? The District of Columbia is unique in that minority populations are the majority, and it has the highest per capita breast cancer mortality in the US. African American women in DC are twice as likely to die of their breast cancers as white women despite the same or higher rates of screening mammography. Similarly, Latinas have a rate of screening mammography only slightly lower than non-Hispanic white women, but they present at later stages of the disease. These disparities suggest barriers navigating the health-care system, both to find timely diagnostic services and to get complete, high-quality care after diagnosis. To address these problems, with the goal of reducing these disparities, four major medical institutions -- George Washington University Cancer Institute (GWCI), Georgetown's Lombardi Comprehensive Cancer Center, Howard University Cancer Center, and Washington Hospital Center's Cancer Center -- will collaborate with two community partners -- Breast Cancer Resource Committee and Nueva Vida -- and the DC government's Department of Health in an unprecedented consortium to create a city-wide program that will evaluate different ways of helping African American and Latino women navigate the health-care system. The overarching aim is to conduct a randomized controlled trial comparing """"""""Standard-Concrete Navigation"""""""" with Standard Navigation plus Enhanced Navigation consisting of linguistically competent peer counseling.
The specific aims are to test these hypotheses: 1) That Enhanced Navigation combined with Standard-Concrete Navigation will be more effective than Standard-Concrete Navigation alone, in decreasing the time from suspicious finding to diagnostic resolution and from diagnosis to initiation of treatment. 2) While significantly more expensive, the combination will be sufficiently more effective in that it will be the most cost-effective strategy in terms of costs per quality-adjusted year of life saved. 3) In testing these hypotheses factors will also be assessed that mediate the intervention effects (coping styles, perceptions of communication with providers, attitudes, fatalism, etc.). Each Recruiting Intake Site has programs and community partnerships that will serve as the point of entry into the navigation program. Enhanced navigation will be delivered by Peer Counseling Sites: The Breast Cancer Resource Committee and Nueva Vida, which provide breast cancer peer-counseling for African American and Latino women, respectively ? ?
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