This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The diagnosis and subsequent surgical therapy of cncer can be emotionally distressing, particulary among African Americans. Across empirical studies, approximately 30-50% of cancer patients across cancer types report moderate to severe levels of anxiety, and up to one third of patients report levels of depressive symptoms suggestive of clinical depression. In one study (Conerly, Baker, Dye, Douglas and Zabora, 2001), African American cancer survivors had distress scores significantly higher than that of other racial groups. Also, African Americans are significantly less likely to receive anti-depressant, anxiolytics, and mental health services, despite evidence of a willingness to participate in mental health programs. This proposal projec will address the prevalence and disparities in psychological distress among cancer patients at two urban universities at the time of surgery for breast, colon, lung, or prostate cancer. The two primary aims of the study are: (1) To identify the prevalence of psychological distress among patients with early stage cancer and to examine the association between these symptoms of distress and racial, socioeconomic, and medical variables. (2) To evaluate the impact and utility of a problem-solving educational intervention integrated with surgical care on the psychological distress of this population. This study will use a quasi-experimental 'multiple times-series' design where the critical variables of interest (e.g. distress) will be measured once before surgery, twice after surgery and before the intervention, and then at 3-, 6-, and 12-monts post-intervention. Sample size (for p <.05 and patients = .80) is estimated to be 71 patients per center. Data analyses will focus on the change in the primary outcomes at each center, but comparisons will be made between centers in an effort to demonstrate an equal level of effectiveness when mental health services are accessible to both populations.
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