Cancer Control Research5R21CA119979-02
GREENSBORO CANCER CARE AND RACIAL EQUITY STUDY (CCARES): A CBPR APPROACH
DESCRIPTION (provided by applicant): The "Greensboro Cancer Care and Racial Equity Study: A CBPR Approach" will investigate the complexities in the system of healthcare which may explain deviations from reasonable breast cancer care obtained by African American patients, as compared to White patients. The research questions and study design were developed, through an 18-month planning grant, by the Greensboro Health Disparities Collaborative of 35 community, academic, and health professionals using a community-based participatory research approach to: (a) establish a research partnership; (b) understand and agree on the language for social/political analysis or racism in creating racial disparities; and (c) design a study to identify characteristics of a local medical community that may or may not contribute to disparities in health outcomes. Aim 1: Characterize the deviations in reasonable breast cancer care received among patients, age 40+ years, by race, zip code, and stage of cancer by extracting and summarizing data from the local cancer registry for 2001 and 2002. An Expert Review Panel will be convened to: describe standards of reasonable breast cancer care for women presenting with stages 1-4, respectively; and review breast cancer registry data for African American and White women to characterize the respective patters of care from these protocols. Aim 2: Identify factors that contribute to adherence to or deviation from care, by using grounded theory techniques to compare and contrast in-depth interview responses from 35 breast cancer providers, representing each of the multiple phases of breast cancer care, with critical incident interview responses from 80 women, age 40+ years, by race, stage of cancer, and who completed or discontinued their treatment at MCHS. Aim 3: Identify protocols designed to reduce racial disparities in reasonable breast cancer care that measure quality of the care, as well as protocols which identify and pursue dropouts from treatment and care by: coding responses from 35 breast cancer care providers representing each of the multiple phases of breast cancer care; and conducting a systematic document review of MCHS and local medical community policies, procedures, and protocols pertaining to breast cancer care. In recognition of persistent disparities in breast cancer mortality among African American and White women nationally, it is critical to characterize the dynamics of healthcare provision and the potential influence of such dynamics have on women's experiences with breast cancer diagnosis, treatment, and , follow-up care. Inspired by a multidisciplinary community collaborative, this study will provide information essential for understanding and improving the care trajectories for all women experiencing breast cancer and critical insight into the development of a capacity building approach to conducting health disparities research.