Overcoming Racial Disparities in Curative Therapies for Hepatocellular Carcinoma

摘要 Lauren D.Nephew医学博士，MA，MSCe的长期职业目标是成为一个独立的，外部的 受资助的研究人员和制定多层次干预措施以减少获得 治疗肝病和胃肠道恶性肿瘤。她已经确定了改善获得治疗的机会 肝细胞癌的治疗是实现这一目标所要解决的关键问题。这项建议 描述了一项为期4年的综合培训计划和指导研究，以期在 卫生服务研究，特别关注促进卫生保健公平。这与NIDDK的情况一致 致力于消除健康差距。虽然Nephew博士在流行病学方面有很强的背景，但这 K23将提供使用以人为中心的设计研究方法进行干预开发的关键培训， 随机对照行为试验，并在卫生系统内实施干预措施。 患有慢性肝病的黑人患者比白人患者患慢性肝炎的可能性低约50% 接受肝细胞癌的根治治疗，即使在出现早期疾病的情况下也是如此。 死亡率差异的原因部分与未能通过复杂的肝细胞癌护理取得进展有关 由于社会和结构分配不均，继续获得根治疗法 健康决定因素(SSDOH)。我们建议开发的HCC-Edulink干预旨在：a) 提高患者对肝癌的相关知识；b)筛查患者的社会需求和物质使用情况，并参考 社会工作与当地服务的联系；以及c)利用我们的多学科肝癌肿瘤委员会促进联系 专门针对肝癌的癌症护理。此应用程序的目标是开发教育计划 HCC-Edulink干预的组成部分和试点测试全面的多层次干预旨在解决 在Black队列中，患者和系统水平的SSDOH变量和促进获得肝癌治疗的机会 患者肝细胞癌。Nephew博士的多学科指导团队包括一位世界知名的胃肠病专家， 一名减少癌症差异的干预专家和一名行为健康统计学家将提供专家 指导，以补充她的课程工作和体验式学习。包括印第安纳州在内的环境 大学西蒙癌症中心，临床和翻译科学研究所，Eskenazi安全网医院 和印第安纳大学学术健康中心，使这里成为她训练和 完成提议的目标。在完成拟议的研究和培训后，Nephew博士将提交 竞争性R级拨款，用于在更大的随机试验中测试试点干预，并将拥有以下技能 以及所需的经验，以通过以下方式为降低肝癌死亡率做出持续和有影响力的贡献 对其他弱势人群进行循证干预。

ABSTRACT Lauren D. Nephew MD, MA, MSCE's long-term career goal is to become an independent, externally funded researcher and leader in developing multilevel interventions to reduce disparities in access to treatments for liver disease and gastrointestinal malignancies. She has identified improving access to curative therapies for hepatocellular carcinoma (HCC) as a critical issue to address to achieve this goal. This proposal describes a 4-year comprehensive program of training and mentored research for an academic career in health services research with a special focus on advancing health care equity. This is in line with NIDDK's commitment to combating health disparities. While Dr. Nephew has a strong background in epidemiology, this K23 will provide key training in using human centered design research methods for intervention development, randomized controlled behavioral trials, and implementation of interventions within health systems. Black patients with chronic liver disease are approximately 50% less likely than White patients to receive curative therapies for hepatocellular carcinoma (HCC) even when presenting with early stage disease. Reasons for disparities in mortality are in part related to failure to progress through the complex HCC care continuum to access curative therapies as a result of the unequal distribution of social and structural determinants of health (SSDOH). The HCC-EduLink intervention we propose to develop is designed to: a) improve patients' HCC-related knowledge; b) screen patients for social needs and substance use and refer to social work for linkage to local services; and c) use our multidisciplinary HCC tumor board to facilitate linkage to subspecialty HCC cancer care. The objectives of this application are to develop the education program component of the HCC-EduLink intervention and pilot test the full multi-level intervention designed to address patient- and system-level SSDOH variables and facilitate access to HCC curative therapies in a cohort of Black patients HCC. Dr. Nephew's multidisciplinary mentorship team including a world-renowned gastroenterologist, an expert in interventions to reduce cancer disparities, and a behavioral health statistician will provide expert guidance to complement her course work and experiential learning. The environment including the Indiana University Simon Cancer Center, Clinical and Translational Science Institute, the Eskenazi Safety-net Hospital and the Indiana University Academic Health Center, make this an ideal environment for her training and to complete the proposed aims. Upon completion of the proposed research and training, Dr. Nephew will submit a competitive R-level grant to test the pilot intervention in a larger randomized trial and will possess the skills and experience needed to make a sustained and impactful contribution to reduce HCC mortality through evidenced-based interventions in other vulnerable populations.