Prostate cancer (PCa) imposes a disproportionate burden on African American men, who have a 63% higher incidence, are more often diagnosed with aggressive disease, and have more than twice the mortality rate of White men. Among the causes of excess mortality is failure to receive definitive treatment (e.g., surgery and radiation) when it would be most beneficial (under-treatment). In addition, over-treatment of low-risk disease (therapies that may not be beneficial yet have serious side effects) contributes to disparities in quality of life, as African American men report more treatment-related side effects that translate to lower quality of life. All of these disparities are most pronounced among low income African American men, many of whom have low health literacy, and receive treatment in low resource settings (e.g., public hospitals and other safety net systems), underscoring the need for targeted research in this setting. PCa treatment options present daunting communication challenges even for high literacy patients, as there are complex trade-offs between survival and quality of life that are very personal. To mitigate this perfect storm of complex treatment options and constraints in communication, we will construct a relational bridge between low income African American men and equal PCa treatment by anchoring the evidence-based intervention of peer navigation in the relational concept of African American brotherhood as a means to foster trust and empowerment, and thus to optimize patient-centered communication and quality of care.
Our specific aims are to: (1) develop a multi-dimensional understanding of current PCa care and treatment decision processes among African American safety net patients; (2) adapt an existing peer navigation intervention to empower African American PCa patients as partners in high quality patient-centered PCa care; and (3) pilot test the adapted peer navigation protocol for feasibility and acceptability, and for impact on patient centeredness and treatment chosen. This K01 project will have significant impact by directly targeting multiple elements of PCa treatment quality in a single integrated approach. The candidate, Nynikka Palmer, DrPH, MPH, is an Assistant Professor in General Internal Medicine at San Francisco General Hospital, University of California, San Francisco with secondary appointments in the Departments of Urology and Radiation Oncology. With support from an exceptional mentoring team, and execution of interconnected training and research activities, Dr. Palmer will carry out formal coursework, independent mentored learning, and experiential learning that converge around three key topics: (1) depth in cultural understanding and methods via ethnography, (2) patient-centered health communication intervention development and implementation, and (3) design and conduct of randomized controlled trials. This K01 project will facilitate Dr. Palmer's long-term career goal to become an independent investigator who develops, implements, and disseminates culturally meaningful interventions to improve the quality of cancer care and reduce the burden of PCa among African American men.
African American men bear an excess burden of prostate cancer that can be attributed in part to disparities in optimal treatment, which are exacerbated by low levels of health literacy among patients treated in low resource settings where time constraints and communication barriers degrade quality of care. The goal of the proposed training and research is to address these barriers by bridging the divide between low-income African American men and equal prostate cancer treatment with the evidence-based intervention of peer navigation adapted through the relational concept of African American brotherhood as a means to foster trust and empowerment, and thus to optimize patient-centered communication and quality of care.
