Colorectal cancer (CRC) is the second leading cause of cancer-related deaths and the third most commonly diagnosed cancer for both men and women in the United States. During 1973-1995, the incidence among African American men and women has increased and exceeds the rate among whites. African American men have the highest incidence rates. Furthermore, although the CRC mortality rate decreased 21 percent among the general population, mortality increased 26 percent among African American males aged 65 years and older, and 16 percent among African American males less than 65. African American women are more likely to die of CRC than are women of any other racial/ethnic group. African Americans are significantly more likely to be diagnosed at late-stage than Whites. Five-year survival rates for the period 1989-94 were 64 percent in whites and 52 percent in African Americans. CRC screening is known to be effective both by early detection and for prevention by removal of precancerous polyps but is underused. We propose a formative feasibility study that will serve as a basis for a subsequent randomized trial testing the effectiveness of innovative strategies in community health centers (CHCs) to improve CRC screening participation by African Americans. In the first component, we will profile the clinical and management information system(s) currently in place in the participating community health centers and other sites as appropriate (e.g., endoscopy clinics) to estimate capability for intervention planning, delivery and evaluation. The second component will explore the feasibility and the potential effectiveness of various intervention strategies, as well as priority messages within the strategies, which are appropriate for this population. The needs assessment approaches will include focus groups of patients and community members, interviews of key informants among health center providers and staff and gastroenterologists, review of medical records and pilot patient surveys. Data collected will also inform the sampling and accrual projections and instrument development of for the subsequent trial. The products of this R2 1 include a) a published report on factors related to CRC screening in African Americans; b) a systems analysis of the context and processes of care; c) pre-tested instruments and d) detailed recommendations for the interventions to be tested in a randomized trial.
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