The long-term goal of this career development application is to launch an independent research program in cancer prevention and control with specific expertise in improving clinician-patient communication in underserved populations. Recent attention has been paid to the vital role of communication in clinical encounters and its effect on patient outcomes. In general, this research has not taken place with underserved populations, although patients in underserved populations have higher levels of mistrust of their clinicians, report lower levels of satisfaction with the encounter, and have poorer adherence. Given the import of clinician-patient communication and the emerging evidence about the effectiveness of interventions to improve clinician-patient communication, a more sophisticated understanding of communication between doctors and underserved patients and its impact on patient outcomes is required. Learning objectives for this career award include: 1) gain an increased understanding of the factors influencing health disparities in order to better plan studies and interpret results;2) obtain a working knowledge of cancer epidemiology to inform my selection of outcome measures;3) learn core principles for developing community interventions to change health behavior;4) develop working relationships with researchers in health disparities through conference attendance and networking;5) explore the communication between providers and low-income, minority patients with a focus on adherence to CRC screening;and 6) use a community-based participatory approach to obtain stakeholders'opinions about feasibility and acceptability of doctor-focused communication training interventions. Colorectal cancer screening will provide the paradigm for study in this application because of the disparities in both screening and cancer incidence by race, income, and education. The in-depth study of the effect of doctor-patient discussions about cancer screening will provide the opportunity to explore unique challenges faced in clinician-patient communication in underserved populations. Ultimately, this work will lead to the development of interventions to improve communication in these settings. Through intensive interaction with mentors and multi- disciplinary colleagues within a well-resourced institutional environment, formal coursework and educational activities, and the proposed research, this award will prepare me for a career as an independent researcher in doctor-patient communication and health disparities.
Doctor-patient communication plays a key role in improving adherence to colorectal cancer screening. The goal of this project is to observe and develop interventions to improve doctor- patient communication about colorectal cancer screening in an underserved patient population.