Mbah Olive, Ford Jean G, Qiu Miaozhen, Wenzel Jennifer, Bone Lee, Bowie Janice, Elmi Ahmed, Slade Jimmie L, Towson Michele, Dobs Adrian S
Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, USA.
BMC Cancer. 2015 Nov 16;15:907. doi: 10.1186/s12885-015-1920-7.
Disadvantaged populations face many barriers to cancer care, including limited support in navigating through the complexities of the healthcare system. Family members play an integral role in caring for patients and provide valuable care coordination; however, the effect of family navigators on adherence to cancer screening has not previously been evaluated. Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients.
Guided by principles of community based participatory research (CBPR), "Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors (COACH)" is a community-based randomized controlled trial to assess the effectiveness of a trained participant-designated coach (support person or care giver) in navigating cancer-screening for older African American adults, 50-74 years old. Participants are randomly assigned as dyads (participant+coach pair) to receiving either printed educational materials only (PEM--control group) or educational materials plus coach training (COACH--intervention group). We defined a coach as family member, friend, or other lay support person designated by the older adult. The coach training is designed as a one-time, 35- to 40-minute training consisting of: 1) a didactic session that covers the role of the coach, basic facts about colorectal, breast and cervical cancers (including risk factors, signs and symptoms and screening modalities), engaging the healthcare provider in cancer screening, insurance coverage for screening, and related healthcare issues, 2) three video skits addressing misconceptions about and planning for cancer screening, and 3) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened. The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings (for breast, cervix or colorectal cancer) between the control and intervention groups.
Building on trusted patient contacts to encourage cancer screening, COACH is a highly sustainable intervention in a high-risk population. It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants' existing support networks. If effective, the intervention could have a high impact on health care disparities research across multiple diseases.
ClinicalTrials.gov ( NCT01613430 ). Registered June 5, 2012.
弱势群体在癌症护理方面面临诸多障碍，包括在应对复杂的医疗系统时获得的支持有限。家庭成员在照顾患者方面发挥着不可或缺的作用，并提供重要的护理协调；然而，此前尚未评估家庭导航员对癌症筛查依从性的影响。培训和评估受信任的家庭成员及其他支持人员可能会改善弱势患者的癌症治疗结果。
以社区参与性研究（CBPR）原则为指导，“评估老年人癌症护理与健康行为指导者（COACH）”是一项基于社区的随机对照试验，旨在评估经过培训的参与者指定指导者（支持人员或护理人员）在指导50至74岁非洲裔美国老年人进行癌症筛查方面的有效性。参与者被随机配对（参与者+指导者对），分为仅接受印刷教育材料组（PEM——对照组）或接受教育材料加指导者培训组（COACH——干预组）。我们将指导者定义为老年人指定的家庭成员、朋友或其他非专业支持人员。指导者培训设计为一次35至40分钟的培训，内容包括：1）一场讲授课程，涵盖指导者的角色、结直肠癌、乳腺癌和宫颈癌的基本事实（包括风险因素、体征和症状以及筛查方式）、促使医疗服务提供者参与癌症筛查、筛查的保险覆盖范围以及相关医疗问题；2）三个视频短剧，解决有关癌症筛查的误解和规划问题；3）与培训师进行互动角色扮演环节，以强化和练习鼓励参与者接受筛查的策略。主要研究结果是对照组和干预组之间完成至少一项推荐筛查（乳腺癌、宫颈癌或结直肠癌）的参与者比例差异。
基于受信任的患者联系人来鼓励癌症筛查，COACH是针对高危人群的一项极具可持续性的干预措施。它有可能通过调动参与者现有的支持网络，将对医疗机构的不信任对筛查行为的影响降至最低。如果有效，该干预措施可能会对多种疾病的医疗保健差异研究产生重大影响。
ClinicalTrials.gov（NCT01613430）。2012年6月5日注册。
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