UNC to test interventions aimed at reducing colon cancer screening disparities

The study will focus on assessing the impact of a clinic-based intervention that includes having patients view a multimedia decision aid (in English or Spanish) before seeing their physician, as well as support from a bilingual patient “navigator” on completion of recommended colon cancer screening tests.

The American Cancer Society has awarded University of North Carolina School of Medicine researcher Dan Reuland, MD, MPH a $1.7 million Research Scholar Grant to test interventions designed to reduce colon cancer screening disparities in vulnerable patient groups, particularly Latinos.  

Reuland, associate professor of medicine in the division of general medicine and clinical epidemiology, will lead a five-year, multi-site project titled “Improving Colon Cancer Screening for Diverse Populations.” Collaborators include Mike Pignone, MD, MPH, professor and chief of the general medicine division and nationally recognized expert on colon cancer screening, as well as researchers from the Mecklenburg Area Partnership for Primary-Care Research (MAPPR) and the University of New Mexico.

Colorectal cancer is the third leading cause of cancer death in the United States. Although screening can reduce colorectal cancer mortality, screening rates are low in certain vulnerable patient populations. U.S. Latinos, the nation’s largest and fastest growing racial/ethnic minority population, have particularly low screening rates. The study will focus on assessing the impact of a clinic-based intervention that includes having patients view a multimedia decision aid (in English or Spanish) before seeing their physician, as well as support from a bilingual patient “navigator” on completion of recommended colon cancer screening tests.

“There is increasing recognition that improving preventive and chronic care will require an enhanced primary care model that employs proactive, team-based approaches. These approaches will need to move beyond the model of having physicians acting as individuals delivering care in brief visits with limited care coordination or support, particularly when it comes to caring for our most vulnerable patient groups,” said Reuland. “The interventions tested in the study are pragmatic and have potential for integration into real world practice under the Patient Centered Medical Home (PCMH) model, particularly if payment for this type of systematic, team-based care can be implemented under provisions of the Affordable Care Act. This work is meant to inform clinical and policy level decisions about how to reduce disparities and promote informed decision making in vulnerable patient groups.”

The grant builds on a line of research dating back to the late 1990s when Russell Harris, MD, MPH, a professor in the UNC School of Medicine and senior investigator at the Sheps Center for Health Services Research, and others developed the original colon cancer screening decision aid. In 2009, Reuland received the American Cancer Society Cancer Control Career Development Award for Primary Care Physicians, which he used to conduct the project’s preliminary studies, including adaptation and testing of the decision aid in Spanish-speaking populations. During that award, he was mentored by Pignone, who holds a National Cancer Institute K05 Established Investigator award.

Preliminary studies were also supported by grant funding from the UNC Lineberger Comprehensive Cancer Center including its Communication for Health Applications and Interventions Core, the NIH Clinical and Translational Science Awards (CTSA) program at UNC-CH, and in-kind support from the Cecil G. Sheps Center for Health Services Research.

Reuland, Pignone and Harris are all members of the UNC Lineberger Comprehensive Cancer Center.

Date: June 4, 2013

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