Cancer Prevention among Urban Poor with Complex Chronic Conditions

描述（由申请人提供）：慢性疾病是造成健康差距的主要因素，复杂慢性疾病（需要多个提供者的多种慢性疾病）越来越普遍。文献表明，与没有慢性疾病的个体相比，患有慢性疾病的个体接受的预防性癌症筛查较少，但很少有研究可用于评估复杂慢性疾病（CCD）患者纳入预防性癌症筛查的情况。对于资源有限和某些慢性病发病率不成比例的少数民族人口，这可能导致更差的结果和更大的差距。这项研究将建立在大学和社区合作伙伴关系的基础上，以评估预防性癌症筛查的障碍和动机，并将设计一种患者驱动的干预措施，将癌症筛查纳入慢性病管理。基于社区的参与性研究（CBPR）团队将由两名pi共同领导，一名来自社区，另一名来自大学。CBPR指导委员会将包括来自医学院、公共卫生学院和癌症研究所的4名研究人员、2个社区组织、2个主要为少数低收入患者服务的初级保健机构和一个由CCD患者组成的患者行动小组。本研究的目的是：(1)通过横断面研究描述CCD患者的癌症预防筛查；(2)设计一个试点癌症预防干预与患者行动小组（由CCD患者组成）基于患者报告的因素，促进或阻碍癌症预防筛查在低收入，少数民族社区的成年人CCD；(3)在CCD患者中进行癌症预防干预试点，为更大规模的CBPR Roll研究做准备。具体来说，本研究将建立一个来自两个社区医疗实践的复杂慢性疾病患者的注册表。登记处将用于：(a)进行描述性横断面研究，以探索癌症预防筛查的差异（目标1）；(b)招募CCD患者加入患者行动小组，设计干预措施（目标2）；(c)招募CCD患者进行以患者为中心的干预试验（目标3）。

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.