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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

基本信息

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
项目类别：
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

项目摘要

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公平乳腺癌结果的持续不平等在很大程度上可以追溯到乳腺癌的不平等。对得不到充分服务的妇女进行筛查和后续护理。虽然美国乳腺癌死亡率有所下降，自1990年以来，在社会和经济上处于不利地位的妇女经历了大约2%的乳腺癌的死亡率在这段时间内不断上升。其中许多死亡是可以预防的。乳房x光造影是以证据为基础的筛查，当充分实施适当的后续护理时，可改善结果为每年数百万接受筛查的女性提供了帮助。包括财政覆盖在内的许多服务都是为了提高服务不足人群的乳房筛查率妇女现在，为了解决健康差距和促进健康公平，我们必须消除长期存在的障碍，对异常筛查检查进行适当的随访-最可能影响降低晚期疾病和死亡率。社会需求负担较重的妇女（例如，对于食物，住房、公用事业、交通），在乳房X光检查异常后进行随访的可能性大约是社会需求最低的女性。迫切需要实施有助于妇女克服了后续行动的障碍，包括获得社区服务资源，这是众所周知的屏障 SINCERE干预，一个有效的筛选和社会需求的转介过程（例如，对于运输，住房、公用事业、食品），在我们之前的研究中发现，在急诊科是可行和可接受的设置.在此之前的工作的基础上，我们现在建议调整和扩展此通过增加社区服务导航进行干预----一项积极的外联干预措施，用社会服务机构筛查病人我们的目标是满足服务不足的妇女的需要，对异常乳腺筛查的随访障碍，减少乳腺癌的差异。我们的首要目标是改善健康公平性，本研究的目标是评估是否增加社区服务导航到社会需求的标准转介过程是一种有效和可扩展的解决异常乳腺癌筛查结果后续工作中差异的战略。在全州范围内社区服务提供者，现有的卫生信息技术和有效的方法，我们将确定社会需求转介与社区服务导航干预相结合的有效性筛查乳房X线摄影设置，以改善乳腺癌筛查结果在服务不足的妇女。我们希望，对服务不足的妇女的外联工作，死亡率乳腺癌，将改善乳腺癌筛查的后续行动和结果，妇女