Tribally Engaged Approaches to Lung Screening (TEALS)

项目摘要 肺癌是美洲印第安人和阿拉斯加原住民(AI/AN)癌症死亡的主要原因，以及 与普通人群相比，AI/AN的肺癌发病率、存活率和死亡率更差。 因为使用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，肺癌死亡率大约降低20% 符合特定资格标准(B级证据)的55-80岁男性和女性的LCS；以及 随后，医疗保险和医疗补助服务中心(CMS)选择覆盖这项测试。然而， 在大多数医疗保健系统中，LCS实施一直很缓慢，而LCS实施在 AI/An从未被研究过。为了解决这个知识和实现上的差距，我们散文“传统的 参与的肺部筛查方法(TEALS)研究，这是Choctaw夫妇共同努力的结果 俄克拉荷马国家大学、斯蒂芬森癌症中心和俄克拉荷马大学健康科学中心 通过开发理论驱动的LCS，直接解决部落环境中LCS的低接受率问题 Choctaw Nation Health Services Authority(CNHSA)内的实施方案。在5年的时间里 几年来，TEALS将：1)对CNHSA患者、临床医生、 和卫生管理员来阐明个人和系统层面的障碍以及影响 实施LCS；2)开发并反复细化LCS护理协调干预，以确定 符合LCS条件的人，帮助这些患者通过筛查过程，并将他们与吸烟联系起来 戒烟服务，如果适用；3)衡量TEALS干预对接受 通过进行一项整群随机的临床试验进行筛查和一系列患者和执业水平的结果 LCS实施；以及4)将TEALS计划传播给其他研究人员和医疗保健系统 为人工智能/人工智能患者提供服务。TEALS将在LCS的证据和临床实践之间架起一座高- 通过在医疗保健系统层面进行干预，需要低资源环境。系统级别的干预措施 与评估个人层面、行为层面的指南实施相比，指南的实施往往研究不足 干预措施。然而，仔细开发和评估LCS筛查计划在 医疗保健系统对于确保更多的患者在适当的时候可以接受LCS至关重要。 通过TEALS，我们的研究将创建一个迫切需要的平台，未来的研究可以从这个平台 将研究如何将LCS指南的应用量身定做，以适应 AI/AN患者。TEAL将在部落系统中建立有效的LCS方案，从而提供直接的 通过增加LCS的参与，使Choctaw民族受益。TEALS将作为建立 为人工智能/AN和其他社区卫生系统中的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最终可以降低AI/AN中的肺癌死亡率 其中许多社区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.