Colorectal Cancer (CRC) incidence and mortality rates are highest in African Americans (AA's) compared with all other ethnic groups. One factor that may contribute to this trend is the lower rate of participation in CRC screening among AAs, which is critical to the prevention and early detection of CRC. Recent data indicate that the removal of precancerous polyps (via colonoscopy) decreases CRC incidence by 75-90 percent. Despite the implementation of national policy changes to increase CRC screening (through Medicaid/Medicare reimbursement for CRC screening and easier """"""""open"""""""" access to colonoscopy) adherence remains alarmingly low. Our preliminary data show that, even after implementation of standard patient navigation (SPN) (i.e., assisting patients with making/keeping their appointments), only 40 percent of low-income minorities followed-through on their physician recommendation. Guided by Cognitive-Behavioral Social Learning Theory as a conceptual framework and cultural targeting as an intervention strategy, the proposed randomized clinical trial will investigate integrating within SPN a targeted discussion of intrapersonal and cultural barriers to colonoscopy (i.e., fear, lack of knowledge, medical mistrust, fatalism and fear) prevalent with low-income AAs. Based on research on source credibility and reference group-based social identity theory, we will also explore navigator status as a peer on the impact of culturally targeted PN. Thus, we will compare three PN strategies: SPN carried out by a professional navigator, Culturally Targeted PN carried out by a professional (CTPN-Pro) and Culturally Targeted PN carried out by a peer who has undergone colonoscopy (CTPN-Peer).
Specific Aims :
Aim 1 : Compare the efficacy of SPN, CTPN-Pro, and CTPN-Peer on adherence to colonoscopy CRC screening in average risk, low-income AAs who have a primary care physician referral for colonoscopy.
Aim 2 : Explore potential mechanisms (i.e., mediators) underlying the beneficial effects of CTPN-Pro and CTPN-Peer and to examine for whom the CTPN-Pro and CTPN-Peer are most effective (i.e., moderators).
Aim 3 : Compare the cost effectiveness of CTPN-Pro and CTPN-Peer. Cost effectiveness will be examined in terms of direct clinical costs of screening (i.e., savings associated with more efficient use of personnel, space, and equipment) and patient costs (i.e., costs of CRC treatment and the opportunity costs to the patient per life-year saved). Results from the proposed work will facilitate the broad dissemination of PN to reduce ethnic and racial health disparities in CRC incidence mortality and will advance our understanding of PN.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA120658-05
Application #
8123371
Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Breslau, Erica S
Project Start
2007-09-01
Project End
2012-07-31
Budget Start
2011-08-01
Budget End
2012-07-31
Support Year
5
Fiscal Year
2011
Total Cost
$554,293
Indirect Cost
Name
Icahn School of Medicine at Mount Sinai
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
078861598
City
New York
State
NY
Country
United States
Zip Code
10029
Sriphanlop, Pathu; Jandorf, Lina; Thompson, Hayley et al. (2017) Preventive Health Behaviors Among Low-Income African American and Hispanic Populations: Can Colonoscopy Screening Serve as a Teachable Moment? J Racial Ethn Health Disparities :
Miller, Sarah J; Iztkowitz, Steven H; Redd, William H et al. (2015) Colonoscopy-specific fears in African Americans and Hispanics. Behav Med 41:41-8
Pelto, Debra J; Sly, Jamilia R; Winkel, Gary et al. (2015) Predicting Colonoscopy Completion Among African American and Latino/a Participants in a Patient Navigation Program. J Racial Ethn Health Disparities 2:101-11
Miller, Sarah J; Sly, Jamilia R; Itzkowitz, Steven H et al. (2015) Racial/Ethnic Minorities Ineligible for Direct Access Colonoscopy (DAC): Identifying Patients Who Fall Through the Cracks. J Racial Ethn Health Disparities 2:86-92
Ladabaum, Uri; Mannalithara, Ajitha; Jandorf, Lina et al. (2015) Cost-effectiveness of patient navigation to increase adherence with screening colonoscopy among minority individuals. Cancer 121:1088-97
Lee, Kristen K; Jandorf, Lina; Thélèmaque, Linda et al. (2014) Colorectal neoplasia detection among black and Latino individuals undergoing screening colonoscopy: a prospective cohort study. Gastrointest Endosc 79:466-72
Philip, Errol J; Shelton, Rachel C; Thompson, Hayley S et al. (2014) Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation? Cancer Causes Control 25:1227-31
Gupta, Samir; Sussman, Daniel A; Doubeni, Chyke A et al. (2014) Challenges and possible solutions to colorectal cancer screening for the underserved. J Natl Cancer Inst 106:dju032
Jandorf, Lina; Stossel, Lauren M; Cooperman, Julia L et al. (2013) Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer 119:612-20
Sly, Jamilia R; Edwards, Tiffany; Shelton, Rachel C et al. (2013) Identifying barriers to colonoscopy screening for nonadherent African American participants in a patient navigation intervention. Health Educ Behav 40:449-57

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