Research Impact is a series that pulls back the curtain of IU Research, showcasing the faculty creating, innovating and advancing knowledge that improves communities and changes lives.
Since she was a little girl, Dr. Lauren Nephew knew she wanted to help people. That desire, coupled with a passion for talking to others and an inquisitive nature, led her to a career as a physician scientist.
Now, Nephew is an assistant professor of medicine in the Division of Gastroenterology and Hepatology and assistant vice chair of health equity at the Indiana University School of Medicine. Her research focuses on understanding the barriers patients face in getting treatment for liver disease and liver cancer, and she is developing tools to remove those barriers.
Lauren Nephew. Photo courtesy of the IU School of Medicine
Question: What is the goal of your research?
Answer: I am a health equity researcher and a liver doctor. I am focused on developing interventions that alleviate health care disparities, particularly for patients with liver cancer and end-stage liver disease, including liver transplant patients.
Beyond just describing the various health disparities between different populations, I am at the point of my research where I am developing interventions to help patients. Indiana University Health is the only liver transplant center in the state, so my main goal is to develop tools that help patients get treatment, and transplant is one of the main treatments for liver cancer.
We have the potential to make a real difference for patients here in Indiana, but lessons we learn here can also be applied across the country.
Q: What tools are your team developing to improve patient outcomes?
A: In talking to patients with liver cancer, we have learned that they feel overwhelmed by the amount of information they receive about their diagnosis and how they receive that information. We have discovered they want to talk to others who have their condition and to feel supported in a way beyond just talking to their physician. We have also learned that they need help navigating the various steps it takes to get from a diagnosis to treatment.
My team has a multi-step approach that includes a social support group for people with liver cancer to engage with each other, education tools that make the information more clear and break it up into modules so it doesn't come to the patient all at once, and a binder with navigation tools and maps to help patients understand upfront the various steps they'll need to take to get to a cure. Used together, we hope to help patients with liver cancer achieve better outcomes and reduce disparities.
Q: How is your research helping to address health disparities?
A: In the United States, there are disparities and outcomes in patients based on race, gender, ethnicity, socioeconomic status and geography. There are diseases like liver cancer and end-stage liver disease where certain populations may not do as well as majority populations do. We call that a disparity.
My work is around understanding those disparities - how large it is, who is experiencing this disparity, and, most importantly, what are the determinants? We want to know whether they exist at the neighborhood level, the health system level, the provider level or the patient level. But more than likely, there is a combination of all those reasons for why the disparities are happening. When we can understand the determinants of those disparities, then we can develop solutions to address them.
I have a three-step process of identifying the disparity a group is experiencing, trying to understand the determinants of that disparity and then developing a solution that will lower, and if we're lucky, completely alleviate that disparity.
Additionally, even though I am a liver doctor, I'm also the associate vice chair for health equity in the Department of Medicine. Our goal is to understand the disparities in care beyond just liver disease, at a population-health level within our health system. I've enjoyed looking at some of the problems that exist upstream of liver disease, such as high blood pressure.
Q: What interested you in pursuing research in this field?
A: I became interested in liver disease and liver transplantation when I was in medical school. I had attended a transplant committee meeting where patient information is reviewed and decisions are made about who gets listed for transplant. I looked around at the people making these decisions and the conversations being had, and I realized it was important to have somebody like me in the room.
It is important to have diversity in voice, perspective and lived experience in that kind of setting, and it just wasn't there. I felt somebody needed to represent the interests of marginalized groups from a place of understanding. That's how I first became interested in this concept of scarce resource allocation and transplant.
Q: What do you wish people knew about liver disease and liver cancer?
A: I wish people knew that alcohol and viruses are not the only cause of liver disease. Having fat in the liver can cause cirrhosis, permanent scarring of the liver, and people with cirrhosis are at a higher risk of developing liver cancer.
Obesity, diabetes and other risk factors for putting fat in the liver can put someone at an increased risk of liver disease and liver cancer. I don't think many people realize that.
Q: What do you enjoy most about your work?
A: I really enjoy talking to patients, hearing their solutions and what they think the barriers and needs are. For a long time, people who have developed interventions have come up with solutions on their own. But we are bringing patients into focus groups, telling them about the problems and asking them how they would solve the problems from their perspectives. If we can understand that better, we have a better chance at being effective and improving outcomes.
