Overcoming Racial Disparities in Curative Therapies for Hepatocellular Carcinoma

克服肝细胞癌治疗中的种族差异

• 批准号: 10572610
• 负责人: Lauren Nephew
• 金额: $ 15.25万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-25 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10572610
• 关键词: Active Learning; Address; Alcohols; Behavior Therapy; Behavioral trial; Black race; Cancer Center; Cancer Prognosis; Caring; Characteristics; Chronic; Clinic; Clinical Sciences; Complement; Complex; Consent; Continuity of Patient Care; Data; Disease; Education; Educational Status; Enrollment; Environment; Epidemiology; Evidence based intervention; Excision; Failure; Funding; Gastroenterologist; Goals; Grant; Health; Health Services Accessibility; Health Services Research; Health system; Healthcare; Hospitals; Improve Access; Indiana; Individual; Institutes; Intervention; Knowledge; Liver; Liver diseases; Malignant neoplasm of gastrointestinal tract; Malignant neoplasm of liver; Mentors; Mentorship; Methods; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Participant; Patients; Poverty; Primary carcinoma of the liver cells; Prospective cohort study; Provider; Randomized; Randomized Controlled Trials; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Research Training; Services; Social Conditions; Social Work; Surveys; System; Testing; Time; Training; Training Programs; Translational Research; Universities; Vulnerable Populations; Waiting Lists; Work; behavior test; behavioral health; black patient; cancer care; cancer health disparity; career; chronic liver disease; cohort; curative treatments; design; disparity reduction; experience; health disparity; high school; human centered design; implementation intervention; implementation science; improved; intervention effect; liver transplantation; medically underserved population; mortality; mortality disparity; multidisciplinary; patient screening; pilot test; programs; racial disparity; randomized trial; safety net; skills; social; social determinants; social health determinants; social structure; standard of care; substance use; therapy design; therapy development; tumor; usability

ABSTRACT Lauren D. Nephew MD, MA, MSCE's long-term career goal is to become an independent, externally funded researcher and leader in developing multilevel interventions to reduce disparities in access to treatments for liver disease and gastrointestinal malignancies. She has identified improving access to curative therapies for hepatocellular carcinoma (HCC) as a critical issue to address to achieve this goal. This proposal describes a 4-year comprehensive program of training and mentored research for an academic career in health services research with a special focus on advancing health care equity. This is in line with NIDDK's commitment to combating health disparities. While Dr. Nephew has a strong background in epidemiology, this K23 will provide key training in using human centered design research methods for intervention development, randomized controlled behavioral trials, and implementation of interventions within health systems. Black patients with chronic liver disease are approximately 50% less likely than White patients to receive curative therapies for hepatocellular carcinoma (HCC) even when presenting with early stage disease. Reasons for disparities in mortality are in part related to failure to progress through the complex HCC care continuum to access curative therapies as a result of the unequal distribution of social and structural determinants of health (SSDOH). The HCC-EduLink intervention we propose to develop is designed to: a) improve patients' HCC-related knowledge; b) screen patients for social needs and substance use and refer to social work for linkage to local services; and c) use our multidisciplinary HCC tumor board to facilitate linkage to subspecialty HCC cancer care. The objectives of this application are to develop the education program component of the HCC-EduLink intervention and pilot test the full multi-level intervention designed to address patient- and system-level SSDOH variables and facilitate access to HCC curative therapies in a cohort of Black patients HCC. Dr. Nephew's multidisciplinary mentorship team including a world-renowned gastroenterologist, an expert in interventions to reduce cancer disparities, and a behavioral health statistician will provide expert guidance to complement her course work and experiential learning. The environment including the Indiana University Simon Cancer Center, Clinical and Translational Science Institute, the Eskenazi Safety-net Hospital and the Indiana University Academic Health Center, make this an ideal environment for her training and to complete the proposed aims. Upon completion of the proposed research and training, Dr. Nephew will submit a competitive R-level grant to test the pilot intervention in a larger randomized trial and will possess the skills and experience needed to make a sustained and impactful contribution to reduce HCC mortality through evidenced-based interventions in other vulnerable populations.

摘要 劳伦·D侄子MD，MA，MSCE的长期职业目标是成为一名独立的， 资助的研究人员和领导者，制定多层次的干预措施，以减少获得 治疗肝病和胃肠道恶性肿瘤。她已经确定了改善获得治疗性药物的途径， 肝细胞癌（HCC）的治疗是实现这一目标的关键问题。这项建议 描述了一个为期4年的培训和指导研究的学术生涯在 卫生服务研究，特别侧重于促进卫生保健公平。这与NIDDK的 致力于消除健康差距。虽然Dr. Nephew在流行病学方面有很强的背景， K23将提供使用以人为本的设计研究方法进行干预开发的关键培训， 随机对照行为试验，以及在卫生系统内实施干预措施。 患有慢性肝病的黑人患者比白色患者的可能性低约50%， 接受肝细胞癌（HCC）的治愈性治疗，即使在出现早期疾病时。 死亡率差异的原因部分与未能通过复杂的HCC护理取得进展有关 由于社会和结构的不平等分配， 健康决定因素（SSDOH）。我们建议开发的HCC-EduLink干预措施旨在：a） 提高患者HCC相关知识; B）筛查患者的社会需求和物质使用，并参考 社会工作与当地服务联系;以及c）利用我们的多学科HCC肿瘤委员会促进联系 肝癌专科治疗此应用程序的目标是开发教育计划 HCC-EduLink干预措施的组成部分，并对旨在解决以下问题的全面多层次干预措施进行试点测试： 患者和系统水平的SSDOH变量，并促进黑人队列中HCC治愈性治疗的获得 HCC患者。Dr. Nephew的多学科指导团队包括一位世界知名的胃肠病学家， 一位减少癌症差异的干预专家和一位行为健康统计学家将提供专家 指导，以补充她的课程工作和体验式学习。包括印第安纳州 西蒙大学癌症中心、临床和转化科学研究所、埃斯肯纳齐安全网医院 和印第安纳州大学学术健康中心，使这成为一个理想的环境，她的训练， 完成提出的目标。完成拟定研究和培训后，Dr. Nephew将提交 一个有竞争力的R级补助金，以测试试点干预在一个更大的随机试验，并将拥有的技能 需要通过以下方式为降低HCC死亡率做出持续和有影响力的贡献 在其他弱势群体中采取循证干预措施。