Patient Navigation for CRC Screening with Low-Income Minorities

描述(由申请人提供)：与所有其他种族相比，非裔美国人(AA)的结直肠癌(CRC)发病率和死亡率最高。造成这一趋势的一个因素可能是AAA中较低的CRC筛查参与率，这对预防和及早发现CRC至关重要。最近的数据表明，切除癌前息肉(通过结肠镜)可将结直肠癌发病率降低75%-90%。尽管实施了增加结直肠癌筛查的国家政策变化(通过对结直肠癌筛查的医疗补助/医疗保险报销，以及更容易获得结肠镜检查)，但结肠镜检查的遵从率仍然低得惊人。我们的初步数据显示，即使在实施了标准的患者导航(SPN)(即帮助患者预约/遵守他们的预约)之后，也只有40%的低收入少数群体遵循了他们的医生建议。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调查在SPN中整合关于低收入AA普遍存在的个人内部和文化障碍(即恐惧、缺乏知识、医学不信任、宿命论和恐惧)的有针对性的讨论。在研究来源可信度和基于参照群体的社会认同理论的基础上，我们还将探讨导航员的同伴身份对文化目标PN的影响。因此，我们将比较三种PN策略：由专业导航员实施的SPN、由专业人员实施的文化定向PN(CTPN-Pro)和由接受过结肠镜检查的同行实施的文化定向PN(CTPN-Peer)。具体目的：目的1：比较SPN、CTPN-Pro和CTPN-Peer在接受结肠镜检查的平均风险、低收入AA中坚持结肠镜检查的效果。目的2：探索CTPN-Pro和CTPN-Peer有益效果的潜在机制(即，介质)，并研究CTPN-Pro和CTPN-Peer对谁最有效(即，调节剂)。目的3：比较CTPN-Pro和CTPN-Peer的成本效果。成本效益将根据筛查的直接临床成本(即与更有效地使用人员、空间和设备相关的节省)和患者成本(即结直肠癌治疗成本和患者每节省生命年的机会成本)进行审查。拟议工作的结果将促进PN的广泛传播，以减少在CRC发病率和死亡率方面的族裔和种族健康差异，并将增进我们对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.