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Grant Details

Grant Number: 5R21CA129881-02 Interpret this number
Primary Investigator: Schoenberg, Nancy
Organization: University Of Kentucky
Project Title: Increasing Colorectal Cancer Screening for Patients with Multiple Morbidities
Fiscal Year: 2009
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Abstract

DESCRIPTION (provided by applicant): Appalachian and rural underserved residents, in general, experience higher rates of multiple morbidities (MM) with fewer resources to prevent and manage disease. Some researchers have speculated that the well-documented cancer health disparities affecting Appalachians may be attributable to multiple morbidity management demands which may deprioritize essential and efficacious cancer screenings. In this pilot study, we examine whether and how multiple morbidities affect colorectal cancer screening rates. Our long-term goal is to turn this disadvantageous situation of competing time and resource pressure into an advantage by increasing cancer screening services during the more frequent medical interactions of those with multiple morbidities. Addressing the nearly three-quarters of middle aged and older adults with MM is essential due to skyrocketing rates of MM, higher rates of cancer mortality among those with MM, and competing demands of disease prevention and management. We aim to expand our limited understanding of the association between MM and colorectal cancer (CRC) screening through three research activities. First, to obtain rich insights into the factors and circumstances that affect patterns of CRC screening behavior among those with multiple morbidities, in-depth interviews will be conducted with 5 health care providers representing diverse practices in Appalachia and with 40 patients who have two or more chronic diseases. These interviews will provide locally grounded perspectives from the two most salient health decision makers, providers and patients. Second, to insure generalizability, we will assess the impact of factors germane to both MM and CRC screening behavior by conducting a stratified representative survey of Appalachians. Finally, after identifying factors, circumstances, and patterns that prevent CRC screening in the context of multiple morbidities, we will hold focus groups to validate our findings and discuss optimal direction for interventions. Ultimately, these findings will lead to the development of a community-based participatory intervention R01 that will capitalize on the relatively frequent medical care visits of those with multiple morbidities and ultimately will increase CRC screening, improve practice coordination, and decrease cancer-associated deaths. PUBLIC HEALTH RELEVANCE: In the US, the majority of the ever-growing middle aged and older population has multiple morbidities or several chronic diseases. Having multiple morbidities generally decreases the likelihood of receiving highly effective cancer prevention, like colorectal cancer screening. This project uses innovative methods to determine the reasons why those with multiple morbidities may be less likely to get colorectal cancer screening and will eventually develop a culturally consistent intervention for the underserved rural health disparities population of Appalachia to increase early detection of this deadly cancer.

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Publications

The relationship between perceived burden of chronic conditions and colorectal cancer screening among Appalachian residents.
Authors: Tarasenko YN, Fleming ST, Schoenberg NE
Source: J Rural Health, 2014 Winter;30(1), p. 40-9.
EPub date: 2013 Jun 28.
PMID: 24383483
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Primary care physicians' prevention counseling with patients with multiple morbidity.
Authors: Bardach SH, Schoenberg NE
Source: Qual Health Res, 2012 Dec;22(12), p. 1599-611.
EPub date: 2012 Aug 27.
PMID: 22927702
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Rural Residents' Perspectives on Multiple Morbidity Management and Disease Prevention.
Authors: Bardach SH, Schoenberg NE, Tarasenko YN, Fleming ST
Source: J Appl Gerontol, 2011 Dec;30(6), p. 671-699.
PMID: 23833393
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Prevalence of colorectal cancer screening among a multimorbid rural Appalachian population.
Authors: Fleming ST, Schoenberg NE, Tarasenko YN, Pearce KA
Source: South Med J, 2011 Dec;104(12), p. 811-8.
PMID: 22089360
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Relationship between colorectal cancer screening adherence and knowledge among vulnerable rural residents of Appalachian Kentucky.
Authors: Bardach SH, Schoenberg NE, Fleming ST, Hatcher J
Source: Cancer Nurs, 2012 Jul-Aug;35(4), p. 288-94.
PMID: 21946905
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Colorectal cancer screening among rural Appalachian residents with multiple morbidities.
Authors: Tarasenko YN, Schoenberg NE
Source: Rural Remote Health, 2011;11(1), p. 1553.
EPub date: 2011 Jan 21.
PMID: 21280973
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Appalachian residents' experiences with and management of multiple morbidity.
Authors: Schoenberg NE, Bardach SH, Manchikanti KN, Goodenow AC
Source: Qual Health Res, 2011 May;21(5), p. 601-11.
EPub date: 2011 Jan 24.
PMID: 21263063
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"It's a toss up between my hearing, my heart, and my hip": prioritizing and accommodating multiple morbidities by vulnerable older adults.
Authors: Schoenberg NE, Leach C, Edwards W
Source: J Health Care Poor Underserved, 2009 Feb;20(1), p. 134-51.
PMID: 19202253
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