A Pilot CHW Model to Facilitate Shared Decision Making and Lung Cancer Screening for Chinese Taxi Drivers

项目摘要 预计中国人口将在2019年成为纽约市最大的移民群体 接下来的几年。在全国范围内，中国移民构成了第二大外国出生群体，仅次于 那些来自墨西哥的。中国移民从事的许多职业使他们患肺癌的风险更高。 癌症，包括出租车司机。中国出租车司机患肺癌的风险可能特别高，因为 高吸烟率和暴露在空气污染中的增加的综合影响。常年流行的 在美国的中国男性吸烟率为42.5%。在我们的初步工作中，我们评估了 在纽约，在外国出生的中国制服司机中，有惊人的73%是现在或以前的吸烟者。肺癌是 这是美国第二种最常见的癌症，也是癌症相关死亡的主要原因。 国家肺部筛查试验(NLST)的结果显示，肺癌死亡率降低了20% 使用低剂量计算机断层扫描(LDCT)筛查。2013年，美国预防服务工作组 (USPSTF)建议55-80岁年龄在30岁的成年人每年进行一次LDCT肺癌筛查 过去15年内有吸烟史或戒烟史的人。2015年，医疗保险和医疗补助中心 服务开始为LCS咨询和共享决策(SDM)访问提供覆盖范围，并每年 LCS和LDCT，如果合适，适用于符合条件的个人。先前的研究描述了较低的筛查率 在外国出生的亚裔美国人和太平洋岛民(AAPIs)与在美国出生的人之间的其他癌症 AAPIs，即使在对与保险相关的护理机会进行调整后也是如此。大量的研究表明 移民在照顾方面面临着独特的障碍，包括语言和文化因素。社区卫生工作者 (CHW)的努力解决了这些障碍，并导致癌症筛查率显著提高。在这 研究，我们将对10名高危、以前未筛查的中国制服司机进行预试，有资格获得 LCS，以完善适应的、现有的移民健康和癌症差异(IHCD)CHW模型，Taxi Haill (关于联系和长寿的卫生获取干预措施)，针对卫生工作者的多个层面的影响 可以清楚地表达，包括个人(司机)、组织(制服基础)和环境(医疗保健 访问/环境)。然后，我们将进行试点随机对照试验(RCT)，以评估 改进的CHW模型与书面材料的对比，以促进50个纽约市之间的SDM和LCS(在适当情况下) 中国制服司机(根据USPSTF标准)有资格获得LCS。该模型还包含了 宾夕法尼亚社区卫生工作者循证CHW模型，IMPaCTTM(个性化 以患者为中心的目标的管理)。可行性结果将用来为规划和 设计大规模RCT，目标是中国司机以及纽约和纽约的其他司机群体 在美国各地，以及其他职业(如餐馆)的中国高危吸烟者 工作、建筑)。

Project Summary The Chinese population is anticipated to become the largest immigrant group in New York City (NYC) in the next few years. Nationwide, immigrants from China constitute the second largest foreign-born group, after those from Mexico. Chinese immigrants work in a number of occupations that put them at higher risk for lung cancer, including taxi driving. Chinese taxi drivers may be at exceptionally high risk for lung cancer due to the combined impact of high rates of smoking and increased exposure to air pollution. The prevalence of ever smoking among Chinese men in the U.S. is 42.5%. In our preliminary work assessing health needs among foreign-born Chinese livery drivers in NYC, a staggering 73% were current or former smokers. Lung cancer is the second most commonly diagnosed cancer in the U.S., and the leading cause of cancer-related deaths. Results from the National Lung Screening Trial (NLST) showed a 20% reduction in mortality from lung cancer with low-dose computed tomography (LDCT) screening. In 2013 the U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) with LDCT in adults age 55-80 years with a 30 pack year history who smoke or quit within the past 15 years. In 2015 the Centers for Medicare and Medicaid Services began providing coverage for a LCS counseling and shared decision making (SDM) visit, and annual LCS with LDCT, if appropriate, for eligible individuals. Previous research describes lower rates of screening for other cancers among foreign-born Asian Americans and Pacific Islanders (AAPIs) compared to U.S. born AAPIs, even after adjusting for insurance-related access to care. A substantial body of research suggests that immigrants face unique barriers to care, including language and cultural factors. Community health worker (CHW) efforts address these barriers, and have led to significant increases in cancer screening rates. In this study, we will conduct a pre-pilot with 10 high risk, previously unscreened Chinese livery drivers eligible for LCS, to refine an adapted, existing Immigrant Health and Cancer Disparities (IHCD) CHW model, Taxi HAILL (Health Access Interventions for Linkages and Longevity), for the multiple levels of influence at which CHWs can articulate, including the individual (drivers), organizations (livery bases), and the environment (health care access/environment). We will then conduct a pilot randomized controlled trial (RCT) to assess the feasibility of the refined CHW model versus written materials to facilitate SDM and LCS (when appropriate) among 50 NYC Chinese livery drivers eligible (by USPSTF criteria) for LCS. The model also incorporates key elements of the Penn Center for Community Health Workers evidence-based CHW model, IMPaCTTM (Individualized Management towards Patient-Centered Targets). Feasibility results will be used to inform the plannning and design of large scale RCTs, targeting Chinese drivers as well as other driver populations in NYC and throughout the U.S., and other high risk Chinese smoking populations in other occupations (e.g. restaurant work, construction).