||5R21CA090743-02 Interpret this number
||Univ Of Massachusetts Med Sch Worcester
||Preparing to Advance Colorectal Screening in Springfield
DESCRIPTION: Colorectal cancer (CRC) is the second leading cause of
cancer-related deaths and the third most commonly diagnosed cancer for both men
and women in the United States. During 1973-1995, the incidence among African
American men and women has increased and exceeds the rate among whites. African
American men have the highest incidence rates. Furthermore, although the CRC
mortality rate decreased 21 percent among the general population, mortality
increased 26 percent among African American males aged 65 years and older, and
16 percent among African American males less than 65. African American women
are more likely to die of CRC than are women of any other racial/ethnic group.
African Americans are significantly more likely to be diagnosed at late-stage
than Whites. Five-year survival rates for the period 1989-94 were 64 percent in
whites and 52 percent in African Americans. CRC screening is known to be
effective both by early detection and for prevention by removal of precancerous
polyps but is underused.
We propose a formative feasibility study that will serve as a basis for a
subsequent randomized trial testing the effectiveness of innovative strategies
in community health centers (CHCs) to improve CRC screening participation by
African Americans. In the first component, we will profile the clinical and
management information system(s) currently in place in the participating
community health centers and other sites as appropriate (e.g., endoscopy
clinics) to estimate capability for intervention planning, delivery and
evaluation. The second component will explore the feasibility and the potential
effectiveness of various intervention strategies, as well as priority messages
within the strategies, which are appropriate for this population. The needs
assessment approaches will include focus groups of patients and community
members, interviews of key informants among health center providers and staff
and gastroenterologists, review of medical records and pilot patient surveys.
Data collected will also inform the sampling and accrual projections and
instrument development of for the subsequent trial.
The products of this R2 1 include a) a published report on factors related to
CRC screening in African Americans; b) a systems analysis of the context and
processes of care; c) pre-tested instruments and d) detailed recommendations
for the interventions to be tested in a randomized trial.
Challenges To Research In Urban Community Health Centers
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