OCT 09, 2019 6:00 AM PDT

Multilevel Interventions in Cancer Prevention and Control: A Community-Based Translational Research Framework to Address Prostate Cancer Disparities

C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Director of the Cancer Health Equity Institute Morehouse School of Medicine (MSM)
    Biography
      Dr. Rivers is the Director of the Cancer Health Equity Institute at Morehouse School of Medicine (MSM). Dr. Rivers is nationally and internationally recognized as a leader in cancer disparities research and currently serves as a member of the National Institutes of Health (NIH) National Advisory Council on Minority Health and Health Disparities (NACMHD). Dr. Rivers is an active member in the American Association for Cancer Research (AACR) community and regularly serves on the faculty for the Scientist to Survivor program. More recently, Dr. Rivers was elected to serve as Chairperson for the Minorities in Cancer Research Council of the AACR. Dr. Rivers is a behavioral scientist with a broad background in implementation science and public health, with specific training and expertise in health behavior research methodologies for addressing health disparities, such as the lay health model and Community-based Participatory Research framework. Dr. Rivers' specific program of research is focused on addressing prostate cancer disparities among African Americans and exploring the role of novel communication interventions, such as mobile health technology. Currently, Dr. Rivers is leading several large randomized controlled trials, funded by NIH and NIMHD R01, to evaluate and characterize app usage and acceptability for education and care coordination among African American men diagnosed with prostate cancer. Dr. Rivers is Multiple-Principal Investigator for the NIH NCI funded U54 Cancer Research Partnership between MSM, Tuskegee University, and the University of Alabama-Birmingham Comprehensive Cancer Center (UAB CCC). Dr. Rivers also directs the Integrating Special Populations Program of the NIH NCATS funded Georgia Clinical and Translational Science Alliance.

    Abstract

    Introduction: Despite the current declines in prostate cancer mortality, African Americans (AA) continue to experience a 60% higher incidence and are twice as likely to die in comparison to men of other racial and ethnic groups. A host of factors have been postulated to explain this inequity, including access to care, patient-centered communication, concordance of patient and physician race, level of prostate cancer knowledge, attitudes and perceptions of care, socioeconomic differences, differences in biological manifestation, type and aggressiveness of treatment, diet, genetics, and lifestyle and environmental factors.  There has been no consistent strategy employed to address prostate cancer disparities, not withstanding an increased effort to provide prostate cancer screening.  Screening and early detection are likely to assist; however, the scientific evidence to date has been insufficient to definitively conclude screening for prostate cancer reduces deaths.  While the uncertainty of the effectiveness of the screening modalities for prostate cancer persists, patients are encouraged to participate in the informed decision making (IDM) process with their healthcare provider to effectively incorporate their values and preferences. However, the extent of the patient-provider interaction in general has been found to be a barrier to securing adequate healthcare among racial and ethnic groups.  Mistrust, fear, discrimination, and racism have all been cited as factors of concern, for African American men in particular, when interfacing with the healthcare system. Four patient mediating outcomes of IDM include: 1) individual risk assessment, 2) consideration of values and beliefs, 3) knowledge of the risk and benefits of screening, and 4) consideration of age and lifespan issues (i.e., existing co-morbidities).  The extent of IDM in clinical settings is unclear.  The goal of this study was to establish effective delivery practice strategies with current recommendations for IDM for prostate cancer screening among African American men.  The use of Community Navigation and digital technology in community based settings allow for the innovativeness of this study.  We conducted a community-based, Randomized Controlled Trial, to assess the effectiveness of community based education as compared to clinical setting usual care in the delivery of the IDM process. The design of the study allowed for the evaluation of the effectiveness of utilizing the Community Navigators and an enhanced Patient Decision Aid in community-based venues to disseminate IDM to AA men. The two study arms were: 1) control (usual care group) and 2) experimental (enhanced patient decision aide and lay health advisory). The eligibility criteria for the participants included: 1) have not been diagnosed or treated for any type of cancer, 2) self-identify as AA, 3) able to understand English (ability to repeat back in their own words), 4) in the age range 40-70, and 5) working telephone number.  Study findings will be presented related to the primary outcome, IDM, measured through four domains: Knowledge, Decisional Conflict, Control Preferences, and Decisional Self-Efficacy. The findings of this study have informed effective community-based strategies with current recommendations for IDM.


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