African American Cancer Research
Intervention Research with African Americans to Reduce and Eliminate Disparities
Breast Cancer
Our research shows that a major cause of racial disparities in cancer treatment is poor communication in oncology visits between African American patients and their non-African American physicians; and second, that patient and oncologist racial attitudes contribute to this poor communication. In visits with African American patients, compared to visits with white patients, physicians spend less time planning treatment, providing health education, assessing health knowledge, engaging in informal conversation and providing treatment information. Further, African American patients participate less actively in the visits by asking fewer questions than white patients and less frequently bringing a companion to the visits, and they report less understanding of the topics discussed. Oncologists were shown to have implicit and explicit racial bias against African Americans; African American patients had higher levels of mistrust in their physicians and more concerns about discrimination than white patients. A randomized controlled trial is underway testing an intervention with breast cancer patients, developed using a community-engaged approach to improve the observed and patient reported quality of communication during the clinic visit, and the appropriateness, receipt, timing, and dosing of the treatment patients actually receive, using medical record data. Although data collection is ongoing, we have observed the video recorded clinic visits and conducted preliminary analyses of the effects of the intervention on the quality of communication.
- Lead Researcher: Drs. Eggly and Penner
Pain Management
A behavioral intervention designed by program members is underway to improve functional status in African American patients and caregivers with cancer pain. This study has enrolled more than 154 participants with complete data. African American cancer patients bear a disproportionate burden from pain and the resultant limitations in function. Excess morbidity from inadequately managed cancer pain in the African American community results in high levels of human suffering, increased family caregiver burdens, and both hidden and explicit economic costs. This nursing intervention, Power over Pain – is a Coaching program to increase self-management of symptoms. The results are expected to provide a strategy to increase pain relief among patients and their families.
- Lead Researcher: Dr. Vallerand
Prostate Cancer
Program members are using daily patient reports of quality of life (QOL) as an intervention to improve physicians’ clinical decisions about how well patients are responding to treatment. Daily diaries can provide physicians with clinically relevant information that may not otherwise be available during routine follow-up (e.g., test results, adverse effects), and as a result, can provide a more comprehensive picture of how patients physical and psychosocial treatment responses. Traditionally QOL information has been acquired either by informal and subjective queries of the patient by a physician or nurse. However, asking patients to retrospectively remember and summarize their QOL since the previous visit can adversely affect the accuracy of recall, thereby leading to an incomplete or erroneous report of symptoms. Using iPads provided to patients, daily diary technology can increase the accuracy of symptom reports and capture daily changes in symptoms that fluctuate and impact patient quality of life (e.g., pain, mood, fatigue). This information has application in monitoring adverse events in clinical trial protocols, improving patient adherence to medication, identifying the need for medication changes, and provide patient feedback to physicians outside of clinical appointment. Thus, daily diary information can improve patient-provider communication and medical management including treatment decision-making.
- Lead Researchers: Drs. Harper and Penner
Colorectal Cancer
Although African Americans are at an increased risk of developing and dying from colorectal cancer (CRC), many efforts to encourage early detection have been unsuccessful. The long-term goal of this research is to develop cost-effective public health messages that reduce health disparities, and to examine psychological processes that serve as mechanisms explaining effective health messaging with African Americans. Program members are testing the effects of an intervention using unique versions of a CRC informational and screening video messaging system. The aims are to 1) identify and compare effects of stand-alone gain versus loss-framed health messages on African-Americans' CRC screening attitudes, intentions, and behavior; 2) identify and compare effects of gain versus loss-framed health messaging on African-Americans' perceived racism and medical mistrust; and 3) determine the effect of coupling gain and loss-framed messages with culturally-targeted personal prevention messages on African-Americans' CRC screening attitudes, intentions, and behavior.
- Lead Researcher: Dr. Lucas
Cancer Survivorship
In a new study program members are conducting a a population-based sample of approximately 1230 African American and white breast, prostate, and colorectal cancer survivors to assess general eHealth activity and are selecting a subsample of 144 participants for an ethnography of personal health history management (PHIM) in one's home or primary PHIM setting to examine the role of eHealth in the context of all PHIM practices. The initial data will guide development of survivor-centered design principles to inform development of a software application prototype that will facilitate access to digital cancer survivorship resources. The team is also comparing cancer survivors with and without internet access, in terms of the social-structural determinants of access and clinical and healthcare-related factors relevant to survivorship. The team is leveraging technology within eHealth resources for the potential to address the needs of diverse populations on a large scale. The Behavioral and Field Research Core and the Epidemiology Research Core are contributing to this five-year project.
- Lead Researcher: Dr. Thompson