Colon cancer disparity elimination: a faith-based participatory partnership

描述（由申请人提供）：消除非洲裔美国人（AA）中明显的结直肠癌相关差异是可能的。在这个基于社区的参与性研究项目（CPBR）中，我们解决了解决方案的供应和需求两个部分。通过聘用在第一阶段成功培训的社区顾问和医生，我们有足够的提供者基础来满足这种以信仰为导向的无障碍结肠镜检查倡议所带来的日益增长的需求。结直肠癌（CRC）主要是通过筛查和切除癌前息肉来预防的。不幸的是，每年有超过5万名不同种族的美国人不必要地死亡。多重障碍导致AA的发病率和死亡率存在不可接受的差异，结果AA男性晚期结直肠癌的死亡率是白人男性的两倍。良性息肉演变为结直肠癌的发现给医生提供了充足的时间在癌症发展之前切除相关组织。从息肉出现到其恶性转化的时间间隔较短，强调了在AA人群中进行筛查的重要性。我们也知道结肠镜检查是“黄金标准”。目前进行结肠镜检查的能力远远低于筛查高危人群所需的能力，因为最近的数据显示，只有三分之一的适当人群符合要求。除了能力问题外，筛查的许多障碍是与患者相关的特征，如知识、态度和信仰、文化和种族问题、筛查方法的可接受性、支付能力以及其他社会经济和环境问题（即交通、污名、社会支持等）。虽然超过80%的结肠镜检查是由胃肠病学家提供的，但在培训中只有不到4%的人是AA，这导致在文化上有能力的结肠镜检查提供者之间的差距越来越大。使用三角理论框架，包括健康信念模型，社会认知理论和RE-AIM评估模型，我们将进一步展示一个成功的解决方案，以解决供应（结肠直肠癌筛查的能力）和需求（有针对性的患者获得和利用结肠直肠癌筛查）。I期研究证实，依从性可以达到与乳腺癌筛查相当的水平（75%）。惊人的高瘤变率（4%）强调了这一努力的关键重要性。

DESCRIPTION (provided by applicant): Elimination of the glaring colorectal cancer-related disparities in African Americans (AA) IS POSSIBLE. In this community based participatory research project (CPBR), we address both the SUPPLY and DEMAND components of the solution. Employing the community consultants and physicians successfully trained in Phase I, we have an adequate provider base to satisfy the increased demand resulting from this faith oriented barrier-free colonoscopy screening initiative. Colorectal cancer (CRC) is predominately preventable through screening for and removal of precancerous polyps. Unfortunately every year over 50,000 Americans of all races die unnecessarily. Multiple barriers result in an unacceptable disparity in both incidence and mortality for the AA, with the result that the death rate for AA males with advanced CRC cancer is double that for white males. The discovery of the evolution of CRC from benign polyps gives physicians ample time to remove the offending tissue prior to the development of cancers. The importance for screening in the AA population is accentuated by the documented shorter interval from the appearance of a polyp until its malignant transformation. We also know that colonoscopy is the "gold standard." The current capacity for performing colonoscopy is far below what is needed to screen the at-risk population as recent data reveals that only one-third of the appropriate population is compliant. In addition to capacity issues, many barriers to screening are patient related characteristics such as knowledge, attitudes and beliefs, cultural and ethnic issues, acceptability of screening method(s), ability to pay, and other socioeconomic and environmental issues (i.e. transportation, stigma, social support, etc.). Although over 80% of colonoscopies are provided by gastroenterologists, less than 4% in training are AA, fostering a growing gap in culturally competent colonoscopy providers. Using a triangulated theoretical framework including the Health Belief Model, the Social Cognitive Theory and the RE-AIM Evaluation model, we will further demonstrate a successful solution to addressing both SUPPLY (capacity for colorectal screening) and DEMAND (targeted patient access to and utilization of colorectal screening). The Phase I study confirmed that compliance can be achieved comparable to that for breast cancer screening (75%). The astounding high-rate of neoplasia (4%) emphasizes the critical importance of this endeavor.