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National Institutes of Health: National Cancer Institute: Division of Cancer Control and Population Sciences
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

Training Experiences Of Lay And Professional Patient Navigators For Colorectal Cancer Screening
Authors: Shelton,R.C. , Thompson,H.S. , Jandorf,L. , Varela,A. , Oliveri,B. , Villagra,C. , Valdimarsdottir,H.B. , Redd,W.H. .
Source: Journal Of Cancer Education : The Official Journal Of The American Association For Cancer Education, 2011 Jun; 26(2), p. 277-84.
PMID: 21287311
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Cost Analysis Of A Patient Navigation System To Increase Screening Colonoscopy Adherence Among Urban Minorities
Authors: Jandorf L. , Stossel L.M. , Cooperman J.L. , Graff Zivin J. , Ladabaum U. , Hall D. , Thélémaque L.D. , Redd W. , Itzkowitz S.H. .
Source: Cancer, 2013-02-01 00:00:00.0; 119(3), p. 612-20.
PMID: 22833205
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Identifying Barriers To Colonoscopy Screening For Nonadherent African American Participants In A Patient Navigation Intervention
Authors: Sly J.R. , Edwards T. , Shelton R.C. , Jandorf L. .
Source: Health Education & Behavior : The Official Publication Of The Society For Public Health Education, 2013 Aug; 40(4), p. 449-57.
PMID: 23086556
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Cancer Care In East And Central Harlem: Community Partnership Needs Assessment
Authors: Edwards T.A. , Jandorf L. , Freemantle H. , Sly J. , Ellison J. , Wong C.R. , Villagra C. , Hong J. , Kaleya S. , Poultney M. , et al. .
Source: Journal Of Cancer Education : The Official Journal Of The American Association For Cancer Education, 2013 Mar; 28(1), p. 171-8.
PMID: 23108854
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Implementation Of Culturally Targeted Patient Navigation System For Screening Colonoscopy In A Direct Referral System
Authors: Jandorf L. , Cooperman J.L. , Stossel L.M. , Itzkowitz S. , Thompson H.S. , Villagra C. , Thélémaque L.D. , McGinn T. , Winkel G. , Valdimarsdottir H. , et al. .
Source: Health Education Research, 2013 Oct; 28(5), p. 803-15.
PMID: 23393099
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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 C.R. , Thelemaque L. , Winkel G. , Thompson H.S. , Redd W.H. , Itzkowitz S.H. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2013 Sep; 22(9), p. 1577-87.
PMID: 23753039
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Colorectal Neoplasia Detection Among Black And Latino Individuals Undergoing Screening Colonoscopy: A Prospective Cohort Study
Authors: Lee K.K. , Jandorf L. , Thélèmaque L. , Itzkowitz S.H. .
Source: Gastrointestinal Endoscopy, 2014 Mar; 79(3), p. 466-72.
PMID: 24528828
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Colonoscopy-specific Fears In African Americans And Hispanics
Authors: Miller S.J. , Iztkowitz S.H. , Redd W.H. , Thompson H.S. , Valdimarsdottir H.B. , Jandorf L. .
Source: Behavioral Medicine (washington, D.c.), 2015; 41(2), p. 41-8.
PMID: 24621051
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Challenges And Possible Solutions To Colorectal Cancer Screening For The Underserved
Authors: Gupta S. , Sussman D.A. , Doubeni C.A. , Anderson D.S. , Day L. , Deshpande A.R. , Elmunzer B.J. , Laiyemo A.O. , Mendez J. , Somsouk M. , et al. .
Source: Journal Of The National Cancer Institute, 2014 Apr; 106(4), p. dju032.
PMID: 24681602
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Is Obesity Associated With Colorectal Cancer Screening For African American And Latino Individuals In The Context Of Patient Navigation?
Authors: Philip E.J. , Shelton R.C. , Thompson H.S. , Efuni E. , Itzkowitz S. , Jandorf L. .
Source: Cancer Causes & Control : Ccc, 2014 Sep; 25(9), p. 1227-31.
PMID: 24946743
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Cost-effectiveness Of Patient Navigation To Increase Adherence With Screening Colonoscopy Among Minority Individuals
Authors: Ladabaum U. , Mannalithara A. , Jandorf L. , Itzkowitz S.H. .
Source: Cancer, 2015-04-01 00:00:00.0; 121(7), p. 1088-97.
PMID: 25492455
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Predicting Colonoscopy Completion Among African American And Latino/a Participants In A Patient Navigation Program
Authors: Pelto D.J. , Sly J.R. , Winkel G. , Redd W.H. , Thompson H.S. , Itzkowitz S.H. , Jandorf L. .
Source: Journal Of Racial And Ethnic Health Disparities, 2015-03-01 00:00:00.0; 2(1), p. 101-111.
PMID: 25893157
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African-americans' And Latinos' Perceptions Of Using Hypnosis To Alleviate Distress Before A Colonoscopy
Authors: Miller S.J. , Schnur J.B. , Montgomery G.H. , Jandorf L. .
Source: Contemporary Hypnosis & Integrative Therapy, 2011 Sep; 28(3), p. 196-203.
PMID: 26566440
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