Tribally Engaged Approaches to Lung Screening (TEALS)

项目摘要 肺癌是美国印第安人和阿拉斯加原住民（AI/AN）癌症死亡的主要原因， 与一般人群相比，AI/AN的肺癌发病率、生存率和死亡率更低。 由于低剂量计算机断层扫描（LDCT）的肺癌筛查（LCS）已被证明可以减少 美国预防服务工作组现在建议， LCS适用于符合特定资格标准的55-80岁男性和女性（B级证据），以及 随后，医疗保险和医疗补助服务中心（CMS）选择覆盖该测试。但 在大多数医疗保健系统中，LCS的实施进展缓慢， AI/AN从未被研究过。为了解决这一知识和实施差距，我们散文“部落 肺筛查方法（TEALS）”研究，这是乔托族和 国家俄克拉荷马州、斯蒂芬森癌症中心和俄克拉荷马州大学健康科学中心 通过开发理论驱动的LCS，直接解决部落环境中LCS使用率低的问题 在乔托民族卫生服务管理局（CNHSA）的实施方案。经过5 年，TEALS将：1）对CNHSA患者，临床医生， 和卫生管理人员，以阐明个人和系统一级的障碍和促进因素，影响 LCS实施; 2）开发并反复完善LCS护理协调干预， 符合LCS条件的人，帮助这些患者浏览筛选过程，并将其与吸烟联系起来 戒烟服务（如适用）; 3）衡量TEALS干预措施对接受 筛选和一组患者和实践水平的结果，通过进行一项群集随机临床试验， LCS实施;以及4）向其他研究人员和医疗保健系统传播TEALS计划 为AI/AN患者服务。TEALS将在高水平上弥合LCS证据与临床实践之间的差距， 通过在医疗保健系统一级进行干预，系统一级的干预措施， 与那些评估个人水平、行为水平和行为水平的方法相比， 干预措施。然而，仔细的发展和评估的LCS筛选计划的水平， 医疗保健系统对于确保更多患者在适当时接受LCS至关重要。 通过TEALS，我们的研究将创建一个急需的平台，未来的研究可以从这个平台上进行。 推出，将研究如何量身定制LCS指南的应用，以个人的喜好， AI/AN患者。TEALS将在部落系统中建立一个有效的LCS计划，从而提供直接的 通过增加LCS的参与，使乔托民族受益。TEALS将作为建立 在AI/AN和其他社区卫生系统中为LCS提供可持续和可访问的基础设施。通过 增加对早期肺癌的筛查，TEALS可以最终降低AI/AN中的肺癌死亡率。 社区，其中许多人非常需要有效的战略，以减少长期存在的癌症差距。

Project Summary Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and AI/AN have worse lung cancer incidence rates, survival, and death compared to the general population. Because lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality by roughly 20%, the United States Preventive Services Task Force now recommends LCS for men and women aged 55-80 years who meet specific eligibility criteria (grade-B evidence), and subsequently the Center for Medicare and Medicaid Services (CMS) opted to cover this test. However, the uptake of LCS implementation has been slow in most healthcare systems, and LCS implementation among AI/AN has never been studied. To address this knowledge and implementation gap, we prose the “Tribally Engaged Approaches to Lung Screening (TEALS)” study, which is a collaborative effort between the Choctaw Nation of Oklahoma, the Stephenson Cancer Center, and the University of Oklahoma Health Sciences Center that directly addresses the low uptake of LCS in tribal settings through the development of a theory-driven LCS implementation program within the Choctaw Nation Health Services Authority (CNHSA). Over the course of 5 years, TEALS will: 1) Conduct focus groups and semi-structured interviews with CNHSA patients, clinicians, and health administrators to elucidate individual- and system-level barriers and facilitators that affect the implementation of LCS; 2) Develop, and iteratively refine an LCS care coordination intervention that will identify eligible persons for LCS, help these patients navigate the screening process, and link them with smoking cessation services, when applicable; 3) Measure the impact of the TEALS intervention on the receipt of screening and a set of patient- and practice-level outcomes by conducting a cluster-randomized clinical trial of LCS implementation; and 4) Disseminate the TEALS program to other researchers and healthcare systems that serve AI/AN patients. TEALS will bridge the gap between evidence and clinical practice for LCS in a high- need, low-resource setting by intervening at the level of the healthcare system. System-level interventions for guideline implementation tend to be understudied compared to those evaluating individual-level, behavioral interventions. However, the careful development and evaluation of an LCS screening program at the level of the healthcare system would be critical to ensure that more patients can receive LCS when appropriate. Through TEALS, our research will create a critically needed platform from which future studies could be launched that will examine how to tailor the application of the LCS guideline to the individual preferences of AI/AN patients. TEALS will establish an effective LCS program in a tribal system and thus provide a direct benefit to the Choctaw Nation by increasing LCS participation. TEALS will serve as a blueprint for establishing a sustainable and accessible infrastructure for LCS in AI/AN and other community health systems. By increasing screening for early stage lung cancer, TEALS could ultimately reduce lung cancer mortality in AI/AN communities, many of which are in great need of effective strategies to reduce longstanding cancer disparities.