Cancer Prevention among Urban Poor with Complex Chronic Conditions

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DESCRIPTION (provided by applicant): Chronic disease is a major contributor to health disparities, and complex chronic disease (multiple chronic conditions requiring multiple providers) is increasingly common. Literature suggests that individuals with chronic disease receive less preventive cancer screening than individuals without a chronic disease, but little research is available to assess the incorporation of preventive cancer screening among patients with complex chronic disease (CCD). For minority populations with limited resources and disproportionate rates of some chronic conditions, this may contribute to poorer outcomes and greater disparities. This study will build upon a well established partnership of university and community collaborators to assess barriers to and motivators for preventive cancer screening and will design a patient-driven intervention to incorporate cancer screening into chronic disease management. The Community Based Participatory Research (CBPR) team will be jointly led by 2 PIs, one from the community and one from a university. A CBPR Steering Committee will include 4 researchers from a School of Medicine, a School of Public Health, and a Cancer Research Institute, 2 community-based organizations, 2 primary care practices serving predominantly minority low- income patients, and a Patient Action Team of patients with CCD. The study aims are to: (1) conduct a cross-sectional study to describe cancer prevention screening among patients with CCD; (2) design a pilot cancer-prevention intervention with a Patient Action Team (composed of patients with CCD) based on patient-reported factors that enable or hinder cancer prevention screening among adults with CCD in low- income, minority communities; and (3) conduct a pilot cancer-prevention intervention among patients with CCD in preparation for a larger CBPR Roll study. Specifically, this study will develop a registry of patients with complex chronic disease from 2 community medical practices. The registry will be used to: (a) conduct a descriptive cross-sectional study to explore disparities in cancer prevention screening (Aim 1); (b) recruit patients with CCD to serve on a Patient Action Team to design an intervention (Aim 2); and (c) recruit patients with CCD to pilot test the patient-centered intervention (Aim 3). RELEVANCE (See instructions): The prevalence of adults with multiple chronic diseases is increasing. This proposal will establish a university-community partnership to engage patients with complex chronic disease living in predominately minority low-income communities to collaborate in developing an intervention to improve cancer prevention screening. The intervention will be based on patient perceptions of need, priority, barriers, and motivators to include preventive cancer screening as part of their patient-centered care regimen.