A Multilevel intervention to address health disparities in lung cancer screening

摘要 在美国，肺癌是癌症相关死亡的主要原因，死亡人数超过13.5万人 预计在2020年。基于国家肺部筛查试验，该试验显示低剂量计算机 断层扫描(肺部筛查)与胸部X光检查相比，肺癌死亡率降低20%，美国预防 服务工作组建议对无症状的高危个人进行年度肺部筛查。尽管如此 建议，利用率较差(3%-14%)。肺部筛查可能对非洲人特别有益 美国人(AA)，因为他们更有可能患有晚期疾病，生存率较低，筛查较低 与白人相比。肺部筛查低摄取率的原因是多因素的，并与 来自其他癌症筛查差异的证据。例如，提供者发起的关于癌症的讨论 总体来说，筛查测试很低，再生障碍性贫血和其他种族/少数民族比白人更不可能患上 这些讨论。筛查差异的另一个关键驱动因素是患者对早期筛查缺乏了解 侦测。有证据表明，需要同时解决多个障碍的多层次干预措施 提高少数民族人群筛查率，降低肺癌发病率和死亡率。这个 拟议的研究将针对医疗保健环境中的两个关键层面的影响：提供者和患者的行为 以解决再生障碍性贫血和白种人在肺部筛查意识和利用方面的差异。指导原则 NIH的健康差距研究框架，在K99阶段，我将接受授课和指导培训 在研究方法方面，以解决医疗保健系统中出现的差异。我会进行可行性研究 和形成性研究，以加强准实验研究的内容和交付(预试- 后测，不等同的对照组)在R00阶段进行。具体目标是： 目标1：评估在初级保健中实施医疗保健提供者提示的可行性和可接受性 网络(K99)。目的2：编制患者教育部分(K99)并进行预试。目标3：测试 初级干预(提供者-患者沟通、筛查意图和知识)的多层次干预 和次级(筛查转诊和完成)结果(R00)。我将探讨健康差距是否 框架因素(例如，种族、健康素养)调节这些关系。建议的多层次 干预措施针对肺部筛查的重要障碍，这些障碍将提供初步数据，为未来的R01提供参考 旨在衡量提供者和患者的独立和重叠贡献的应用程序 干预措施。这一奖项，以及机构环境、培训、研究资源和指导 通过乔治敦隆巴迪综合癌症中心向我提供的团队，将提供 必要的培训，以制定减少临床环境中出现的差异的方法，并将启动 作为一名独立的癌症控制科学家，我的职业生涯专注于消除癌症差异。

Abstract Lung cancer is the leading cause of cancer-related mortality in the US, with more than 135,000 deaths expected in 2020. Based on the National Lung Screening Trial, which showed that low-dose computed tomography (lung screening) vs. chest X-ray reduced mortality due to lung cancer by 20%, the US Preventive Services Task Force recommends annual lung screening for asymptomatic high risk individuals. Despite this recommendation, utilization is poor (3%-14%). Lung screening may be particularly beneficial for African Americans (AA), because they are more likely to have advanced disease, lower survival, and lower screening rates compared to whites. The causes of low uptake of lung screening are multifactorial and consistent with evidence from other cancer screening disparities. For example, provider-initiated discussions about cancer screening tests are low overall, and AA and other racial/ethnic minorities are less likely than whites to have these discussions. Another key driver of screening disparities is patients’ lack of knowledge about early detection. Evidence points to the need for multilevel interventions that simultaneously address multiple barriers to increase screening rates and decrease lung cancer morbidity and mortality in minority populations. The proposed study will target two key levels of influence in the healthcare setting: provider and patient behavior in order to address disparities between AA and whites in lung screening awareness and utilization. Guided by NIH’s Health Disparities Research Framework, in the K99 phase, I will receive didactic and mentored training in research methods to address disparities occurring in the healthcare system. I will conduct feasibility studies and formative research to strengthen the content and delivery of the quasi-experimental study (pretest- posttest, with a nonequivalent control group) to be conducted in the R00 phase. The specific aims are to: Aim 1: Evaluate the feasibility and acceptability of implementing a healthcare provider prompt in a primary care network (K99). Aim 2: Develop and pre-test the patient education component (K99). Aim 3: Test the impact of the multilevel intervention on primary (provider-patient communication, screening intentions, and knowledge) and secondary (screening referrals and completion) outcomes (R00). I will explore whether Health Disparities Framework factors (e.g., race, health literacy) moderate these relationships. The proposed multilevel intervention targets important barriers to lung screening that will provide preliminary data to inform a future R01 application designed to measure the independent and overlapping contributions of the provider and patient interventions. This award, along with the institutional environment, training, research resources, and mentoring team available to me through the Georgetown Lombardi Comprehensive Cancer Center, will provide the necessary training to develop approaches to reduce disparities that arise in the clinical setting and will launch my career as an independent cancer control scientist focused on eliminating cancer disparities.