参与使用美国手语社区健康导航员项目的聋人、聋盲及重听成人对癌症筛查共同决策的体验：一项嵌套定性研究的初步发现。

文献信息

中文摘要

引言： 使用美国手语（ASL）的聋人、聋盲及重听（DDBHH）成人在癌症筛查依从性方面持续面临差异，并因系统性沟通障碍以及与医疗提供者之间共同决策（SDM）方面已记录的不足而进一步加剧。精通ASL的社区健康导航员（CHN）已被提出作为弥合这些差距的一种策略。本研究探讨1）使用ASL的CHN如何促进或未能促进对筛查建议不依从的DDBHH成人癌症筛查的共同决策，以及2）识别影响该人群筛查决策的因素。方法：2025年6月至7月开展了一项嵌套定性研究，通过视频会议以ASL对15名DDBHH成人进行半结构化退出访谈，这些成人来自一项旨在解决常规癌症筛查依从性的随机临床试验，且所有人在访谈时均已完成结束访视。采用定向内容分析，使用围绕四个领域组织的先验编码手册：背景与筛查情境、癌症知识、提供者参与与共同决策、导航员角色。结果：提供者关于癌症筛查的沟通简短且具指令性；正式的风险-获益讨论基本缺失。干预组参与者描述了自主决策、更高的预约前知识以及更高的信心，而标准治疗组参与者更常描述为不加斟酌地遵从提供者建议。视频远程口译（VRI）可及性限制几乎是实现有意义共同决策的普遍障碍。与参与者共享DDBHH身份的CHN被描述为对建立信任以及支持参与者的筛查参与和决策很重要。结论：具有共享DDBHH身份且精通ASL的CHN支持DDBHH患者以更高的自我感知准备度和自我效能来面对癌症筛查。然而，结构性障碍，包括口译员可及性不足和提供者培训不足，是所报告的共同决策的重要障碍。将使用ASL的导航员整合到癌症筛查项目中，同时系统性改善沟通可及性和医学教育，仍是改善DDBHH人群癌症筛查体验的有前景的方法。

英文摘要

IntroductionDeaf, DeafBlind, and hard of hearing (DDBHH) adults using American Sign Language (ASL) face persistent disparities in cancer screening adherence, compounded by systemic communication barriers and documented deficits in shared decision making (SDM) with health care providers. Community health navigators (CHNs) who are fluent in ASL have been proposed as a strategy to bridge these gaps. This study explores 1) how ASL-using CHNs contributed or did not contribute to SDM for cancer screening among DDBHH adults who were nonadherent to screening recommendations and 2) identified factors influencing screening decisions in this population.MethodsA nested qualitative study from June to July 2025 with semi-structured exit interviews was conducted in ASL via videoconferencing with 15 DDBHH adults within a randomized clinical trial to address routine cancer screening adherence, all of who had completed closeout at the time of the interviews. Directed content analysis was applied using an a priori codebook organized around four domains: background and screening context, cancer knowledge, provider engagement and SDM, and navigator role.ResultsProvider communication about cancer screening was brief and directive; formal risk-benefit discussions were largely absent. Intervention participants described self-directed decision-making, greater pre-appointment knowledge, and higher confidence, whereas SOC participants more commonly described deferring to provider recommendations without deliberation. Video remote interpreting (VRI) access limitations were a near-universal barrier to meaningful shared decision-making. CHNs sharing a DDBHH identity were described as important to building trust and supporting participants' screening engagement and decision-making.ConclusionASL-fluent CHNs with shared DDBHH identity supported DDBHH patients in approaching cancer screening with greater self-perceived preparedness and self-efficacy. However, structural barriers, including inadequate interpreter access and insufficient provider training, are significant reported obstacles to shared decision-making. Integrating ASL-using navigators into cancer screening programs, alongside systemic improvements in communication access and medical education, remain promising approaches to improve cancer screening experiences for DDBHH populations.