Racial disparities in cancer treatment contribute significantly to Black-White differences in mortality and survival. Our prior collaborations with our community, our research, and the research of others suggest that Black-White disparities in the quality of communication and information exchange during clinical interactions often lead Black patients to refuse appropriate treatments and oncologists to plan treatments for their Black patients that are inconsistent with clinical practice guidelines. We propose a community-based participatory research (CBPR) approach to developing and testing an intervention to change Black patients' attitudes toward and behavior during clinical interactions, thus changing their own and their oncologists'beliefs and attitudes related to treatment. This, in turn, will result in more appropriate patient and oncologist treatment decisions for older African American cancer patients. Our highly experienced multidisciplinary team of researchers and active community stakeholders have extensive experience collaborating to conduct research to reduce Black-White health disparities in southeast Michigan. For this intervention study, we will recruit medical oncologists from two cancer centers and their African American patients before an appointment to discuss curative chemotherapy for breast, colorectal, or lung cancer. Our intervention is designed to encourage patients to participate actively in the clinical interaction with their oncologist The intervention has two components: a question prompt list (QPL), which suggests questions that patients might want to consider asking their oncologist;and a patient advocate, matched to the patient's gender and race and specially trained to encourage patients to participate actively in the interaction. We will randomize patients into one of three arms. Patients in the first arm will receive standard of care. Patients in the second arm will receive only the QPL priorto the interaction. Patients in the third arm will receive both the QPL and the assistance of a patient advocate. We will administer self-report questionnaires and video record the clinical interaction so that we can assess patients and oncologists before, during, and after the interaction. The primary goal of our intervention is to improve the likelihood that patients and oncologists will make an appropriate treatment decision. Secondary outcomes will be improvements in the quality of communication and information exchange during the interactions and attitudes and beliefs related to the decisions. The proposed research is both innovative and significant. First, we base our research on an innovative, theoretically-driven model explaining how communication and information exchange during clinical interactions can affect patient and physician treatment-related attitudes and beliefs, and thus treatment disparities. In collaboration with our community partners, the model leads to a practical intervention combining the improvement of patient communication skills and attitudes with the assistance of a patient advocate, which will encourage patients to participate actively in oncology interactions. The study is significant because it will result in a feasible, effective, and exportable intervention to reduce well-documented treatment disparities.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA153606-04
Application #
8547011
Study Section
Special Emphasis Panel (ZCA1-PCRB-G)
Project Start
Project End
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
4
Fiscal Year
2013
Total Cost
$46,825
Indirect Cost
Name
Wayne State University
Department
Type
DUNS #
001962224
City
Detroit
State
MI
Country
United States
Zip Code
48202
Penner, Louis A; Harper, Felicity W K; Dovidio, John F et al. (2017) The impact of Black cancer patients' race-related beliefs and attitudes on racially-discordant oncology interactions: A field study. Soc Sci Med 191:99-108
Eggly, Susan; Hamel, Lauren M; Foster, Tanina S et al. (2017) Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists. Patient Educ Couns 100:818-826
Chou, Wen-Ying Sylvia; Hamel, Lauren M; Thai, Chan L et al. (2017) Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists' language. Health Expect 20:1073-1080
Hamel, Lauren M; Penner, Louis A; Eggly, Susan et al. (2017) Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists. J Oncol Pract 13:e249-e258
Hagiwara, Nao; Dovidio, John F; Eggly, Susan et al. (2016) The effects of racial attitudes on affect and engagement in racially discordant medical interactions between non-Black physicians and Black patients. Group Process Intergroup Relat 19:509-527
Penner, Louis A; Dovidio, John F; Hagiwara, Nao et al. (2016) An Analysis of Race-related Attitudes and Beliefs in Black Cancer Patients: Implications for Health Care Disparities. J Health Care Poor Underserved 27:1503-20
Manning, Mark; Burnett, Janice; Chapman, Robert (2016) Predicting Incongruence between Self-reported and Documented Colorectal Cancer Screening in a Sample of African American Medicare Recipients. Behav Med 42:238-47
Penner, Louis A; Dovidio, John F; Gonzalez, Richard et al. (2016) The Effects of Oncologist Implicit Racial Bias in Racially Discordant Oncology Interactions. J Clin Oncol 34:2874-80
Hamel, Lauren M; Chapman, Robert; Malloy, Mary et al. (2015) Critical Shortage of African American Medical Oncologists in the United States. J Clin Oncol 33:3697-700
Tucker-Seeley, Reginald D; Mitchell, Jamie A; Shires, Deirdre A et al. (2015) Financial hardship, unmet medical need, and health self-efficacy among African American men. Health Educ Behav 42:285-92

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