Training African American Peers as Patient Navigators for Colon Cancer Screening

培训非裔美国同龄人作为结肠癌筛查的患者导航员

• 批准号: 8116074
• 负责人: Lina Jandorf
• 金额: $ 32.07万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-11 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8116074
• 关键词: Address; Adherence; African American; Age; American Cancer Society; Church; Clinical Trials Design; Collaborations; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Communities; Cost Effectiveness Analysis; Cost Savings; Data; Development; Early Diagnosis; Educational Intervention; Educational process of instructing; Effectiveness; Ethnic Origin; Evaluation; Flexible fiberoptic sigmoidoscopy; Funding; Goals; Health; Health Promotion; Health Status; Health education; Healthcare; Healthcare Systems; Hospitals; Incidence; Institute of Medicine (U.S.); Institution; Investigation; Knowledge; Morbidity - disease rate; New York City; Outcome; Paper; Patients; Policies; Prevention; Primary Care Physician; Program Evaluation; Public Health; Race; Randomized; Randomized Clinical Trials; Recruitment Activity; Relative (related person); Reporting; Research; Review Literature; Role; Role playing therapy; Schedule; Screening for cancer; Screening procedure; Supervision; Tape Recording; Training; Training Programs; Woman; Work; base; behavior test; cancer health disparity; colorectal cancer screening; cost; cost effective; cost effectiveness; follow-up; men; mortality; peer; programs; skill acquisition; success; volunteer

DESCRIPTION (provided by applicant): Cancer health disparities related to race and ethnicity are among the most serious problems facing the US health care system. A recent Institute of Medicine report stated that such disparities are seen at every level of health care, from prevention to treatment and follow-up. This problem is acutely evident in the figures for colorectal cancer (CRC) among African Americans (AAs). According to the American Cancer Society, AAs have the highest CRC incidence and mortality of any ethnic/racial group. Indeed, CRC incidence and mortality are 15% and 43% higher among AAs than Whites, respectively. These disparities could be effectively reduced through greater AA participation in CRC screening and early detection. More importantly, due to the preponderance of CRC in AAs beyond the reach of the flexible sigmoidoscopy, increased adherence to colonoscopy among AAs will save lives. Although there is clear evidence that providing patients with someone to help them manage/navigate the health care system (i.e., patient navigation (PN)) is effective in helping them to complete cancer screening, very few hospitals provide PN for colonoscopy. The vast majority of hospitals in NYC are unable to provide PN for patients for whom colonoscopy is recommended, in large part because of the costs associated with professional-led PN. The proposed R-25E seeks to address this serious public health problem by investigating the success of training AAs who have undergone colonoscopy to serve as peer patient navigators to help others from their community complete CRC screening via colonoscopy. The proposed training plan is supported by seven distinct lines of evidence: 1) research indicating a 76-90% reduction in CRC mortality through colonoscopy, 2) the success of PN in increasing participation in health promotion, 3) data from the NYC Department of Health showing underuse of PN for colonoscopy, 4) research demonstrating increased credibility of peers in providing health information, 5) research on volunteer-led health education interventions, 6) the cost savings we found in our preliminary research on peer led PN (PPN) for colonoscopy, and 7) our success in promoting cancer screening and preventative health care practices in AA communities of New York City through our collaboration with community leaders and church groups. The overall goal of the proposed R-25E is to reduce CRC morbidity and mortality by increasing AA participation in colonoscopy in a cost effective way. This will be accomplished through three specific aims: 1) The development and implementation of a training program for Peer Patient Navigation (PPN) to increase participation of AAs in colonoscopy; 2) The examination of the cost effectiveness of the PPN training program in completion of colonoscopy from the perspective of AAs for whom colonoscopy is recommended; and 3) The investigation of the relative cost effectiveness of the PPN training program from the perspective of hospitals.

描述（由申请人提供）：与种族和民族相关的癌症健康差异是美国医疗保健系统面临的最严重问题之一。医学研究所最近的一份报告指出，这种差异存在于医疗保健的各个层面，从预防到治疗和随访。这个问题在非裔美国人 (AA) 结直肠癌 (CRC) 数据中表现得非常明显。根据美国癌症协会的数据，AA 族的 CRC 发病率和死亡率是所有民族/种族群体中最高的。事实上，AA 人群的 CRC 发病率和死亡率分别比白人高 15% 和 43%。通过更多 AA 参与 CRC 筛查和早期检测，可以有效减少这些差异。更重要的是，由于 AA 中 CRC 的比例超出了柔性乙状结肠镜的范围，因此增加 AA 中结肠镜检查的依从性将挽救生命。尽管有明确证据表明，为患者提供专人帮助他们管理/导航医疗保健系统（即患者导航 (PN)）可有效帮助他们完成癌症筛查，但很少有医院提供 PN 进行结肠镜检查。纽约市的绝大多数医院无法为建议进行结肠镜检查的患者提供 PN，很大程度上是因为专业主导的 PN 相关的费用。拟议的 R-25E 旨在通过调查培训接受过结肠镜检查的 AA 作为同伴患者导航员以帮助社区中的其他人通过结肠镜检查完成 CRC 筛查的成功情况来解决这一严重的公共卫生问题。 拟议的培训计划得到七个不同证据的支持：1) 研究表明，通过结肠镜检查可将结直肠癌死亡率降低 76-90%，2) PN 在增加健康促进参与方面取得成功，3) 来自纽约市卫生局的数据健康表明结肠镜检查中 PN 的使用不足，4) 研究表明同伴在提供健康信息方面的可信度有所提高，5) 关于志愿者主导的健康教育干预措施的研究，6) 我们在同伴主导的 PN 的初步研究中发现了成本节省(PPN) 结肠镜检查，以及 7) 我们通过与社区领袖和教会团体的合作，成功地在纽约市 AA 社区推广癌症筛查和预防性医疗保健实践。 拟议 R-25E 的总体目标是通过以具有成本效益的方式增加 AA 参与结肠镜检查来降低 CRC 发病率和死亡率。这将通过三个具体目标来实现： 1) 制定和实施同伴患者导航 (PPN) 培训计划，以提高 AA 参与结肠镜检查的程度； 2) 从推荐结肠镜检查的 AA 角度检查完成结肠镜检查的 PPN 培训计划的成本效益； 3）从医院角度考察PPN培训项目的相对成本效益。