Implementing tobacco use treatment in HIV clinics in Viet Nam

摘要 本申请是为了响应特别利益通知（NOSI）而提交的，该通知被确定为 NOT-CA-23-036。医疗保健提供者（HCP）中的癌症耻辱感会阻碍和减少有效的治疗。 癌症护理的提供和质量，特别是在低收入和中等收入国家（LMIC）的环境中。准确， 在HCP中对LMIC中的癌症耻辱进行文化适应性评估，这些评估已经被研究， 因此，可以为缓解这一关键障碍的努力提供信息，并有助于临床医生有效控制 并在这些环境中预防癌症。补充研究，这是集成到一个三臂烟草 越南艾滋病病毒携带者中的戒烟实施效果随机对照试验，将制定一项 临床医生多成分癌症耻辱量表（MCCSS-C），额外关注肺癌， 在治疗有癌症风险的患者的临床医生中使用，并研究癌症耻辱感是如何影响 与社会心理和行为因素有关。首先，将进行定性调查， 了解如何癌症的耻辱，特别是肺癌的耻辱，表现在临床医生谁治疗 有癌症风险的患者，告知越南HCP制定癌症污名措施的情况 南在这项调查中，HCP对癌症患者（以及他们的同龄人）的态度和信念 同事的）将用于归纳识别对癌症患者的新的临床医生耻辱域， 主要目的是探索HCP癌症污名的不同成分（即，感知 社区耻辱、消极态度和情绪、制定的同事耻辱和卫生设施政策/工作 环境）被认为是越南HCP的。在选择了构成每一个项目的最后项目之后， 具体维度的耻辱子量表，MCCSS-C将进行初步的心理测量评估。订正 MCCS-C（包括“一般癌症污名”和“肺癌污名”版本）将对30名新的 HCP评估其初始心理测量学特性以及不同癌症耻辱感之间的关系 维度和选择的心理社会因素。关于癌症耻辱感如何在HCP中表现出来，我们知之甚少 他们的患者患癌症的风险更高，特别是在中低收入国家， 社会动态沿着文化上突出的耻辱表现将在以下过程中阐明： 发展我们的措施。对治疗艾滋病毒感染者的临床医生进行的癌症耻辱感评估将作为 这是朝着开发未来量表迈出的关键一步，该量表将推广到越南的所有临床医生， 适用于LMIC的临床医生。

ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23-036. Cancer stigma among healthcare providers (HCPs) can impede and decrease the effective delivery and quality of cancer care, particularly in low-and-middle income country (LMIC) settings. Accurate, culturally-adapted assessments of cancer stigma in LMICs among HCP’s, who have been understudied to date, can thus inform efforts to mitigate this key barrier and contribute to clinicians’ efforts to effectively control and prevent cancer in these settings. The supplemental study, which is integrated into a three-arm tobacco cessation implementation-effectiveness randomized control trial among PLWH in Viet Nam, will develop a multi-component cancer stigma scale for clinicians (MCCSS-C), with an additional focus on lung cancer, for use among clinicians who treat patients who are at risk for cancer, and examine how cancer stigma is correlated with psychosocial and behavioral factors. First, a qualitative investigation will be conducted to understand how cancer stigma—and specifically lung cancer stigma—manifests among clinicians who treat patients who are at risk for cancer to inform the development of a cancer stigma measure for HCPs in Viet Nam. In this investigation, HCP’s attitudes and beliefs towards cancer patients (as well as those of their peer co-workers’) will be used to inductively identify new clinician domains of stigma towards people with cancer, with the main objective of exploring how the different components of HCP cancer stigma (i.e., perceived community stigma, negative attitudes and emotions, enacted co-worker stigma, and health facility policies/work environment) are perceived among Vietnamese HCP’s. Following selection of the final items to comprise each dimension-specific stigma subscale, the MCCSS-C will undergo initial psychometric evaluation. The revised MCCSS-C (both the “general cancer stigma” and “lung cancer stigma” versions) will be administered to 30 new HCPs to assess both its initial psychometric properties and the relationships between different cancer stigma dimensions and select psychosocial factors. Little is known about how cancer stigma may manifest in HCPs whose patients are at higher risk of developing cancer, specifically in LMICs, and key insights into this harmful social dynamic along with culturally-salient expressions of stigma will be elucidated in the process of developing our measure. An evaluation of cancer stigma among clinicians who treat people with HIV will act as a key step towards developing a future scale that will generalize to all clinicians in Vietnam and have applicability to clinicians in LMICs overall.