Assessing how multilevel factors shape disparities in cancer screening

评估多层次因素如何影响癌症筛查的差异

• 批准号: 10581403
• 负责人: Natalie Del Vecchio
• 金额: $ 13.37万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581403
• 关键词: Adherence; Affect; Attitude; Award; Belief; Breast Cancer Detection; Cancer Control; Cancer Etiology; Caring; Cervical Cancer Screening; Cessation of life; Clinical Trials; Colorectal Cancer; Community Healthcare; Data; Development; Development Plans; Disparity; Dose; Ensure; Ethnic Origin; Goals; Health Care Rationing; Health Disparities Research; Health system; Healthcare Systems; Incentives; Incidence; Integrated Health Care Systems; Intervention; Interview; Knowledge acquisition; Lung; Lung CAT Scan; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Malignant neoplasm of lung; Mentorship; National Cancer Institute; Outcome; Patients; Policies; Population; Population Heterogeneity; Population Research; Process; Provider; Qualitative Evaluations; Race; Recommendation; Regulation; Research; Research Methodology; Research Personnel; Sampling; Screening for cancer; Shapes; Structure; Surveys; Testing; Theoretical model; Training; Underserved Population; Work; cancer care; cancer health disparity; cancer prevention; cancer survival; cancer type; career; career development; clinical decision support; colorectal cancer screening; ethnic disparity; ethnic diversity; experience; health care delivery; health disparity; implementation science; improved; improved outcome; lung cancer screening; mortality; mortality disparity; multilevel analysis; outcome disparities; primary care provider; programs; provider factors; racial disparity; racial diversity; screening; screening policy; screening program; skills; success; support tools; uptake

PROJECT SUMMARY/ABSTRACT Cancer screening is an essential cancer control strategy for several cancer types, including colorectal, cervical, and lung cancer screening. However, cancer screening utilization rates are suboptimal and disparities by race and ethnicity persist. Observed disparities in cervical, colorectal, and lung cancer screening by race and ethnicity likely contribute to the persistent and historic disparities in survival for these cancers. Prior research and theoretical models indicate that multilevel (e.g., patient-, provider-, healthcare system-level) cancer screening initiatives are the most effective for improving outcomes and understanding modifiable drivers of disparities. However, such initiatives have been difficult to implement given the paucity of research on healthcare system- level factors, including how factors at the healthcare system-level intersect with those at the other levels. Improving utilization of cancer screening is critical to achieve population-level mortality reduction, but care must be taken to tailor interventions to underserved populations in order to ensure that existing disparities are narrowed, rather than widened. The objective of the proposed research is to improve understanding of the synergistic effects of patient-, provider-, and healthcare system-level factors on cancer screening rates, and how these multilevel factors modify racial and ethnic disparities. My specific aims are: 1) Assess cervical, colorectal, and lung cancer screening rates by healthcare system-level factors (e.g., screening policies and programs), and compare the magnitude of any observed disparities by race and ethnicity across different healthcare system- level factors (K99), 2) Characterize patient and provider perspectives on multilevel factors throughout the lung screening process using qualitative interviewing and thematic analysis (K99), and 3) Elucidate provider-level drivers of cervical, colorectal, and lung cancer screening and employ a multilevel approach to examine associations with cancer screening rates, including interactions with race and ethnicity (R00). To achieve these aims, data from the National Cancer Institute’s Population-based Research to Optimize the Screening Process (PROSPR II) consortium will be leveraged, which is unique, rich data comprised of a racially and ethnically diverse population receiving care at community healthcare systems across the US. The results of this analysis will provide evidence for the identification of potential targets for a multilevel intervention to improve screening utilization and narrow disparities. In addition to this research, Dr. Del Vecchio’s comprehensive career development plan includes structured mentorship from leaders in cancer screening research and additional training in qualitative and mixed methods research, healthcare delivery research, health disparities research, implementation science, and multilevel analysis. Throughout this award, Dr. Del Vecchio will acquire the knowledge, skills, and experience necessary to achieve her long-term goal of becoming an independent investigator studying factors contributing to suboptimal care throughout the cancer control continuum and developing multilevel interventions to improve healthcare delivery and cancer outcomes.

项目摘要/摘要 癌症筛查是几种癌症类型的基本癌症控制策略，包括结直肠癌、子宫颈癌、 和肺癌筛查。然而，癌症筛查的利用率并不理想，而且不同种族之间存在差异。 种族问题依然存在。观察到不同种族和民族在宫颈癌、结直肠癌和肺癌筛查中的差异 可能是导致这些癌症存活率长期和历史性差异的原因之一。先前的研究和 理论模型表明，多层次(例如，患者、提供者、医疗保健系统级别)的癌症筛查 主动行动是改善结果和了解差异的可改变驱动因素的最有效方法。 然而，由于缺乏对医疗保健系统的研究，此类举措很难实施- 水平因素，包括医疗保健系统水平的因素如何与其他水平的因素相交。 提高癌症筛查的利用率是实现人口死亡率下降的关键，但护理必须 采取针对服务不足人群的干预措施，以确保现有的差距 缩小了，而不是扩大了。拟议研究的目的是增进对 患者、提供者和医疗保健系统水平的因素对癌症筛查率的协同影响，以及如何 这些多层面的因素改变了种族和民族差异。我的具体目标是：1)评估宫颈、结直肠、 和按医疗保健系统层面因素(例如，筛查政策和计划)的肺癌筛查率，以及 比较不同医疗系统中按种族和民族划分的任何观察到的差异的大小- 水平因素(K99)，2)表征患者和提供者对整个肺的多水平因素的看法 使用定性访谈和主题分析的筛选过程(K99)，以及3)阐明提供者级别 宫颈癌、结直肠癌和肺癌筛查的驱动因素，并采用多层次方法检查 与癌症筛查率的关系，包括与种族和民族(R00)的相互作用。要实现这些目标 AIMS，来自国家癌症研究所基于人群的研究数据，以优化筛查过程 (PROSPR II)财团将被利用，这是一个独特的、丰富的数据，由种族和民族组成 在美国各地的社区医疗系统接受护理的不同人群。这一分析的结果 将为确定多水平干预以改进筛查的潜在目标提供证据 利用和缩小差距。除了这项研究，德尔·维奇奥博士的全面职业生涯 发展计划包括癌症筛查研究领域领导者的结构化指导和其他 在定性和混合方法研究、医疗保健提供研究、健康差距研究、 实施科学和多层次分析。在整个奖项过程中，Del Vecchio博士将获得 知识、技能和经验是实现她成为独立人士这一长期目标所必需的 研究人员研究在整个癌症控制连续过程中导致次优护理的因素 开发多层次干预措施，以改善医疗保健提供和癌症预后。