A Multilevel intervention to address health disparities in lung cancer screening

解决肺癌筛查健康差异的多层次干预

• 批准号: 10115433
• 负责人: Randi M. Williams
• 金额: $ 11.82万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10115433
• 关键词: Accounting; Address; Advisory Committees; Affect; African American; Award; Awareness; Behavior; Cancer Control; Cancer Etiology; Cessation of life; Clinic; Clinical; Collaborations; Colorectal Cancer; Comprehensive Cancer Center; Computerized Medical Record; Control Groups; Data; Development; Diagnosis; Disease; Early Diagnosis; Eligibility Determination; Enrollment; Environment; Ethnic group; Feasibility Studies; Future; Health; Health Personnel; Health Services Accessibility; Healthcare Systems; Individual; Insurance Coverage; Intention; Intervention; Interview; Knowledge; Length; Lung; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Mentors; Minority; Minority Groups; Morbidity - disease rate; Outcome; Participant; Patient Education; Patient Preferences; Patients; Persons; Phase; Physicians; Preventive service; Primary Health Care; Provider; Public Health; Quasi-experiment; Race; Recommendation; Recording of previous events; Reporting; Research; Research Methodology; Resources; Schedule; Scientist; Screening for cancer; Smoker; Smoking History; Specialist; Surveys; System; Telephone; Testing; Thoracic Radiography; Training; United States; United States National Institutes of Health; Visit; acceptability and feasibility; advanced disease; base; cancer health disparity; cancer survival; care preference; care providers; career; design; disparity reduction; ethnic minority population; former smoker; health care disparity; health care settings; health disparity; health literacy; high risk; improved; intervention participants; low dose computed tomography; lung cancer screening; malignant breast neoplasm; mortality; outreach; patient-clinician communication; preference; primary outcome; racial and ethnic; screening; screening disparities; secondary outcome; tool; uptake

Abstract Lung cancer is the leading cause of cancer-related mortality in the US, with more than 135,000 deaths expected in 2020. Based on the National Lung Screening Trial, which showed that low-dose computed tomography (lung screening) vs. chest X-ray reduced mortality due to lung cancer by 20%, the US Preventive Services Task Force recommends annual lung screening for asymptomatic high risk individuals. Despite this recommendation, utilization is poor (3%-14%). Lung screening may be particularly beneficial for African Americans (AA), because they are more likely to have advanced disease, lower survival, and lower screening rates compared to whites. The causes of low uptake of lung screening are multifactorial and consistent with evidence from other cancer screening disparities. For example, provider-initiated discussions about cancer screening tests are low overall, and AA and other racial/ethnic minorities are less likely than whites to have these discussions. Another key driver of screening disparities is patients’ lack of knowledge about early detection. Evidence points to the need for multilevel interventions that simultaneously address multiple barriers to increase screening rates and decrease lung cancer morbidity and mortality in minority populations. The proposed study will target two key levels of influence in the healthcare setting: provider and patient behavior in order to address disparities between AA and whites in lung screening awareness and utilization. Guided by NIH’s Health Disparities Research Framework, in the K99 phase, I will receive didactic and mentored training in research methods to address disparities occurring in the healthcare system. I will conduct feasibility studies and formative research to strengthen the content and delivery of the quasi-experimental study (pretest- posttest, with a nonequivalent control group) to be conducted in the R00 phase. The specific aims are to: Aim 1: Evaluate the feasibility and acceptability of implementing a healthcare provider prompt in a primary care network (K99). Aim 2: Develop and pre-test the patient education component (K99). Aim 3: Test the impact of the multilevel intervention on primary (provider-patient communication, screening intentions, and knowledge) and secondary (screening referrals and completion) outcomes (R00). I will explore whether Health Disparities Framework factors (e.g., race, health literacy) moderate these relationships. The proposed multilevel intervention targets important barriers to lung screening that will provide preliminary data to inform a future R01 application designed to measure the independent and overlapping contributions of the provider and patient interventions. This award, along with the institutional environment, training, research resources, and mentoring team available to me through the Georgetown Lombardi Comprehensive Cancer Center, will provide the necessary training to develop approaches to reduce disparities that arise in the clinical setting and will launch my career as an independent cancer control scientist focused on eliminating cancer disparities.

抽象的 肺癌是美国与癌症相关死亡率的主要原因，死亡超过135,000 预计在2020年。根据国家肺筛查试验，该试验表明低剂量计算 层析成像（肺部筛查）与胸部X射线降低了肺癌的死亡率20％，美国预防性 服务工作队建议对无症状高风险个人进行年度肺部筛查。尽管如此 建议，利用率很差（3％-14％）。肺部筛查可能对非洲特别有益 美国人（AA），因为他们更可能患有晚期疾病，较低的生存和较低的筛查 与白人相比。肺部筛查摄取低的原因是多因素的，并且与 来自其他癌症筛查分布的证据。例如，提供者引发了有关癌症的讨论 筛查测试的总体较低，AA和其他种族/少数民族的可能性少于白人 这些讨论。筛选分布的另一个主要驱动力是患者缺乏有关早期的知识 检测。证据表明需要简单地解决多个障碍的多层次干预措施 提高筛查率并降低少数民族人群的肺癌发病率和死亡率。这 拟议的研究将针对医疗保健环境中的两个关键影响水平：提供者和患者行为 为了解决肺部筛查意识和利用中AA和白人之间的差异。指导 NIH的健康差异研究框架，在K99阶段，我将接受教学和修改培训 在解决医疗保健系统中发生的分布的研究方法中。我将进行可行性研究 和形成性研究以加强准实验研究的内容和传递（预测 - 测试后，有一个非对照组）将在R00阶段进行。具体目的是： 目标1：评估在初级保健中实施医疗保健提供者的可行性和可接受性 网络（K99）。目标2：开发和预测试患者教育部分（K99）。目标3：测试影响 对初级的多层次干预（提供者与患者交流，筛查意图和知识） 以及次级（筛选转介和完成）结果（R00）。我将探讨健康差异是否 框架因素（例如种族，健康素养）使这些关系降低。拟议的多级 干预目标是肺部筛查的重要障碍，该障碍将提供初步数据以告知未来R01 旨在衡量提供商和患者的独立和重叠贡献的应用程序 干预措施。该奖项以及机构环境，培训，研究资源和心理 我通过乔治敦伦巴第综合癌症中心向我提供的团队将提供 必要的培训以开发方法，以减少临床环境中出现的分布并将启动 我作为独立癌症控制科学家的职业专注于消除癌症分布。