Developing a Navigation System for Latinos with Lung or Head-and-Neck Cancer

描述(由申请人提供)：这是一项为期一年的发展研究，旨在提供必要的信息，以准备成功的拨款申请，进行多中心试验，以测试导航系统的有效性，以改善患有肺癌和/或头颈部(H&N)癌症的拉丁裔患者的预后。这些癌症患者的发病率很高，通常需要多个医学专科之间的仔细协调才能接受适当的治疗和康复。与其他医疗服务不足的患者一样，拉美裔患者在这一过程中失去了后续行动或经历了可以避免的延误，这一比例不成比例。拉美裔人面临着许多文化、语言和医疗保健方面的挑战，这使得协调护理特别困难，因为癌症的发病率如此之高。因此，有必要创建有效的患者导航程序，以更好地帮助拉丁裔患者及其医疗团队应对这些癌症。将使用深度访谈设计，并辅之以病历审查，从丹佛健康中心的相关卫生保健专业人员、非专业卫生工作者以及肺癌和H&N癌症患者那里获得有关关键障碍的信息。将与来自初级保健、肺内科、耳鼻咽喉科、外科、内科肿瘤科和放射肿瘤科的卫生保健专业人员进行六次关键的信息者访谈。每个成员6人的焦点小组访谈将与至少四组个人进行：1)患有或曾经患有肺癌的患者，2)患有或曾经患有H&N癌的患者，3)患有或曾经患有肺癌和/或H&N癌的患者的照顾者，以及4)在丹佛健康公司受雇为其他癌症患者担任患者导航员的非专业卫生工作者。将要求关键告密者和焦点小组受访者确定其他未被约谈但应包括在内的关键个人，因为他们在护理这些患者方面发挥了相关作用。从名单中，另外8人将接受一对一的半结构化面试。最终结果将是一项协议，将在未来的一项随机对照试验中进行测试，该试验是针对这些患者的癌症治疗和康复的导航计划。制定有效的干预措施以减少拉美裔癌症治疗的差异具有重大的公共卫生影响，因为肺癌是拉美裔癌症死亡的首要原因，在拉美裔中排名第二(美国肺脏协会，2005年)。

DESCRIPTION (provided by applicant): This is a proposal to conduct a one year developmental study designed to provide the information necessary to prepare a successful grant application to conduct a multi-center trial to test the effectiveness of navigation to improve the outcomes of Latino patients with Lung and/or Head-and-Neck (H&N) cancers. Patients with these cancers experience high levels of morbidity that often require careful coordination between multiple medical specialties to receive proper treatment and rehabilitation. Like other medically underserved patients, Latinos are disproportionately lost-to-follow-up or experience avoidable delays during this process. The many cultural, language, and health care access challenges faced by Latinos make the coordination of care especially difficult for cancers with such high morbidity as these. Thus, there is a need to create effective patient navigation programs that can better assist Latino patients and their health care team for these cancers. An in-depth interview design, augmented with medical chart reviews, will be used to obtain information on key barriers from relevant health care professionals, lay-health workers, and Lung and H&N cancer patients at Denver Health. Six key informant interviews will be conducted with health care professionals from the divisions of primary care, pulmonary medicine, otorhinolaryngology, surgery, medical oncology, and radiation oncology. Focus group interviews of 6 members each will be conducted with at least four groups of individuals: 1) patients who have or had Lung cancer, 2) patients who have or had H&N cancer, 3) caregivers of patients who have or had Lung and/or H&N cancer, and 4) lay health-workers who are employed as patient navigators for other cancer patients at Denver Health. Key informants and focus group interviewees will be asked to identify other key individuals that have not been interviewed but that should be included because of their relevant role in the care of these patients. From the list, an additional 8 individuals will be interviewed using one-on-one semi-structured interviews. The final outcome will be a protocol to be tested in a future randomized, controlled trial of a navigation program for cancer treatment and recovery for these patients. Creating effective interventions to reduce cancer treatment disparities among Latinos has significant public health implications given that Lung cancer is the leading cause of cancer death among Latinos and second among Latinas (American Lung Association, 2005).