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

项目摘要/摘要 前列腺癌(PCA)给非洲裔美国男性带来了不成比例的负担，他们的发病率高出63%。 发病率，更常被诊断为侵袭性疾病，死亡率是 白人。死亡率过高的原因之一是没有得到明确的治疗(例如，手术和 放射治疗)在最有益的时候(治疗中)。此外，过度治疗低风险疾病 (可能无益但有严重副作用的疗法)会导致生活质量的差异，因为 非洲裔美国男性报告说，更多的与治疗相关的副作用转化为较低的生活质量。所有的 这些差距在低收入的非洲裔美国男性中最为明显，他们中的许多人的收入都很低。 普及保健知识，在低资源环境(如公立医院和其他安全网)接受治疗 )，强调在这一背景下进行有针对性的研究的必要性。PCA治疗选择令人望而生畏 即使对高识字率的患者来说，沟通也是一项挑战，因为在生存和生存之间存在复杂的权衡 以及非常个人化的生活质量。为了缓解这场复杂的治疗方案的完美风暴 在沟通方面的限制，我们将在低收入非裔美国人之间建立关系桥梁 并通过在关系中锚定基于证据的同伴导航干预来同等的PCA处理 非洲裔美国人兄弟会的概念，作为促进信任和赋权的手段，从而优化 以患者为中心的沟通和护理质量。我们的具体目标是：(1)发展多维 非裔美国人安全网对当前前列腺癌护理和治疗决策流程的了解 患者；(2)采用现有的同行导航干预措施，使非裔美国人PCA患者成为 高质量以患者为中心的PCA护理合作伙伴；以及(3)试点测试适用于以下项目的对等导航协议 可行性和可接受性，以及对以患者为中心和选择的治疗方法的影响。这个K01项目将 通过直接针对多个要素在单个集成的PCA治疗质量中产生重大影响 接近。候选人Nynikka Palmer博士，公共卫生硕士，普通内科助理教授 在旧金山加州大学旧金山综合医院，二期预约 泌尿外科和放射肿瘤科。在卓越的指导团队的支持下，以及 执行相互关联的培训和研究活动，帕尔默博士将开展正式的课程工作， 独立辅导式学习和体验式学习，围绕三个关键主题：(1)深度 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，以及(3)随机对照试验的设计和实施。这个K01项目 将有助于帕尔默博士的长期职业目标，成为一名独立的调查员， 实施和传播具有文化意义的干预措施，以提高癌症护理和治疗的质量 减轻非洲裔美国男性的PCA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.