A Multilevel intervention to address health disparities in lung cancer screening

摘要 肺癌是美国癌症相关死亡率的主要原因，死亡人数超过135，000人 预计在2020年。基于国家肺部筛查试验，该试验表明低剂量计算 与胸部X光相比，断层扫描（肺部筛查）可将肺癌死亡率降低20%，美国预防医学研究所 服务工作组建议每年对无症状的高危人群进行肺部筛查。尽管如此 建议，利用率很差（3%-14%）。肺筛查可能对非洲人特别有益 美国人（AA），因为他们更有可能患有晚期疾病，生存率较低，筛查率较低 与白人相比。肺筛查摄取率低的原因是多因素的， 其他癌症筛查差异的证据。例如，提供者发起的关于癌症的讨论 筛查测试总体上较低，AA和其他种族/少数民族比白人更不可能有 这些讨论。筛查差异的另一个关键驱动因素是患者缺乏早期诊断的知识。 侦测有证据表明，需要采取多层次的干预措施，同时解决多种障碍 提高筛查率，降低少数群体肺癌发病率和死亡率。的 拟议的研究将针对医疗保健环境中的两个关键影响水平： 以解决AA和白人之间在肺部筛查意识和利用方面的差异。指导 NIH的健康差异研究框架，在K99阶段，我将接受教学和指导培训 研究方法，以解决医疗保健系统中出现的差异。我会进行可行性研究 和形成性研究，以加强准实验研究的内容和交付（预测试- 后测，使用非等效对照组）在R 00阶段进行。具体目标是： 目标1：评估在初级保健中实施医疗保健提供者提示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组件（K99）。目标3：测试 多层次干预的主要内容（医患沟通、筛查意向和知识） 和次要（筛选转诊和完成）结局（R 00）。我将探讨健康差异是否 框架因素（例如，种族，健康素养）调节这些关系。拟议的多层次 干预措施针对肺部筛查的重要障碍，将为未来的R 01提供初步数据 应用程序，旨在衡量提供者和患者的独立和重叠贡献 干预措施。这个奖项，沿着制度环境、培训、研究资源和指导 乔治敦隆巴迪综合癌症中心的团队将为我提供 必要的培训，以制定减少临床环境中出现的差异的方法，并将启动 作为一名独立的癌症控制科学家，我的职业生涯专注于消除癌症差异。

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.