Developing a Trustworthy Multilevel Intervention to Improve Equity in Lung Cancer Screening

项目摘要/摘要 使用低剂量计算机断层扫描进行肺癌筛查显著降低了肺癌死亡率， 是美国癌症死亡的主要原因。尽管有挽救生命的潜力，肺癌筛查 在符合条件的人群中，吸食率仍然极低(约5%)。肺癌筛查使用率持平 在肺癌负担不成比例的人群(例如黑人和低收入人群)中较低 美国人)。2021年11月，美国预防服务工作组(USPSTF)呼吁提供更多证据 在提交给国会的年度报告中增加肺癌筛查的公平性。然而，多层次的壁垒 对肺癌的筛查存在于患者、提供者和卫生系统层面。然而，之前的研究 这些障碍的评估受到种族、民族和社会经济多样性不足的限制 参与者，并排除经常支持筛查计划的关键医疗保健人员(例如护士)。 医学上的不信任是另一个普遍报道的筛查障碍。然而，不信任通常被当作病人来研究-- 在这一点上，他们认为这是一种水平障碍，忽视了不信任是由结构引起的，例如医疗保健中的种族主义。许多医疗保健服务 干预措施也缺乏可信度，部分原因是它们的设计往往没有社区参与。一点儿 了解如何通过以公平为中心的实施战略来解决筛选障碍 并有一个明确的目标，赢得耐心的信任。通过三个具体目标，这项研究将解决这些问题 知识鸿沟。这些目标是：1)确定多层次的障碍和促进者 实施肺癌筛查(K99阶段)，2)与社区顾问和关键人员接触 利益攸关方确定促进肺癌筛查公平的多层次实施战略(K99 阶段)和3)试点测试旨在公平改进的多级实施战略的可行性 肺癌筛查摄取(一个在患者层面，一个在提供者/系统层面，R00阶段)。至 要完成这些研究目标，候选人(詹妮弗·里士满博士)需要授课和指导培训 肺癌领导、实施科学和设计/评估多层次健康的方法 股权干预。里士满博士组建了一支杰出的指导团队(梅林达·奥尔德里奇博士， Consuelo Wilkins、Eric Grogan和Carolyn Audet)拥有这些领域的集体专业知识，帮助她实现 研究和培训目标。总体而言，这项创新研究将是第一批对USPSTF做出回应的研究之一 呼吁提供证据以增加肺癌筛查的公平性。它还将为R01应用程序奠定基础 对本研究测试的干预试点进行评估。得到了她的导师的支持和杰出的 在范德比尔特大学医学中心的培训和研究环境中，里士满博士将到达她的长期- 过渡到独立并成为肺癌股权研究的全国领先者的长期目标。

PROJECT SUMMARY/ABSTRACT Lung cancer screening using low-dose computed tomography significantly reduces lung cancer mortality, the leading cause of cancer mortality in the United States. Despite its life-saving potential, lung cancer screening uptake remains extremely low among eligible populations (about 5%). Lung cancer screening utilization is even lower among populations that experience a disproportionate burden of lung cancer (e.g., Black and low-income Americans). In November 2021, the U.S. Preventive Services Task Force (USPSTF) called for more evidence to increase equity in lung cancer screening uptake in their Annual Report to Congress. Yet, multilevel barriers to lung cancer screening exist at the patient, provider, and health system levels. However, prior research assessing these barriers is limited by inadequate racial, ethnic, and socioeconomic diversity among participants and exclusion of key health care staff (e.g., nurses) who often champion screening programs. Medical mistrust is another commonly reported screening barrier. Yet, mistrust is often studied as a patient- level barrier, ignoring that mistrust arises from structures, such as racism in health care. Many health care interventions also lack trustworthiness, partly because they are often designed without community input. Little is known about how screening barriers can be addressed through implementation strategies that center equity and have an explicit goal to earn patient trust. Through three specific aims, this study will address these knowledge gaps. These aims are to: 1) identify multilevel barriers and facilitators to the equitable implementation of lung cancer screening (K99 phase), 2) engage with community advisors and key stakeholders to identify multilevel implementation strategies to promote equity in lung cancer screening (K99 phase), and 3) pilot test the feasibility of multilevel implementation strategies designed to equitably improve lung cancer screening uptake (one at the patient level and one at the provider/system level, R00 phase). To complete these research aims, the candidate (Dr. Jennifer Richmond) requires didactic and mentored training in lung cancer leadership, implementation science, and methods for designing/evaluating multilevel health equity interventions. Dr. Richmond has assembled an outstanding mentoring team (Drs. Melinda Aldrich, Consuelo Wilkins, Eric Grogan, and Carolyn Audet) with collective expertise in these areas to help her achieve the research and training goals. Overall, this innovative study will be among the first to respond to the USPSTF call for evidence to increase lung cancer screening equity. It will also lay the groundwork for a R01 application to evaluate the intervention pilot tested in this study. With support from her mentors and the exceptional training and research environment at Vanderbilt University Medical Center, Dr. Richmond will reach her long- term goal of transitioning to independence and becoming a national leader in lung cancer equity research.