Designing a Plan of Action for Better Access and Quality of Surgery for African-Americans with Gastrointestinal Cancers in the Deep South

目前的证据表明，患有胃肠道（GI）癌（结直肠癌、胰腺癌和 食管癌）不太可能接受手术，并表明那些接受手术的人可能不太可能 及时接受最佳证据的手术护理，并最大限度地减少不良手术结果。努力消除这些 种族/民族差异是有道理的，特别是在亚拉巴马（AL）和密西西比（MS）。美国这两个州的深度 南方GI癌症发病率和死亡率高，AA死亡率高，特别是AA人群， 获得优质护理的挑战，如负担能力和可用性有限。手术护理差异和 在这些国家，对它们的驱动机制进行了审查。此外，奠定导航和增强恢复后， 外科手术（ERAS）是有效的模型，在此基础上建立一个计划，以消除外科手术的差距。在我们的机构， ERAS流程的实施消除了住院时间的手术差异， 影响手术效果我们的长期目标是最终消除胃肠道癌症手术护理的差异 通过改善获得及时手术和促进在AL和MS中采用ERAS，我们的目标是： 1)通过对450名AA和550名白色GI癌症患者的调查， 和医疗图表摘要，我们将评估AA和白人在i）接受手术，ii）从 诊断手术，和iii）暴露于17个ERAS过程; 2）检查手术差异的潜在机制。 将调查结果与48名AA和白色患者以及48名GI癌症护理人员的个人访谈结果相结合 提供者在混合方法的综合分析，我们将提供一个全面的评估病人，提供者， 影响获得护理机制的系统层面因素，即，手术护理和ERAS过程是否可接受， 负担得起的、可用的、可获得的和可容纳的; 3）评估以外科手术为重点的联合布局的可行性 导航和ERAS干预GI癌症。目标1和2的结果将指导以外科手术为重点的 导航程序，以方便访问及时手术和支持病人在手术后阶段。通过 为了实现目标1-3，我们将定义：i）AL和MS中GI癌症患者的未来干预目标，即， 人口和手术过程; ii）解决机制，以实现有效的手术护理;以及iii） 以手术为重点的导航计划，以优化AA的手术和ERAS实施。因此 该项目的预期成果是一个具体而详细的可操作计划，以消除AL中的手术差异， 女士如果没有这些重要的新知识，消除胃肠道癌症手术差异的进展将是困难的。 受限有了这个计划，我们将为实现我们的目标做好充分的准备，并对实现 国家少数民族健康和健康差异研究所（NIMHD）和国家癌症研究所（NCI） 科学知识，这将有助于所有人活得更长，更健康的生活，并消除健康差距。

Current evidence shows that African-Americans (AAs) with gastrointestinal (GI) cancers (colorectal, pancreatic and esophageal cancer) are less likely to undergo surgery, and suggests that those who undergo surgery may be less likely to receive best-evidence surgical care that is timely and minimizes adverse surgical outcomes. An effort to eliminate these racial/ethnic disparities is warranted especially in Alabama (AL) and Mississippi (MS). These two states of the US Deep South have high GI cancer incidence and mortality, and high mortality for AAs in particular, large AA populations, and challenges for access to quality care such as limited affordability and availability. Neither surgical care disparities nor their driving mechanisms have been examined in these states. In addition, lay navigation and Enhanced Recovery After Surgery (ERAS) are effective models on which to build a plan to eliminate surgical disparities. At our institution, the implementation of ERAS processes has led to the elimination of surgical disparities in length of stay without compromising surgical outcomes. Our long term objective is to ultimately eliminate disparities in GI cancer surgery care and outcomes by improving access to timely surgery and facilitating the adoption of ERAS in AL and MS. Our aims are to: 1) Identify gaps in surgical care for GI cancers in AL and MS. With a survey of 450 AA and 550 white GI cancer patients, and medical chart abstraction, we will assess differences for AAs and whites in i) receipt of surgery, ii) time from diagnosis to surgery, and iii) exposure to 17 ERAS processes; 2) Examine potential mechanisms of surgical disparities. Combining survey results with those of individual interviews with 48 AA and white patients and with 48 GI cancer care providers in a mixed methods integrated analysis, we will provide a comprehensive assessment of patient, provider, and system level factors that affect access to care mechanisms, i.e., whether surgery care and ERAS processes are acceptable, affordable, available, accessible and accommodating; 3) Assess the feasibility of a combined surgery-focused lay navigation and ERAS intervention in GI cancer. Results from Aims 1 an 2 will guide the development of a surgery-focused navigator program to facilitate access to timely surgery and support patients in the peri- to post- surgery phases. By accomplishing Aims 1-3, we will define: i) future intervention targets for GI cancer patients in AL and MS, i.e., populations and surgery processes; ii) mechanisms to address in order to achieve effective surgical care; and iii) a surgery focused navigation program to optimize the uptake of surgery and implementation of ERAS for AAs. Thus, the expected outcome of this project is a concrete and detailed actionable plan to eliminate surgical disparities in AL and MS. Without this significant new knowledge, progress toward the elimination of disparities in GI cancer surgery is hindered. With this plan, we will be well prepared to achieve our objective and have a high impact on the goals of the National Institute on Minority Health and Health Disparities (NIMHD) and the National Cancer Institute (NCI) to advance scientific knowledge that will help all people live longer, healthier lives, and eliminate health disparities.