The overall study objective is to develop a culturally targeted patient navigation training curriculum aimed at increasing breast, cervical and colorectal cancer screening behaviors in lesbian, gay, bisexual and transgendered (LGBT) persons. We propose a rigorous plan of formative research (qualitative interviews and learner verification trials) with key stakeholders (non-adherent LGBT adults, health care providers and medical center directors) to identify general and unique sociocultural (social stigma, mistrust, provider bias, concealment and identity and health), provider (appropriateness, cultural competency, quality of providers, patient adherences and communication) and system level (availability, costs, transportation, organization) barriers to cancer screening experienced by LGBT individuals. The obtained information will serve as a basis for adapting and culturally targeting an existing Health System Navigation curriculum that will guide patient navigators in the reduction of barriers to appropriate cancer screening and follow-up care among non-adherent LGBT individual. A secondary goal is to pilot test the adapted cancer screening Health System Navigation (CS- HSN) training curriculum with a cohort of LGBT health educators and lay PN. Pilot testing the CS-HSN training methods and curriculum will help to establish the feasibility of training protocols, the acceptability of the curriculum and materials and performance outcomes based on the curriculum as measured during simulated clinical encounters with standardized patients.
Specific aims are:
Aim 1 a: To determine using in-depth interviews with key stakeholders (non-adherent LGBT, medial providers and medical center directors) barriers to cancer screening (sociocultural, provider and system) for LGBT who are non-adherent to age-appropriate cancer screening guidelines (breast, cervical, and colon).
Aim 1 b: To use the interview data as a basis for adapting the Health System Navigation curriculum and training protocol for use in reducing barriers to cancer screening in LGBT persons and finalizing the Cancer Screening-Health System Navigation curriculum (CS-HSN).
Aim 2 : To use the generated CS-HSN curriculum, to pilot test the training of a cohort of health educators (N=6) and lay patient navigators (N=10) and to systematically evaluate feasibility (recruitment and retention), acceptability (program satisfaction), and performance outcomes (knowledge, interviewing skills, patient navigation roles) as measured by simulated clinical with standardized patients.
This study will be one of the first attempts to systematically develop a targeted patient navigation (PN) training curriculum aimed at reducing cancer screening disparities in Lesbian, Gay, Bisexual, and Transgender (LGBT) persons. Anticipated outcomes from the current project, including the identification of LGBT specific barriers to cancer screening, the development of a new patient navigation targeting cancer screening, experience training health educators and PN using the curriculum, and the evaluation of the health system barriers to providing cancer screening at 7 LGBT medical centers will provide the preliminary data necessary to conduct a full randomized trial testing the cancer screening patient navigation program.
