Patient Navigation for Cervical Cancer in Appalachia

描述（由申请人提供）：在过去五十年中，子宫颈癌的死亡率下降了约75%。这种减少主要归因于巴氏涂片检查和治疗的改善。尽管有这种令人鼓舞的减少，但某些妇女群体并没有得到显著的好处，仍然面临着死于宫颈癌的不成比例的风险。这些妇女中有生活在农村地区的妇女，特别是生活在阿巴拉契亚农村的中年和老年妇女。这一人口的宫颈癌死亡率仍然是最高的，解决这一问题的努力没有达到其目标。为了减轻阿巴拉契亚农村妇女因宫颈癌所承受的不平等和不必要的负担，我们建议与当地公共卫生部门合作开展以社区为基础的患者导航员（PN）干预。在这个拟议的项目中，我们打算制定、管理和评估一项计划，以便在地方卫生部门的宫颈癌筛查项目中有效利用非专业卫生工作者作为全科医生。目的是：1)提高对宫颈抹片检查结果异常的妇女随访障碍的认识；2)与指定的护士病例管理人员一起，在地方卫生部门的宫颈癌筛查和后续治疗方案中招募、培训和利用非专业卫生工作者作为执业医师；3)从异常结果后没有随访的妇女那里获得广泛的意见，并通过制定PN计划，增加坚持建议及时进行异常巴氏试验随访的患者比例。该项目将在肯塔基州东南部农村地区的26个公共卫生部门进行。将采用滞后设计，将卫生部门随机分为干预组或延迟干预组。项目共纳入858例患者，干预组429例，延迟干预组429例。不按照常规随访检查子宫颈抹片检查结果异常的患者将有资格被转介给全科医生并登记入组。评估将在基线时进行面对面访谈，并在干预后的两点再次进行。

DESCRIPTION (provided by applicant): Over the past five decades, mortality rates from cervical cancer have decreased by approximately 75%. This reduction is largely attributable to the Pap smear and improvements in treatment. Despite this encouraging reduction, certain groups of women have not experienced significant benefits and remain at disproportionate risk of death from cervical cancer. Among these women are those living in rural areas, particularly middle aged and older women who live in rural Appalachia. This population continues to have among the highest cervical cancer mortality rates, and efforts to address this problem have fallen short of their objectives. To reduce the unequal and unnecessary burden from cervical cancer experienced by rural Appalachian women, we propose to undertake a community-based patient navigator (PN) intervention in partnership with local public health departments. In this proposed project we intend to develop, administer, and evaluate a plan for effective utilization of lay health workers as PNs in local health department cervical cancer screening programs. The aims are: 1) to improve understanding of the barriers to follow-up experienced by women with abnormal Pap test results; 2) in conjunction with designated nurse case managers, to recruit, train and utilize lay health workers as PNs in local health departments' cervical cancer screening and follow-up treatment programs; and 3) with extensive input from women who do not follow-up after abnormal results and through the development of a PN program, to increase the proportion of patients who are adherent with recommendations for timely abnormal Pap test follow-up. The project will be conducted in 26 public health departments in rural southeastern Kentucky. A lagged design will be used in which the health departments will be randomized to intervention or delayed intervention groups. A total of 858 patients will be enrolled in the project, 429 in the intervention group and 429 in the delayed intervention group. Patients who do not keep scheduled follow-up appointments for abnormal Pap smear results will be eligible and referred to PNs and enrolled. Assessment will occur in face-to-face interviews at baseline and again at two points after the intervention.