Training African American Peers as Patient Navigators for Colon Cancer Screening

描述(由申请人提供)：与种族和民族有关的癌症健康差距是美国医疗保健系统面临的最严重的问题之一。医学研究所最近的一份报告指出，从预防到治疗和后续治疗，在卫生保健的各个层面都可以看到这种差异。这一问题在非裔美国人的结直肠癌(CRC)数据中表现得尤为明显。根据美国癌症协会的数据，在任何种族/种族群体中，AA的CRC发病率和死亡率都是最高的。事实上，AAA的结直肠癌发病率和死亡率分别比白人高15%和43%。通过让AA更多地参与结直肠癌筛查和早期发现，可以有效地减少这些差异。更重要的是，由于结直肠癌在乙状结肠镜检查范围之外的腹主动脉占优势，增加对结肠镜检查的依从性将挽救生命。尽管有明确的证据表明，为患者提供帮助他们管理/导航医疗系统的人员(即患者导航(PN))在帮助他们完成癌症筛查方面是有效的，但很少有医院为结肠镜检查提供PN。纽约市的绝大多数医院无法为推荐结肠镜检查的患者提供PN，这在很大程度上是因为与专业主导的PN相关的成本。拟议的R-25E旨在通过调查培训接受结肠镜检查的AA作为同行患者导航员的成功情况来解决这一严重的公共卫生问题，以帮助他们社区的其他人通过结肠镜检查完成结直肠癌筛查。 拟议的培训计划得到了七条不同证据的支持：1)研究表明，通过结肠镜检查，CRC死亡率降低了76%-90%；2)PN成功地增加了对健康促进的参与；3)来自纽约市卫生局的数据显示，在结肠镜检查中，PN的使用不足；4)研究表明，同行在提供健康信息方面的可信度提高了；5)关于志愿者领导的健康教育干预的研究；6)我们在用于结肠镜检查的同行主导的PN(PPN)的初步研究中发现了成本节约。以及7)我们通过与社区领袖和教会团体的合作，成功地在纽约市AA社区推广癌症筛查和预防性医疗实践。 拟议的R-25E的总体目标是通过以经济有效的方式增加AA对结肠镜检查的参与来降低结直肠癌的发病率和死亡率。这将通过三个具体目标实现：1)制定和实施同行患者导航(PPN)培训计划，以增加AA对结肠镜检查的参与；2)从推荐结肠镜检查的AA的角度检查PPN培训计划在完成结肠镜检查方面的成本效益；以及3)从医院的角度调查PPN培训计划的相对成本效益。

DESCRIPTION (provided by applicant): Cancer health disparities related to race and ethnicity are among the most serious problems facing the US health care system. A recent Institute of Medicine report stated that such disparities are seen at every level of health care, from prevention to treatment and follow-up. This problem is acutely evident in the figures for colorectal cancer (CRC) among African Americans (AAs). According to the American Cancer Society, AAs have the highest CRC incidence and mortality of any ethnic/racial group. Indeed, CRC incidence and mortality are 15% and 43% higher among AAs than Whites, respectively. These disparities could be effectively reduced through greater AA participation in CRC screening and early detection. More importantly, due to the preponderance of CRC in AAs beyond the reach of the flexible sigmoidoscopy, increased adherence to colonoscopy among AAs will save lives. Although there is clear evidence that providing patients with someone to help them manage/navigate the health care system (i.e., patient navigation (PN)) is effective in helping them to complete cancer screening, very few hospitals provide PN for colonoscopy. The vast majority of hospitals in NYC are unable to provide PN for patients for whom colonoscopy is recommended, in large part because of the costs associated with professional-led PN. The proposed R-25E seeks to address this serious public health problem by investigating the success of training AAs who have undergone colonoscopy to serve as peer patient navigators to help others from their community complete CRC screening via colonoscopy. The proposed training plan is supported by seven distinct lines of evidence: 1) research indicating a 76-90% reduction in CRC mortality through colonoscopy, 2) the success of PN in increasing participation in health promotion, 3) data from the NYC Department of Health showing underuse of PN for colonoscopy, 4) research demonstrating increased credibility of peers in providing health information, 5) research on volunteer-led health education interventions, 6) the cost savings we found in our preliminary research on peer led PN (PPN) for colonoscopy, and 7) our success in promoting cancer screening and preventative health care practices in AA communities of New York City through our collaboration with community leaders and church groups. The overall goal of the proposed R-25E is to reduce CRC morbidity and mortality by increasing AA participation in colonoscopy in a cost effective way. This will be accomplished through three specific aims: 1) The development and implementation of a training program for Peer Patient Navigation (PPN) to increase participation of AAs in colonoscopy; 2) The examination of the cost effectiveness of the PPN training program in completion of colonoscopy from the perspective of AAs for whom colonoscopy is recommended; and 3) The investigation of the relative cost effectiveness of the PPN training program from the perspective of hospitals.