Patient Navigation for Cervical Cancer in Appalachia

描述(申请人提供)：在过去的50年里，宫颈癌的死亡率下降了大约75%。这一减少在很大程度上是由于巴氏涂片和治疗的改进。尽管这一下降令人鼓舞，但某些妇女群体并没有获得显著的好处，仍然面临着死于宫颈癌的不成比例的风险。这些妇女中有生活在农村地区的妇女，特别是生活在阿巴拉契亚农村地区的中老年妇女。这一人口仍然是宫颈癌死亡率最高的人群之一，解决这一问题的努力没有达到他们的目标。为了减轻阿巴拉契亚农村妇女患宫颈癌的不平等和不必要的负担，我们建议与当地公共卫生部门合作，开展基于社区的患者导航器(PN)干预。在这个拟议的项目中，我们打算制定、管理和评估一项计划，以便在当地卫生部门的宫颈癌筛查项目中有效地利用非专业卫生工作者作为PNS。其目的是：1)提高对巴氏试验结果异常的妇女在随访中遇到的障碍的了解；2)与指定的护士病例经理合作，在当地卫生部门的宫颈癌筛查和后续治疗计划中招募、培训和使用非专业卫生工作者作为PNS；3)广泛吸收在结果异常后未进行跟进的妇女的意见，并通过制定PN计划，提高遵守及时进行巴氏试验异常随访建议的患者的比例。该项目将在肯塔基州东南部农村的26个公共卫生部门进行。将使用滞后设计，将卫生部门随机分为干预组或延迟干预组。共有858名患者参加该项目，其中干预组429人，延迟干预组429人。因巴氏涂片结果异常而未按预定时间进行随访的患者将符合资格，并被转介至PNS并登记。评估将在基线面谈中进行，并在干预后的两点再次进行。

DESCRIPTION (provided by applicant): Over the past five decades, mortality rates from cervical cancer have decreased by approximately 75%. This reduction is largely attributable to the Pap smear and improvements in treatment. Despite this encouraging reduction, certain groups of women have not experienced significant benefits and remain at disproportionate risk of death from cervical cancer. Among these women are those living in rural areas, particularly middle aged and older women who live in rural Appalachia. This population continues to have among the highest cervical cancer mortality rates, and efforts to address this problem have fallen short of their objectives. To reduce the unequal and unnecessary burden from cervical cancer experienced by rural Appalachian women, we propose to undertake a community-based patient navigator (PN) intervention in partnership with local public health departments. In this proposed project we intend to develop, administer, and evaluate a plan for effective utilization of lay health workers as PNs in local health department cervical cancer screening programs. The aims are: 1) to improve understanding of the barriers to follow-up experienced by women with abnormal Pap test results; 2) in conjunction with designated nurse case managers, to recruit, train and utilize lay health workers as PNs in local health departments' cervical cancer screening and follow-up treatment programs; and 3) with extensive input from women who do not follow-up after abnormal results and through the development of a PN program, to increase the proportion of patients who are adherent with recommendations for timely abnormal Pap test follow-up. The project will be conducted in 26 public health departments in rural southeastern Kentucky. A lagged design will be used in which the health departments will be randomized to intervention or delayed intervention groups. A total of 858 patients will be enrolled in the project, 429 in the intervention group and 429 in the delayed intervention group. Patients who do not keep scheduled follow-up appointments for abnormal Pap smear results will be eligible and referred to PNs and enrolled. Assessment will occur in face-to-face interviews at baseline and again at two points after the intervention.