X

Download Disparities In Care For Early Stage Lung Cancer PowerPoint Presentation


Login   OR  Register
X


Iframe embed code :



Presentation url :

X

Description :

Available Disparities In Care For Early Stage Lung Cancer powerpoint presentation for free download which is uploaded by search an active user in belonging ppt presentation Health & Wellness category.

Tags :

Disparities In Care For Early Stage Lung Cancer

Home / Health & Wellness / Health & Wellness Presentations / Disparities In Care For Early Stage Lung Cancer PowerPoint Presentation

Disparities In Care For Early Stage Lung Cancer PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

About This Presentation


Description : Available Disparities In Care For Early Stage Lung Cancer powerpoint presentation for free download ... Read More

Tags : Disparities In Care For Early Stage Lung Cancer

Published on : Feb 24, 2014
Views : 491 | Downloads : 0


Download Now

Share on Social Media

             

User Presentation
SlidesFinder: Advertise with us
Related Presentation
Free PowerPoint Templates
Donuts Free PowerPoint Template

Donuts

Views : 611

Meditation Free PowerPoint Template

Meditation

Views : 212

Injecting Free PowerPoint Template

Injecting

Views : 260

Email Free PowerPoint Template

Email

Views : 276

Obesity Free PowerPoint Template

Obesity

Views : 647

Happy Birthday Free PowerPoint Template

Happy Birthday

Views : 384

Heart Free PowerPoint Template

Heart

Views : 280

Nature Abstract Free PowerPoint Template

Nature Abstract

Views : 274

Agriculture Free PowerPoint Template

Agriculture

Views : 643

Butterfly Free PowerPoint Template

Butterfly

Views : 390

Synapse Free PowerPoint Template

Synapse

Views : 515

Laboratory Free PowerPoint Template

Laboratory

Views : 457

Airplane Free PowerPoint Template

Airplane

Views : 217

Dollar Free PowerPoint Template

Dollar

Views : 265

Herbal Pills Free PowerPoint Template

Herbal Pills

Views : 377

Dental Brush Free PowerPoint Template

Dental Brush

Views : 301

Bales Free PowerPoint Template

Bales

Views : 363

Quit Smoking Free PowerPoint Template

Quit Smoking

Views : 414

Slide 1 - Funding Source Lung Cancer Surgery: Decisions Against Life Saving Care Sponsored by the American Cancer Society Grant #: RSGPB-05-217-01-CPPB
Slide 2 - Racial Disparities in the Treatment  of Early Stage Lung Cancer: Which Interventions Will Work?
Slide 3 - Case 1 A 53 year old African-American man presented to the emergency department with cough. A CXR was performed that revealed a 2.5 cm pulmonary nodule. A CT was immediately obtained and showed the nodule to be spiculated and not calcified. The patient was told that he might have a cancerous tumor and was referred for a follow-up appointment.
Slide 4 - Case 1 His cough resolved, so he did not keep the appointment. He returned 6 months later and had an 8cm tumor on CXR with mediastinal invasion. ***What could have been done differently?
Slide 5 - Case 2 A 67 year old smoker who had a CXR for a persisting cough after a URI was found to have a 2.1 cm lung nodule. Also has multiple blebs surrounding the nodule precluding a needle biopsy. PET CT shows the nodule is hot (18 SUV). There’s a 1.6 cm ipsilateral, hilar node on the CT that does not light up on the PET.
Slide 6 - Case 2 Other pertinent clinical data: FEV-1 45% of predicted Has known CAD with an LAD stent 6 months ago (no current sx) and a 50-60% RCA lesion EF – 35 to 40% Baseline Creatinine 2.4 ***Surgery yes or no?
Slide 7 - ppt slide no 7 content not found
Slide 8 - Proportion responding that they believe that clinically similar patients receive different care on the basis of race/ethnicity by proximity to practice (n=344) Lurie, N. et al. Circulation 2005;111:1264-1269
Slide 9 - Why Study Early Stage Lung Cancer? Fatal Disease Surgery only reliable chance of cure No treatment only 6% survive five-years A few absolute contraindications are defined Have to have strong reasons to refuse or recommend against
Slide 10 - Administrative data reveal lower surgical rates and survival for African-Americans diagnosed with Stages I and II, non-small cell lung cancer
Slide 11 - Bach et al. Racial differences in the treatment of early stage lung cancer. N Engl J Med 1999;341:1198. 44 excess deaths per 1000 lung cancer cases due to decisions against surgery!
Slide 12 - ppt slide no 12 content not found
Slide 13 - Lathan et al. J Clin Onc 2006;24:413-418 OR for Black patients to receive staging procedures compared to Caucasians 0.75 OR for Black patients who were actually staged to receive surgery compared to Caucasians 0.55
Slide 14 - Lathan, C. S. et al. J Clin Oncol; 24:413-418 2006 Fig 1. Reasons recorded in Surveillance, Epidemiology, and End Results for why surgery was not performed among patients who had undergone invasive staging
Slide 15 - Administrative data controlled for insurance, income, and co-morbidities. No specific reasons for treatment disparity despite near certain death within 4 years post-diagnosis
Slide 16 - Reference – Prospective Cohort Study Cykert, Dilworth-Anderson,Monroe, et al. Factors associated with decisions to undergo surgery among patients with newly diagnosed early stage lung cancer. JAMA 2010; 303:2368-2376.
Slide 17 - Methods 5 communities Pulmonary, Oncology, Thoracic Surgery, ED, and Generalist Practices Direct referral vs chest CT review protocol
Slide 18 - Inclusion Criteria > 18 years old Tissue diagnosis of non-small cell lung cancer or > 60% probability using a Bayesian Model Clinical / Radiological Stage I or II disease English Speaking
Slide 19 - Timing of Enrollment Patient informed of the diagnosis of definite or probable lung cancer Survey administered verbally by trained RA before treatment plan established
Slide 20 - The Questionnaire 106 items Including: Demographics SF-12 Mental Adjustment to Cancer Scale Trust Perceptions of provider-patient communication
Slide 21 - “Exposure to air” Perceived certainty of diagnosis Attitudes about lung cancer Dyspnea Decision participants Religiosity
Slide 22 - Chart Abstraction Timing: At least 4 months after diagnosis Surgery: Yes / No and Date PFT’s Co-Morbid Diagnoses Clinical Stage Surgical Stage
Slide 23 - Statistical Analysis Primary Outcome: Lung Cancer Surgery Within 4 Months of Diagnosis Independent variables a priori in models: - demographics - SF-12 component scores - tissue vs presumptive diagnosis - perception of diagnostic certainty - Mental Adjustment to Cancer scales - “air exposure” - trust - co-morbid conditions
Slide 24 - Variables entered after bivariate comparisons if p < 0.1 - attitudes about lung cancer - religiosity - other decision participant - perceptions of provider-patient communications
Slide 25 - Results Patients enrolled – 437 - 7 patients not Caucasian or AA - 32 with advanced cancer - 6 with benign dx - 6 with FEV-1 < 25% predicted (no surgeries below this level) 386 met entry criteria and remained eligible for lung resection surgery
Slide 26 - Results 67 percent (N = 257) with biopsy proven diagnosis at enrollment - 62% surgical resection 33 percent CT-defined probable disease - 64% surgical resection 88 percent tissue diagnosis confirmed
Slide 27 - Results: Demographic Data
Slide 28 - 4 Month Surgery Rates All enrollees (N = 386) Caucasian 66%* African-American 55% *p = .05
Slide 29 - 4 Month Surgery Rates Tissue confirmed only (N = 339) Caucasian 75%* African-American 63% *p = .03
Slide 30 - Lung Surgery Rates – Bivariate Comparisons
Slide 31 - Regression Analysis - All Patients
Slide 32 - Regression Analysis - All Patients
Slide 33 - Regression Analysis - African Americans
Slide 34 - Regression Analysis - African-Americans * The Trust Paradox
Slide 35 - Regression Analysis – White Patients
Slide 36 - Regression Analysis – White Patients No Regular Source of Care OR 1.3, 95% CI .32 – 5.3
Slide 37 - Co-morbidities Strand TE et al. Risk factors for 30-day mortality after resection of lung cancer and prediction of their magnitude. Thorax 2007;62:991-7. - Minimal effect of Charlson Co-morbidity Index on 30 day survival (3.8% CCI of 0, 5.8% CCI 1-2, only 6.5% of patients had CCI > 3)
Slide 38 - Co-morbidities Battafarano et al. Impact of comorbidity on survival after surgical resection in patients with stage I non-small cell lung cancer. Journal of Thoracic and Cardiovascular Surgery 2002;123:280-7. - Average 3-year survival – no comorbidities 86% - Average 3-year survival – severe comorbidities 70% - Average 3-year survival without surgery* 10 – 15% * Bach N Engl J Med 1999; 341:1198
Slide 39 - Results N = 386 66 deaths at one year 100% follow up AA patients 4.4 years younger than W Average age of survivors 65.6 years; average age died 70.1 years (p = 0.002)
Slide 40 - Results *P < 0.05
Slide 41 - -------------------------------------------------------------------------- pt_died | Odds Ratio Std. Err. z P>|z| [95% Conf. Interval] -------------+---------------------------------------------------------------- d_demomari2 | .5643592 .175378 -1.84 0.066 .3069302 1.037699 medincy1 | .8405706 .2744353 -0.53 0.595 .4432697 1.593971 d2_demoedu | 1.124134 .350837 0.37 0.708 .6097647 2.072403 d_demorace | 1.097042 .3950806 0.26 0.797 .5415986 2.222126 age50th | 3.445103 1.14981 3.71 0.000 1.791067 6.626626 dxdiabetes | 1.255789 .4429175 0.65 0.518 .629068 2.506894 dxcoronary~e | 1.121822 .3708338 0.35 0.728 .5868777 2.144374 demosex | 1.288879 .3964429 0.83 0.409 .7053315 2.355217 had_surg | .5193712 .1558765 -2.18 0.029 .2884102 .9352874 rscy | .6981523 .3100482 -0.81 0.418 .2923701 1.667122 dxhyperten~n | .5987609 .1868083 -1.64 0.100 .3248522 1.103624 comorbtotal3 | 2.785209 1.175041 2.43 0.015 1.218282 6.367485 comorbtotal1 | 1.454711 .4823543 1.13 0.258 .7595123 2.786242 ------------------------------------------------------------------------------
Slide 42 - Results Factors associated with one-year mortality for early stage lung cancer - Age over 66 (OR 3.4, 1.8 – 6.6) - >2 comorbidities (OR 2.8, 1.2 – 6.4) - lung cancer surgery (OR 0.52, 0.29 – 0.93)
Slide 43 - Conclusions Excluding patients with PFT defined absolute contra-indications, disparities in treatment for early stage, non-small cell lung cancer remain The impact of poor communication is apparent in both White patients and African-Americans Lack of a regular source of care exacerbates the effect on African-Americans
Slide 44 - Conclusions Co-morbid conditions are markedly associated with decisions against surgery for African-American patients This impact is NOT apparent with White patients This finding suggests a systematic or implicit bias when considering higher risk African-American patients for lung cancer surgery
Slide 45 - Implicit (Unintended) Bias Schulman et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med 1999;340:618-26. Green et al. Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. Journal of General Internal Medicine 2007;22:1231-8.
Slide 46 - Possible Solutions Know that disparities (beyond what is attributable to SES, education, and insurance) exist Think in the context of the ideal
Slide 47 - Communication Johnson RL et al., Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health 2004;94:2084-90. Gordon HS et al. Racial differences in doctors' information-giving and patients' participation. Cancer 2006;107:1313-20. Williams SW, et al. Communication, Decision Making, and Cancer: What African Americans Want Physicians to Know. Journal of Palliative Medicine 2008:1221-6. (Interest on a human level person and family - appropriate language)
Slide 48 - Communication Paasche-Orlow MK et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med 2005;172:980-6. Clever SL, Ford DE, Rubenstein LV, et al. Primary care patients' involvement in decision-making is associated with improvement in depression. Med Care 2006;44:398-405.
Slide 49 - Communication Rosenzweig et al. The attitudes, communication, treatment, and support intervention to reduce breast cancer disparity. Oncol Nurse Forum 2011;38: 85-89. - Pilot delivered by AA breast cancer survivor 1. Discussion chemotherapy 2. Importance of communicating knowledge needs and distress 3. Explanation of path results and rx plan 4. Survivor video - (N = 24) % total dose chemo received / prescribed 94% vs. 74%
Slide 50 - Intervention Design Provider education: Lung cancer disparity data and local surgical and co-morbidity data by race Co-morbidity checklist with individual patients Real time registry with warning indicators Provider receives race-specific data feedback Super-navigator – Enhanced communication; dropout interventions (stratify by low health literacy)
Slide 51 - Intervention Caveat Super-Navigator
Slide 52 - Case 1 A 53 year old African-American man presented to the emergency department with cough. A CXR was performed that revealed a 2.5 cm pulmonary nodule. A CT was immediately obtained and showed the nodule to be spiculated and not calcified. The patient was told that he might have a cancerous tumor and was referred for a follow-up appointment.
Slide 53 - Case 1 His cough resolved, so he did not keep the appointment. He returned 6 months later and had an 8cm tumor on CXR with mediastinal invasion. ***What could have been done differently?
Slide 54 - Case 2 A 67 year old smoker who had a CXR for a persisting cough after a URI was found to have a 2.1 cm lung nodule. Also has multiple blebs surrounding the nodule precluding a needle biopsy. PET CT shows the nodule is hot (18 SUV). There’s a 1.6 cm ipsilateral, hilar node on the CT that does not light up on the PET.
Slide 55 - Case 2 Other pertinent clinical data: FEV-1 45% of predicted Has known CAD with an LAD stent 6 months ago (no current sx) and a 50-60% RCA lesion EF – 35 to 40% Baseline Creatinine 2.4 ***Surgery yes or no?
Slide 56 - For Discussion The role of implicit bias – how do we affect providers biases? Should we be pushing African-American patients toward lung cancer surgery? Is this a violation of the principle of autonomy? Do you see anything applicable here to other health disparities?