Lisa Berry-Bobovski

Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

OBJECTIVE Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. METHODS Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. RESULTS The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. CONCLUSION This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. PRACTICE IMPLICATIONS This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

The national cancer institute’s community networks program initiative to reduce cancer health disparities: Outcomes and lessons learned

Background: We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.Methods: Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.Results: Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.Implications: Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.

Barriers to Cancer Screening Among Orthodox Jewish Women

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3–5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

Evaluation of a preparatory community-based prostate health education program.

BACKGROUND Medical organizations are divided on the issue of screening for prostate cancer, yet there is agreement that men should be educated about prostate health. Shared decision making involves patients and practitioners in this process, yet some men need preparatory education prior to the physician encounter. This study assessed the effectiveness of a community prostate health awareness program, focusing on men at risk for prostate cancer. METHODS Participants were given a pretest and a posttest to assess knowledge gains and impact on short-term intentions to address their prostate health. RESULTS There was a statistically significant increase in knowledge. Short-term intentions increased for those participants meeting the inclusion criteria. DISCUSSION Community outreach programs remain an excellent vehicle to educate the public and complement the efforts of health care providers.

Abstract A28: Reaching vulnerable populations: A process-oriented approach to breast screening

This community-based project evolved out of relationships established through the Detroit CNP for Older, Underserved African-Americans (NIH# U01-CA114583-04) to address the unmet needs of the clientele of three partnering community agencies. The need for breast cancer screening among older women from lower socioeconomic groups, the mentally ill, and the disabled has been well-documented. However, mammography among these special populations is low. This project brought together five organizations (three community service agencies, the NCI9s Cancer Information Service Partnership Program, and the Karmanos Cancer Institute9s Community Network Program) to provide breast health awareness, mammography screening, and navigation to underserved African American women. The five agencies collaborated to address the needs of the homebound, developmentally disabled, homeless, nursing home residents, grandparents raising grandchildren, and others. All groups were identified through a community assessment to identify significant barriers to accessing preventive health care services. Through community-based participatory research (CBPR), the members of the partner organizations worked with community health education professionals to define: 1) community-level needs; 2) assess how best to integrate screening messages and health service navigation into existing service provision; and 3) identify ways to obtain external funding for program implementation. The CBPR process yielded an intervention that consisted of staff training, improved screening needs assessment and procedures for case management referral and follow-up that increased agency capacity to address breast health disparities. A total of 490 women participated in this “high-touch” breast health education and screening intervention. Of those, 170 women received screening mammography and six women were diagnosed and received subsequent treatment and follow-up. The project was recently recognized by the Michigan Cancer Consortium, receiving their highest recognition, the Spirit of Collaboration Award. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A28.

Abstract B14: Understanding beliefs about biospecimen collection and use for cancer research among older, urban African Americans

Purpose: Biological specimens donated by cancer patients and population-based controls provide important research material that may advance knowledge of molecular and genetic aspects of disease and promote development of new treatments. Increased biospecimen collection and banking will impact the quality of biomedical cancer research involving older African Americans now and in the future. For biospecimen collection, banking and analysis systems to be valuable, African Americans must be engaged early and often, to discuss their views, voice concerns and expectations. The study9s purpose is to examine how cultural beliefs, perceptions and feelings about the process of collecting biospecimens for research affect the decision to donate biospecimens for clinical studies among older, urban African Americans. Methods: Using community-based participatory research (CBPR), Karmanos and community partners-the Southeast Michigan CNP Community Advisory Group (CAG) and our Research Advisory Committee (RAC), will conduct focus groups on biospecimen collection and banking. The participants in the four focus groups will be African American, age 55 and older, 50% men and 50% women. CAG members will assist in planning and conducting focus groups and assist in interpreting focus group findings. Collaborating with the CAG and RAC, themes from the focus group analysis will be used to develop a survey to assess relationships between demographics, health, attitudinal factors and decisions to donate biospecimens (tumor pathology tissue, blood, buccal swabs, urine, and hair)among older, African Americans. The CAG and RAC will participate in the selection and/ or development of reliable and valid survey instruments to assess health history, decision to donate, trust in health care providers and institutions and attitudes toward participating in research. The survey will be administered to 250 older, African Americans. In collaboration with the CAG, using results from the focus group and survey, a culturally sensitive educational intervention will be developed and offered to the community. The intervention9s purpose is to inform older African Americans about biospecimen collection and banking and how they impact efforts to reduce cancer health disparities. The workshop/ presentation will address the importance of CBPR methods to understanding factors related to biospecimen collection and banking. A pre/post instrument will assess participant9s knowledge, attitudes and intentions to donate specimens. All study results will be shared with the CAG, RAC and the community, in general. Conclusion: Given the alarming history regarding the abuse of African Americans participating in research and ethical issues associated with biospecimen collection, banking and use, makes it morally and ethically imperative to ascertain how older African Americans feel about biospecimen related activities Their feelings, perceptions, expectations and concerns can and will affect biospecimen collection and banking. The study9s results will advance the understanding of issues affecting older African Americans decisions and beliefs concerning biospecimen banking and produce a tested educational intervention to increase awareness and understanding of the importance of participation in biospecimen collection and banking among older African Americans. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B14.