We plan to implement a novel, community based educational program to inform and motivate underserved older adults to forge partnerships with their doctors, targeting cancer prevention as a shared goal. Using a randomized controlled trial (RCT), we will evaluate the efficacy of our social learning theory based intervention that promotes patient participation in order to enhance patient centered medical care. This study builds on findings of our ongoing study of Health Care Partnerships in Cancer Prevention and Care. Specifically we propose a multi-modal health communication training program for older adults. This educational intervention (""""""""Speak Up"""""""" program), aims to improve patient initiative, competence, and confidence in communication with physicians. Based on foundations of social learning theory the intervention is expected to result in increased discussion between older adults and their primary care physicians about cancer prevention and screening. Participants in the intervention are also expected to receive more age and risk specific preventive advice from their doctors and report greater satisfaction with their health care. Participants in the """"""""Speak Up"""""""" facilitated discussion groups (N=480) will be compared to participants in """"""""Connect"""""""" attention control groups (N=480). The latter program addresses important goals of enhancing civic and social engagement. The intervention program will be conducted in small groups and offer user-friendly experiential learning including information, discussion, and role play in order to help older persons develop better communication skills. The study will be conducted among randomly selected community dwelling elders who had participated in our prior research, and among community based older adults who attend Senior Center nutrition programs, sponsored by Area Agencies on Aging (AAA). Based on comparing pre-intervention assessments with 2 week, 6 month, and 12 month telephone follow-up evaluations, we will determine both the short term and long term impact of the intervention. We will consider participants'personal characteristics and their physicians'background and supportiveness as they may influence uptake of the intervention. We designed the study based on intervention research (CONSORT) guidelines for conducting RCTs, and will carefully evaluate treatment fidelity. In addition to patient reported outcomes, we will also consider objective indices based on Medicare claims data and AAA data on program utilization. We will use multilevel models with fixed and random effects in our quantitative data analyses. Using a mixed methods design, we will also include a qualitative study component based on in-depth interviews with 60 participants selected based on high versus low program benefits. Our study is closely aligned with the mission of the National Cancer Institute to improve cancer control and to reduce health disparities in cancer prevention and care. We plan an active dissemination effort to insure that this portable and cost effective intervention may be widely adopted by community organizations such as Area Agencies on Aging that serve diverse older adults.

Public Health Relevance

The proposed study has direct relevance to public health. Our goal is to improve older patients'advocacy skills and their ability to communicate with their physicians regarding cancer prevention and general medical care. We expect that the confidence and initiative they will acquire as a result of our intervention will result in improvements in the preventive care they will receive. Having well informed patients, who also respect physician expertise, participating in medical encounters, will improve both efficiency and effectiveness of office visits for the aged. Prevention and early detection of cancer have been recognized as important public health strategies for reducing the burden of chronic and life threatening illnesses, both on society and on individuals. Our focus on communication skills training among low health literacy and minority elders should also contribute to minimizing health disparities.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Patrick, Heather A
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Case Western Reserve University
Social Sciences
Schools of Arts and Sciences
United States
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Kahana, Eva; Kahana, Boaz; Langendoerfer, Kaitlyn Barnes et al. (2016) Elderly Cancer Survivors Reflect on Coping Strategies During the Cancer Journey. J Gerontol Geriatr Res 5:
Kahana, Eva; Lee, Jeong Eun; Kahana, Boaz et al. (2015) Patient Planning and Initiative Enhances Physician Recommendations for Cancer Screening and Prevention. J Fam Med Community Health 2:
Kahana, Eva; Kahana, Boaz (2014) Baby boomers' expectations of health and medicine. Virtual Mentor 16:380-4
Kowalski, Christoph; Kahana, Eva; Kuhr, Kathrin et al. (2014) Changes over time in the utilization of disease-related Internet information in newly diagnosed breast cancer patients 2007 to 2013. J Med Internet Res 16:e195
Kahana, Eva; Kahana, Boaz; Lee, Jeong Eun (2014) Proactive approaches to successful aging: one clear path through the forest. Gerontology 60:466-74
Kahana, Eva; Bhatta, Tirth; Lovegreen, Loren D et al. (2013) Altruism, helping, and volunteering: pathways to well-being in late life. J Aging Health 25:159-87
Choi, Moon; Adams, Kathryn Betts; Kahana, Eva (2012) The impact of transportation support on driving cessation among community-dwelling older adults. J Gerontol B Psychol Sci Soc Sci 67:392-400
Kahana, Eva; Kelley-Moore, Jessica; Kahana, Boaz (2012) Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life. Aging Ment Health 16:438-51
Kahana, Boaz; Kahana, Eva; Deimling, Gary et al. (2011) Determinants of altered life perspectives among older-adult long-term cancer survivors. Cancer Nurs 34:209-18
Kahana, Eva; Kahana, Boaz; Wykle, May et al. (2009) Marshalling Social Support: A ""Care-Getting"" Model for Persons Living with Cancer. J Fam Soc Work 12:168-193

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