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Grant Details

Grant Number: 5R01CA120658-05 Interpret this number
Primary Investigator: Redd, William
Organization: Icahn School Of Medicine At Mount Sinai
Project Title: Patient Navigation for Crc Screening with Low-Income Minorities
Fiscal Year: 2011
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Abstract

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.

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Publications

Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation?
Authors: Philip EJ, Shelton RC, Thompson HS, Efuni E, Itzkowitz S, Jandorf L
Source: Cancer Causes Control, 2014 Sep;25(9), p. 1227-31.
EPub date: 2014 Jun 20.
PMID: 24946743
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Challenges and possible solutions to colorectal cancer screening for the underserved.
Authors: Gupta S, Sussman DA, Doubeni CA, Anderson DS, Day L, Deshpande AR, Elmunzer BJ, Laiyemo AO, Mendez J, Somsouk M, Allison J, Bhuket T, Geng Z, Green BB, Itzkowitz SH, Martinez ME
Source: J Natl Cancer Inst, 2014 Apr;106(4), p. dju032.
EPub date: 2014 Mar 28.
PMID: 24681602
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Colonoscopy-specific fears in African Americans and Hispanics.
Authors: Miller SJ, Iztkowitz SH, Redd WH, Thompson HS, Valdimarsdottir HB, Jandorf L
Source: Behav Med, 2014 Mar 12;null, p. null.
EPub date: 2014 Mar 12.
PMID: 24621051
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Colorectal neoplasia detection among black and Latino individuals undergoing screening colonoscopy: a prospective cohort study.
Authors: Lee KK, Jandorf L, Thélèmaque L, Itzkowitz SH
Source: Gastrointest Endosc, 2014 Mar;79(3), p. 466-72.
PMID: 24528828
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Barriers and facilitators to adherence to screening colonoscopy among African-Americans: a mixed-methods analysis.
Authors: Wong CR, Bloomfield ER, Crookes DM, Jandorf L
Source: J Cancer Educ, 2013 Dec;28(4), p. 722-8.
PMID: 23832432
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Culturally targeted patient navigation for increasing african americans' adherence to screening colonoscopy: a randomized clinical trial.
Authors: Jandorf L, Braschi C, Ernstoff E, Wong CR, Thelemaque L, Winkel G, Thompson HS, Redd WH, Itzkowitz SH
Source: Cancer Epidemiol Biomarkers Prev, 2013 Sep;22(9), p. 1577-87.
EPub date: 2013 Jun 10.
PMID: 23753039
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Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system.
Authors: Jandorf L, Cooperman JL, Stossel LM, Itzkowitz S, Thompson HS, Villagra C, Thélémaque LD, McGinn T, Winkel G, Valdimarsdottir H, Shelton RC, Redd W
Source: Health Educ Res, 2013 Oct;28(5), p. 803-15.
EPub date: 2013 Feb 7.
PMID: 23393099
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Cancer care in East and Central Harlem: community partnership needs assessment.
Authors: Edwards TA, Jandorf L, Freemantle H, Sly J, Ellison J, Wong CR, Villagra C, Hong J, Kaleya S, Poultney M, Villegas C, Brenner B, Bickell N
Source: J Cancer Educ, 2013 Mar;28(1), p. 171-8.
PMID: 23108854
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Identifying barriers to colonoscopy screening for nonadherent African American participants in a patient navigation intervention.
Authors: Sly JR, Edwards T, Shelton RC, Jandorf L
Source: Health Educ Behav, 2013 Aug;40(4), p. 449-57.
EPub date: 2012 Oct 19.
PMID: 23086556
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Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities.
Authors: Jandorf L, Stossel LM, Cooperman JL, Graff Zivin J, Ladabaum U, Hall D, Thélémaque LD, Redd W, Itzkowitz SH
Source: Cancer, 2013 Feb 1;119(3), p. 612-20.
EPub date: 2012 Jul 25.
PMID: 22833205
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Training experiences of lay and professional patient navigators for colorectal cancer screening.
Authors: Shelton RC, Thompson HS, Jandorf L, Varela A, Oliveri B, Villagra C, Valdimarsdottir HB, Redd WH
Source: J Cancer Educ, 2011 Jun;26(2), p. 277-84.
PMID: 21287311
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