Colon cancer disparity elimination: a faith-based participatory partnership

描述(由申请人提供)：在非裔美国人(AA)中消除明显的结直肠癌相关差异是可能的。在这个以社区为基础的参与性研究项目(CPBR)中，我们解决了解决方案的供需两个部分。聘用了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项面向信仰的无障碍结肠镜筛查计划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50,000多名不同种族的美国人不必要地死亡。多重障碍导致了再生障碍性贫血的发病率和死亡率的不可接受的差异，结果是再生障碍性贫血男性晚期结直肠癌的死亡率是白人男性的两倍。从良性息肉演变而来的结直肠癌的发现为医生提供了充足的时间，在癌症发展之前切除有害组织。有文献记载，从息肉出现到恶变的时间间隔较短，这突显了在再障人群中筛查的重要性。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。除能力问题外，筛查的许多障碍是与患者有关的特点，如知识、态度和信仰、文化和种族问题、筛查方法的可接受性(S)、支付能力以及其他社会经济和环境问题(即交通、耻辱、社会支持等)。虽然超过80%的结肠镜检查是由胃肠科医生提供的，但只有不到4%的培训人员是AA，这导致了具有文化能力的结肠镜检查提供者之间的差距越来越大。使用一个包括健康信念模型、社会认知理论和RE-AIM评估模型的三角理论框架，我们将进一步展示一个成功的解决方案，以满足供应(结直肠筛查的能力)和需求(目标患者获得和利用结直肠筛查的机会)。第一阶段研究证实，依从性可以达到与乳腺癌筛查(75%)相当的水平。令人震惊的高肿瘤发生率(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.