Investigating the Roles of Patient Beliefs, Stigma, and Physician Implicit Bias on Disparities in Lung Cancer Screening

肺癌特别具有侵袭性、致命性，并因其与肺癌的强烈相关性而被污名化。 吸烟者5年生存率<15%。美国肺癌的负担 国家福尔斯在道义上属于少数民族。黑人肺癌发病率最高， 黑人和西班牙裔患者的结果都比他们的白色对应者差。肺 癌症筛查包括每年一次的低剂量计算机断层扫描（LDCT）， 目前由美国预防服务工作组推荐给800万 吸烟者患肺癌的风险很高， 肺癌死亡人数令人震惊的是，新兴的国家数据表明，只有3%的黑人 符合条件的吸烟者接受了筛查，而2017年白色吸烟者的比例为12%。先前的研究 对癌症的差异未能解决肺癌特有的问题（耻辱，高 死亡率和宿命论）和LDCT筛查（新测试，增加辐射暴露）， 极大地限制了这些研究结果对肺癌筛查的普遍性。在 在这个项目中，我们计划评估可改变的健康信念，并检查心理健康状况。 对歧视的反应，如可能影响肺部的耻辱和医疗不信任 少数吸烟者的癌症筛查。我们还计划评估内隐偏见的作用 在医生中。鉴于肺癌筛查的新颖性和独特挑战， 准确地识别障碍，并在早期让黑人和西班牙裔参与LDCT筛查， 为了早日纠正这种不平等，必须采取行动。的具体目标 本研究目的是：1）评估不同种族对肺癌和LDCT的认知差异 筛查及其与接受筛查和LDCT的同意率较低的相关性 完成; 2）评估是否种族和民族差异的耻辱和医疗不信任， 与接受筛查和LDCT完成的同意率较低相关， 筛选差异的基础; 3）评估内隐偏见与种族和性别的关系。 肺癌筛查转诊和LDCT完成率的种族差异。实现这些 我们将招募符合肺癌筛查条件的吸烟者及其初级保健提供者 来自纽约市一个庞大的初级保健实践网络。我们计划测量病人的 关于肺癌和LDCT筛查的信念，耻辱和医疗不信任，以及 测量医生的偏见和测试与肺癌筛查转诊的关联， 建成研究结果将直接指导制定有针对性的战略， 提高少数民族肺癌筛查率。

Lung cancer is particularly aggressive, lethal, and stigmatized by its strong association with cigarette smoking, with a 5-year survival rate <15%. The burden of lung cancer in the United States falls disproportionally on minorities. Blacks have the highest incidence of lung cancer and both Black and Hispanic patients have worse outcomes than their white counterparts. Lung cancer screening, consisting of an annual low-dose computed tomography (LDCT) scan, is currently recommended by the United States Preventive Services Task Force to the 8 million smokers who are at high risk of developing lung cancer, and is poised to substantially reduce lung cancer deaths. Alarmingly, emerging national data demonstrates that only 3% of black eligible smokers received screening compared to 12% of white smokers in 2017. Prior research on cancer disparities fails to address issues that are specific to lung cancer (stigma, high mortality, and fatalism) and LDCT screening (new test, increased radiation exposure) and greatly limits the generalizability of the findings from these studies to lung cancer screening. In this project, we plan to assess modifiable health beliefs as well as examine psychological responses to discrimination, such as stigma and medical mistrust that may influence lung cancer screening use among minority smokers. We also plan to evaluate the role of implicit bias among physicians. Given the newness and unique challenges of lung cancer screening, efforts to accurately identify barriers and engage Black and Hispanics in LDCT screening early in its adoption are imperative to achieving an early correction to this disparity. The Specific Aims of the study are to: 1) Assess racial and ethnic differences in beliefs about lung cancer and LDCT screening and their association with lower rates of agreement to undergo screening and LDCT completion; 2) Evaluate if racial and ethnic differences in stigma and medical mistrust are associated with lower rates of agreement to undergo screening and LDCT completion and underlie screening disparities; and 3) Assess the association of implicit bias with racial and ethnic disparities in lung cancer screening referral and LDCT completion. To achieve these aims, we will recruit lung cancer screening-eligible smokers and their primary care providers from a vast network of primary care practices in New York City. We plan to measure patient’s beliefs about lung cancer and LDCT screening, stigma, and medical mistrust, as well as measure physicians’ bias and test associations with lung cancer screening referral and completion. The results of the study will directly guide the development of targeted strategies to improve lung cancer screening rates among minorities.