
• 负责人: Tracy Onega
• 金额: $ 63.81万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-25 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10719957
• 关键词: Accident and Emergency department; Address; Breast Cancer Detection; Cancer Control; Caring; Cervical Cancer Screening; Clinical Trials; Community Services; Disease; Disparity; Equity; Food; Goals; Grant; Health Promotion; Housing; Inequity; Intervention; Longevity; Mammographic screening; Mammography; Methods; Outcome; Participant; Patient Self-Report; Patients; Population Heterogeneity; Preventive care; Preventive service; Process; Randomized, Controlled Trials; Recommendation; Reduce health disparities; Resources; Role; Screening Result; Services; Social Work; Testing; Time; Transportation; United States Preventative Services Task Force; Visit; Woman; Work; World Health Organization; acceptability and feasibility; breast imaging; cancer health disparity; cancer prevention; care episode; disadvantaged women; economic disparity; effectiveness evaluation; evidence base; experience; falls; follow-up; health disparity; health equity; health equity promotion; health inequalities; health information technology; implementation intervention; improved; improved outcome; interest; malignant breast neoplasm; mortality; outreach; patient screening; point of care; preventable death; programs; referral services; remediation; routine screening; screening; screening program; service providers; social; social disparities; social health determinants; treatment as usual; uptake

Project Abstract Community Services Navigation to Advance Health Equity in Breast Cancer Screening Persistent inequities in breast cancer outcomes can be traced in large part to inequities in breast cancer screening follow-up care among underserved women. While U.S. breast cancer mortality rates have decreased approximately 2% per year since 1990, socially and economically disadvantaged women have experienced increasing breast cancer mortality over that time. Many of these deaths are preventable. Mammography is evidence-based screening that, when fully implemented with appropriate follow-up care, improves outcomes for millions of women who are screened each year. Many services, including financial coverage, exist to improve breast screening rates among underserved women. Now, to address health disparities and promote health equity we must remove persistent barriers to appropriate follow-up of abnormal screening exams – the point of care with the most potential impact to decrease late-stage disease and mortality. Women with a higher burden of social needs (e.g., for food, housing, utilities, transportation), are about half as likely to follow-up after an abnormal mammogram than women who experience minimal social needs. There is a critical need to implement programs that will help women overcome barriers to follow-up, including access to community service resources, which is a known barrier. The SINCERE intervention, a validated screener and referral process for social needs (e.g., for transportation, housing, utilities, food), was found in our prior studies to be feasible and acceptable in Emergency Department settings. Building on this prior work, we now propose to adapt and extend the implementation of this intervention by adding community services navigation – an active outreach intervention to connect breast screening patients with social services. We aim to address the needs of underserved women that act as barriers to follow-up of abnormal breast screening and reduce breast cancer disparities. Our overarching objective is to improve health equity, and the goal of this study is to evaluate if adding community services navigation to the standard referral process for social needs is an effective and scalable strategy for addressing disparities in follow-up to abnormal breast cancer screening results. With statewide community service providers, existing health information technology, and validated methods, we will determine the effectiveness of social needs referrals combined with a community services navigation intervention in the screening mammography setting to improving breast screening outcomes in underserved women. We expect that outreach to underserved women, who represent a large proportion of late-stage and higher mortality breast cancers, will improve breast cancer screening follow-up and outcomes for underserved women.

项目摘要 社区服务导航以促进乳腺癌筛查中的健康平等 乳腺癌预后的持续不平等可以很大程度上追溯到乳腺癌的不平等现象 在服务不足的妇女中筛查后续护理。而美国的乳腺癌死亡率提高了 自1990年以来，每年约2％ 在这段时间内增加乳腺癌死亡率。这些死亡中的许多是可以预防的。乳房X线摄影是 基于证据的筛查，当通过适当的后续护理实施充分实施时，会改善结果 对于每年被筛选的数百万妇女。 许多服务，包括财务覆盖范围，以提高服务欠佳的乳房筛查率 女性。现在，要解决健康差异并促进健康平等，我们必须消除持续的障碍 对异常筛查考试的适当随访 - 具有最大潜在影响的护理点 晚期疾病和死亡率降低。社会需求负担更高的妇女（例如，食物， 住房，公用事业，运输），在乳房X线照片异常后进行跟进的可能性大约是 经历最小社会需求的妇女。实施计划的迫切需要 妇女克服后续行动的障碍，包括获得社区服务资源，这是一个已知的 障碍。 真诚的干预措施，经过验证的筛选员和社会需求的推荐过程（例如，运输， 在我们先前的研究中发现住房，公用事业，食物）在急诊室是可行的和可接受的 设置。在这项先前的工作的基础上，我们现在建议适应并扩展实施此功能 通过添加社区服务导航进行干预 - 积极的外展干预以连接乳房 通过社会服务筛查患者。我们旨在满足服务不足的妇女的需求 随访异常乳房筛查并减少乳腺癌差异的障碍。 我们的总体目标是提高健康公平，本研究的目的是评估是否添加 社区服务导航到社会需求的标准推荐过程是有效且可扩展的 解决异常乳腺癌筛查结果的随访差异的策略。与全州 社区服务提供商，现有的健康信息技术和经过验证的方法，我们将确定 社会需求推荐的有效性与社区服务导航干预相结合 筛查乳房X线摄影设置，以改善服务不足的女性的乳房筛查。 我们期望对服务不足的妇女进行宣传，这些妇女代表了很大比例的晚期和更高的妇女 死亡率乳腺癌将改善乳腺癌筛查的随访和服务不足的结果 女性。