Improving the Process of Cancer Screening for Low Income Diverse Populations

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DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. There has been a steady decrease in the mortality rates for this preventable disease over the last two decades due in part to an increase in screening. Screening has the potential to both reduce incidence and deaths for CRC. However, only about 29% of persons > 50 years from families with incomes below 200% of federal poverty level have ever had CRC screening compared to 36% among those in higher income brackets. Consequently, disadvantaged populations have a higher risk of death from CRC. Federally-qualified community health centers (CHC) provide comprehensive health care services to medically underserved persons regardless of ability to pay and are governed by a community board that includes consumers of services. Therefore, this provides a unique setting for an academic-community partnership for reducing cancer disparities. However, there is limited literature on the patterns of CRC screening in CHCs using the community-based participatory research (CBPR) approach. This pilot proposal will examine several key facets of CRC screening for disadvantaged patients at two CHCs in central Massachusetts using CBPR approach. This project will: 1) examine patterns of screening among adults served in the CHC setting; and 2) conduct qualitative interviews of healthcare providers involved in providing CRC screening services at the health centers and area hospitals in order to identify barriers and opportunities for improving rates of screening and follow-up of abnormal tests. In exploratory analyses, we will examine the follow-up of abnormal screening. The long-term goal is to reduce CRC disparities by producing meaningful improvements in cancer screening for disadvantaged persons through community-based efforts, a key goal of the parent Community Networks Program project grant for this project -MassCONECT. This proposal is part of the ongoing efforts of MassCONECT, and will be implemented using CBPR principles to: 1) build on strengths and resources within the community; 2) facilitate collaborative and equitable involvement of partners in all phases of the research; 3) promote a co-learning and empowering process; and 4) disseminate findings and knowledge gained to all partners using the CBPR partners as vehicles of dissemination. We expect that this new research experience will benefit the academic and community partners, and the populations served. This research proposal is also part of the career development of Dr. Doubeni, a minority junior clinician-investigator whose research interest is focused on eliminating CRC disparities. Dr. Doubeni will work with a dedicated mentor who will partner with the community partners and a team of experienced researchers from the Harvard School of Public Health in implementing this project.