Patient Navigation for CRC Screening with Low-Income Minorities

描述（由申请人提供）：与所有其他种族群体相比，非裔美国人（AA）的结直肠癌（CRC）发病率和死亡率最高。可能导致这一趋势的一个因素是AA中CRC筛查的参与率较低，这对CRC的预防和早期发现至关重要。最近的数据表明，癌前息肉的切除（通过结肠镜检查）可使CRC发病率降低75- 90%。尽管实施了国家政策变化，以增加CRC筛查（通过医疗补助/医疗保险报销CRC筛查和更容易“开放”获得结肠镜检查），但依从性仍然低得惊人。我们的初步数据显示，即使在实施标准患者导航（SPN）（即，帮助病人预约/保持预约），只有40%的低收入少数民族遵循了医生的建议。在认知行为社会学习理论作为概念框架和文化目标作为干预策略的指导下，拟议的随机临床试验将研究在SPN中整合对结肠镜检查的个人和文化障碍的有针对性的讨论（即，恐惧、缺乏知识、对医学的不信任、宿命论和恐惧）。基于对来源可信度和参照群体社会认同理论的研究，我们还将探讨导航员作为同伴的地位对文化目标PN的影响。因此，我们将比较三种PN策略：由专业导航员进行的SPN，由专业人员进行的文化靶向PN（CTPN-Pro）和由接受结肠镜检查的同行进行的文化靶向PN（CTPN-Peer）。具体目标：目标1：比较SPN、CTPN-Pro和CTPN-Peer在有初级保健医生转诊进行结肠镜检查的平均风险、低收入AA患者中对结肠镜检查CRC筛查依从性的有效性。目标2：探索潜在机制（即，介导物），并检查CTPN-Pro和CTPN-Peer对谁最有效（即，主持人）。目的3：比较CTPN-Pro和CTPN-Peer的成本效益。将根据筛查的直接临床成本（即，与人员、空间和设备的更有效使用相关的节省）和患者成本（即，CRC治疗的成本和患者每挽救生命年的机会成本）。从拟议的工作结果将促进PN的广泛传播，以减少种族和种族的CRC发病率，死亡率的健康差异，并将促进我们对PN的理解。

DESCRIPTION (provided by applicant): Colorectal Cancer (CRC) incidence and mortality rates are highest in African Americans (AA's) compared with all other ethnic groups. One factor that may contribute to this trend is the lower rate of participation in CRC screening among AAs, which is critical to the prevention and early detection of CRC. Recent data indicate that the removal of precancerous polyps (via colonoscopy) decreases CRC incidence by 75-90 percent. Despite the implementation of national policy changes to increase CRC screening (through Medicaid/Medicare reimbursement for CRC screening and easier "open" access to colonoscopy) adherence remains alarmingly low. Our preliminary data show that, even after implementation of standard patient navigation (SPN) (i.e., assisting patients with making/keeping their appointments), only 40 percent of low-income minorities followed-through on their physician recommendation. Guided by Cognitive-Behavioral Social Learning Theory as a conceptual framework and cultural targeting as an intervention strategy, the proposed randomized clinical trial will investigate integrating within SPN a targeted discussion of intrapersonal and cultural barriers to colonoscopy (i.e., fear, lack of knowledge, medical mistrust, fatalism and fear) prevalent with low-income AAs. Based on research on source credibility and reference group-based social identity theory, we will also explore navigator status as a peer on the impact of culturally targeted PN. Thus, we will compare three PN strategies: SPN carried out by a professional navigator, Culturally Targeted PN carried out by a professional (CTPN-Pro) and Culturally Targeted PN carried out by a peer who has undergone colonoscopy (CTPN-Peer). Specific Aims: Aim 1: Compare the efficacy of SPN, CTPN-Pro, and CTPN-Peer on adherence to colonoscopy CRC screening in average risk, low-income AAs who have a primary care physician referral for colonoscopy. Aim 2: Explore potential mechanisms (i.e., mediators) underlying the beneficial effects of CTPN-Pro and CTPN-Peer and to examine for whom the CTPN-Pro and CTPN-Peer are most effective (i.e., moderators). Aim 3: Compare the cost effectiveness of CTPN-Pro and CTPN-Peer. Cost effectiveness will be examined in terms of direct clinical costs of screening (i.e., savings associated with more efficient use of personnel, space, and equipment) and patient costs (i.e., costs of CRC treatment and the opportunity costs to the patient per life-year saved). Results from the proposed work will facilitate the broad dissemination of PN to reduce ethnic and racial health disparities in CRC incidence mortality and will advance our understanding of PN.