Development of a culturally targeted patient navigation curriculum for LGBT adult

描述（由申请人提供）：总体研究目标是开发一种针对文化的患者导航培训课程，旨在增加女同性恋、男同性恋、双性恋和变性（LGBT）人群的乳腺癌、宫颈癌和结直肠癌筛查行为。我们提出了一个严格的形成性研究计划（定性访谈和学习者验证试验）（非同性恋、双性恋和变性者成年人、卫生保健提供者和医疗中心主任），以确定一般和独特的社会文化（社会耻辱，不信任，提供者偏见，隐瞒和身份和健康），提供者（适当性、文化能力、提供者质量、患者依从性和沟通）和系统水平（可用性，成本，交通，组织）LGBT个体经历的癌症筛查障碍。所获得的信息将作为调整和文化上针对现有卫生系统导航课程的基础，该课程将指导患者导航员减少非依从性LGBT个体进行适当癌症筛查和后续护理的障碍。第二个目标是与一组LGBT健康教育工作者和非专业PN一起对适应性癌症筛查健康系统导航（CS-HSN）培训课程进行试点测试。CS-HSN培训方法和课程的试点测试将有助于建立培训方案的可行性，课程和材料的可接受性以及基于课程的性能结果，如在模拟标准化患者的临床接触期间所测量的。具体目标是：目标1a：通过与关键利益相关者（非依从性LGBT、医疗服务提供者和医疗中心主任）的深入访谈，确定不依从年龄段癌症筛查指南（乳腺癌、宫颈癌和结肠癌）的LGBT人群进行癌症筛查（社会文化、医疗服务提供者和系统）的障碍。目标1b：使用访谈数据作为调整卫生系统导航课程和培训协议的基础，用于减少LGBT人群癌症筛查的障碍，并最终确定癌症筛查-卫生系统导航课程（CS-HSN）。目标二：使用生成的CS-HSN课程，对一组健康教育者（N=6）和非专业患者导航员（N=10）的培训进行试点测试，并通过标准化患者的模拟临床测量，系统地评价可行性（招募和保留）、可接受性（计划满意度）和绩效结局（知识、访谈技能、患者导航角色）。公共卫生相关性：这项研究将是首次尝试系统地开发有针对性的患者导航（PN）培训课程，旨在减少女同性恋，男同性恋，双性恋和变性人（LGBT）的癌症筛查差异。当前项目的预期成果，包括确定LGBT癌症筛查的具体障碍，开发针对癌症筛查的新患者导航，使用课程培训健康教育工作者和PN的经验，对7个LGBT医疗中心提供癌症筛查的卫生系统障碍的评估将为进行一项全面的癌症随机试验提供必要的初步数据筛选患者导航程序。

DESCRIPTION (provided by applicant): The overall study objective is to develop a culturally targeted patient navigation training curriculum aimed at increasing breast, cervical and colorectal cancer screening behaviors in lesbian, gay, bisexual and transgendered (LGBT) persons. We propose a rigorous plan of formative research (qualitative interviews and learner verification trials) with key stakeholders (non-adherent LGBT adults, health care providers and medical center directors) to identify general and unique sociocultural (social stigma, mistrust, provider bias, concealment and identity and health), provider (appropriateness, cultural competency, quality of providers, patient adherences and communication) and system level (availability, costs, transportation, organization) barriers to cancer screening experienced by LGBT individuals. The obtained information will serve as a basis for adapting and culturally targeting an existing Health System Navigation curriculum that will guide patient navigators in the reduction of barriers to appropriate cancer screening and follow-up care among non-adherent LGBT individual. A secondary goal is to pilot test the adapted cancer screening Health System Navigation (CS- HSN) training curriculum with a cohort of LGBT health educators and lay PN. Pilot testing the CS-HSN training methods and curriculum will help to establish the feasibility of training protocols, the acceptability of the curriculum and materials and performance outcomes based on the curriculum as measured during simulated clinical encounters with standardized patients. Specific aims are: Aim 1a: To determine using in-depth interviews with key stakeholders (non-adherent LGBT, medial providers and medical center directors) barriers to cancer screening (sociocultural, provider and system) for LGBT who are non-adherent to age-appropriate cancer screening guidelines (breast, cervical, and colon). Aim 1b: To use the interview data as a basis for adapting the Health System Navigation curriculum and training protocol for use in reducing barriers to cancer screening in LGBT persons and finalizing the Cancer Screening-Health System Navigation curriculum (CS-HSN). Aim 2: To use the generated CS-HSN curriculum, to pilot test the training of a cohort of health educators (N=6) and lay patient navigators (N=10) and to systematically evaluate feasibility (recruitment and retention), acceptability (program satisfaction), and performance outcomes (knowledge, interviewing skills, patient navigation roles) as measured by simulated clinical with standardized patients. PUBLIC HEALTH RELEVANCE: This study will be one of the first attempts to systematically develop a targeted patient navigation (PN) training curriculum aimed at reducing cancer screening disparities in Lesbian, Gay, Bisexual, and Transgender (LGBT) persons. Anticipated outcomes from the current project, including the identification of LGBT specific barriers to cancer screening, the development of a new patient navigation targeting cancer screening, experience training health educators and PN using the curriculum, and the evaluation of the health system barriers to providing cancer screening at 7 LGBT medical centers will provide the preliminary data necessary to conduct a full randomized trial testing the cancer screening patient navigation program.