Constructing a Relational Bridge to Achieve High-Quality Prostate Cancer Care for African Americans

项目总结/摘要 前列腺癌（PCa）对非洲裔美国男性造成了不成比例的负担，他们的前列腺癌发病率比男性高63%。 发病率，更经常被诊断为侵袭性疾病，死亡率是 白色男人。死亡率过高的原因之一是未能接受明确的治疗（例如，手术和 当它是最有益的（治疗不足）。此外，过度治疗低风险疾病 （可能没有益处但有严重副作用的疗法）导致生活质量的差异， 非裔美国男性报告更多的治疗相关的副作用，转化为较低的生活质量。所有 这些差异在低收入的非洲裔美国人中最为明显，其中许多人的收入很低， 卫生知识普及，并在资源匮乏的环境中接受治疗（例如，公立医院和其他安全网 系统），强调需要在这种情况下进行有针对性的研究。PCa治疗选择令人望而生畏 即使是高文化程度的患者也面临沟通挑战，因为生存和死亡之间存在复杂的权衡。 和生活质量都是非常个人化的。为了缓解复杂治疗方案的完美风暴， 在沟通的限制，我们将建立一个低收入的非洲裔美国人之间的关系桥梁 和平等的PCa治疗，通过锚定基于证据的干预，同伴导航的关系， 非洲裔美国人兄弟情谊的概念，作为一种手段，以促进信任和赋权，从而优化 以病人为中心的沟通和护理质量。我们的具体目标是：（1）发展一个多层面的 了解非洲裔美国人安全网中当前PCa护理和治疗决策过程 患者;（2）调整现有的同伴导航干预措施，使非洲裔美国PCa患者能够 合作伙伴在高质量的以患者为中心的PCa护理;和（3）试点测试适应同行导航协议， 可行性和可接受性，以及对以患者为中心和治疗选择的影响。K 01项目将 通过直接针对PCa治疗质量的多个要素， approach.候选人Nynikka Palmer，DrPH，MPH，是普通内科助理教授 在旧金山弗朗西斯科总医院，加州大学旧金山分校弗朗西斯科， 泌尿外科和放射肿瘤科。在优秀的指导团队的支持下， 在执行相互关联的培训和研究活动时，帕尔默博士将开展正式的课程作业， 独立的指导学习和体验式学习，围绕三个关键主题：（1）深度学习 通过民族志的文化理解和方法，（2）以患者为中心的健康沟通干预 开发和实施;（3）设计和实施随机对照试验。K 01项目 将促进帕尔默博士的长期职业目标，成为一个独立的调查员谁开发， 实施和传播具有文化意义的干预措施，以提高癌症护理的质量， 减少非裔美国人中PCa的负担。

PROJECT SUMMARY/ABSTRACT Prostate cancer (PCa) imposes a disproportionate burden on African American men, who have a 63% higher incidence, are more often diagnosed with aggressive disease, and have more than twice the mortality rate of White men. Among the causes of excess mortality is failure to receive definitive treatment (e.g., surgery and radiation) when it would be most beneficial (under-treatment). In addition, over-treatment of low-risk disease (therapies that may not be beneficial yet have serious side effects) contributes to disparities in quality of life, as African American men report more treatment-related side effects that translate to lower quality of life. All of these disparities are most pronounced among low income African American men, many of whom have low health literacy, and receive treatment in low resource settings (e.g., public hospitals and other safety net systems), underscoring the need for targeted research in this setting. PCa treatment options present daunting communication challenges even for high literacy patients, as there are complex trade-offs between survival and quality of life that are very personal. To mitigate this perfect storm of complex treatment options and constraints in communication, we will construct a relational bridge between low income African American men and equal PCa treatment by anchoring the evidence-based intervention of peer navigation in the relational concept of African American brotherhood as a means to foster trust and empowerment, and thus to optimize patient-centered communication and quality of care. Our specific aims are to: (1) develop a multi-dimensional understanding of current PCa care and treatment decision processes among African American safety net patients; (2) adapt an existing peer navigation intervention to empower African American PCa patients as partners in high quality patient-centered PCa care; and (3) pilot test the adapted peer navigation protocol for feasibility and acceptability, and for impact on patient centeredness and treatment chosen. This K01 project will have significant impact by directly targeting multiple elements of PCa treatment quality in a single integrated approach. The candidate, Nynikka Palmer, DrPH, MPH, is an Assistant Professor in General Internal Medicine at San Francisco General Hospital, University of California, San Francisco with secondary appointments in the Departments of Urology and Radiation Oncology. With support from an exceptional mentoring team, and execution of interconnected training and research activities, Dr. Palmer will carry out formal coursework, independent mentored learning, and experiential learning that converge around three key topics: (1) depth in cultural understanding and methods via ethnography, (2) patient-centered health communication intervention development and implementation, and (3) design and conduct of randomized controlled trials. This K01 project will facilitate Dr. Palmer's long-term career goal to become an independent investigator who develops, implements, and disseminates culturally meaningful interventions to improve the quality of cancer care and reduce the burden of PCa among African American men.