Improving the Process of Cancer Screening for Low Income Diverse Populations

改善低收入多样化人群的癌症筛查过程

• 批准号: 7459206
• 负责人: HOWARD K. KOH
• 金额: $ 9.84万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-05-06 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7459206
• 关键词: Adult; Area; Cancer Etiology; Cessation of life; Colorectal Cancer; Communities; Community Health Centers; Community Networks; Comprehensive Health Care; Data Analyses; Development; Disadvantaged; Disease; Endoscopy; Family; Goals; Health; Health Personnel; Health Services; Hospitals; Incidence; Income; Interview; Knowledge; Learning; Literature; Low income; Massachusetts; Mentors; Minority; Parents; Patients; Pattern; Perception; Persons; Phase; Pilot Projects; Population; Population Heterogeneity; Process; Program Research Project Grants; Provider; Public Health Schools; Qualifying; Rate; Research; Research Personnel; Research Proposals; Resources; Risk; Screening for cancer; Screening procedure; Services; Testing; Underserved Population; United States; Work; base; cancer health disparity; career; colorectal cancer screening; community based participatory research; experience; federal poverty level; follow-up; improved; interest; medically underserved; mortality; programs

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.

描述（由申请人提供）：结直肠癌（CRC）是美国癌症死亡的第二大原因。在过去二十年中，这种可预防疾病的死亡率稳步下降，部分原因是筛查的增加。筛查有可能降低结直肠癌的发病率和死亡率。然而，在收入低于联邦贫困线200%的50岁以下家庭中，只有29%的人曾经做过结直肠癌筛查，而在高收入阶层中，这一比例为36%。因此，弱势群体死于结直肠癌的风险更高。联邦认证的社区保健中心（CHC）向医疗服务不足的人提供全面的保健服务，无论其支付能力如何，并由包括服务消费者在内的社区委员会管理。因此，这为缩小癌症差异的学术界伙伴关系提供了一个独特的环境。然而，关于基于社区的参与式研究（CBPR）方法在CHCs中筛查CRC模式的文献有限。该试点提案将研究在马萨诸塞州中部的两个CHCs中使用CBPR方法对弱势患者进行CRC筛查的几个关键方面。该项目将：1)检查在CHC环境中服务的成年人的筛查模式；2)对在卫生中心和地区医院提供结直肠癌筛查服务的卫生保健提供者进行定性访谈，以确定提高筛查率和异常检查随访率的障碍和机会。在探索性分析中，我们将检查异常筛查的随访情况。长期目标是通过以社区为基础的努力，对弱势群体的癌症筛查产生有意义的改善，从而减少结直肠癌的差异，这是本项目的母社区网络计划项目拨款massconect的一个关键目标。该提案是MassCONECT持续努力的一部分，并将使用CBPR原则实施，以：1)利用社区内的优势和资源；2)促进合作伙伴在研究各个阶段的协作和公平参与；3)促进共同学习和授权过程；4)利用CBPR伙伴作为传播工具，向所有伙伴传播所获得的发现和知识。我们期望这种新的研究经验将使学术界和社区合作伙伴以及所服务的人群受益。该研究计划也是Doubeni博士职业发展的一部分，他是一名少数民族初级临床研究员，其研究兴趣集中在消除CRC差异上。Doubeni博士将与一位专门的导师合作，该导师将与社区合作伙伴和哈佛大学公共卫生学院的一组经验丰富的研究人员合作实施该项目。