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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


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.


Patient and provider perspectives on the relationship between multiple morbidity management and disease prevention.
Authors: Schoenberg N.E. , Tarasenko Y.N. , Bardach S.H. , Fleming S.T. .
Source: Journal of applied gerontology : the official journal of the Southern Gerontological Society, 2015 Apr; 34(3), p. 359-76.
EPub date: 2013-09-17.
PMID: 24652900
Related Citations

The relationship between perceived burden of chronic conditions and colorectal cancer screening among Appalachian residents.
Authors: Tarasenko Y.N. , Fleming S.T. , Schoenberg N.E. .
Source: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2014 Winter; 30(1), p. 40-9.
EPub date: 2013-06-28.
PMID: 24383483
Related Citations

Primary care physicians' prevention counseling with patients with multiple morbidity.
Authors: Bardach S.H. , Schoenberg N.E. .
Source: Qualitative health research, 2012 Dec; 22(12), p. 1599-611.
EPub date: 2012-08-27.
PMID: 22927702
Related Citations

Relationship between colorectal cancer screening adherence and knowledge among vulnerable rural residents of Appalachian Kentucky.
Authors: Bardach S.H. , Schoenberg N.E. , Fleming S.T. , Hatcher J. .
Source: Cancer nursing, 2012 Jul-Aug; 35(4), p. 288-94.
PMID: 21946905
Related Citations

Rural Residents' Perspectives on Multiple Morbidity Management and Disease Prevention.
Authors: Bardach S.H. , Schoenberg N.E. , Tarasenko Y.N. , Fleming S.T. .
Source: Journal of applied gerontology : the official journal of the Southern Gerontological Society, 2011 Dec; 30(6), p. 671-699.
PMID: 23833393
Related Citations

Prevalence of colorectal cancer screening among a multimorbid rural Appalachian population.
Authors: Fleming S.T. , Schoenberg N.E. , Tarasenko Y.N. , Pearce K.A. .
Source: Southern medical journal, 2011 Dec; 104(12), p. 811-8.
PMID: 22089360
Related Citations

Appalachian residents' experiences with and management of multiple morbidity.
Authors: Schoenberg N.E. , Bardach S.H. , Manchikanti K.N. , Goodenow A.C. .
Source: Qualitative health research, 2011 May; 21(5), p. 601-11.
EPub date: 2011-01-24.
PMID: 21263063
Related Citations

Colorectal cancer screening among rural Appalachian residents with multiple morbidities.
Authors: Tarasenko Y.N. , Schoenberg N.E. .
Source: Rural and remote health, 2011; 11(1), p. 1553.
EPub date: 2011-01-21.
PMID: 21280973
Related Citations

"It's a toss up between my hearing, my heart, and my hip": prioritizing and accommodating multiple morbidities by vulnerable older adults.
Authors: Schoenberg N.E. , Leach C. , Edwards W. .
Source: Journal of health care for the poor and underserved, 2009 Feb; 20(1), p. 134-51.
PMID: 19202253
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