2002 — 2006 |
Bodurtha, Joann Norma |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Breast Cancer Risk-Tailored Messages For More Women @ Virginia Commonwealth University
DESCRIPTION (provided by applicant): This project will investigate the impact of a low-intensity intervention on mammography use. The intervention consists of a self-administered computerized breast cancer risk assessment with subsequent receipt of printed health messages that are tailored to calculated risk. The computerized risk assessment program is based on the Gail model for breast cancer risk calculation. The intervention promotes mammography by applying principles of the expanded Health Belief Model. The health messages are tailored to the individual's level of risk (Usual, Moderate, Strong). This 5-year trial will prospectively evaluate the intervention on women coming for routine visits in a gynecology clinic. The specific aims are: 1) to assess the impact of the intervention on the primary outcome of mammography practice; 2) to measure the effect of the intervention on the secondary outcomes of breast self-examination, clinical breast exam, risk perceptions, and breast cancer worry; and 3) to understand the mechanism of action of the intervention by assessing the impact of covariates (coping mechanisms, expanded Health Belief Model variables, breast cancer worry, breast cancer risk factors, risk perceptions, discussion of breast cancer with relatives, previous screening practices, intentions to screen, and various demographic variables-age, race, and education) on breast cancer screening. Nine hundred women at least 40 years old will be randomly assigned to intervention or control conditions. All participants will complete baseline surveys while waiting for their appointments. Immediately following the baseline survey, intervention participants will self-administer the computer program (under the guidance of a research assistant) to calculate their breast cancer risks and receive the printed health messages. Belief and behavioral outcomes will be assessed at 1, 6, and 18 months post-intervention by telephone. Follow-up surveys of both groups will measure planned and actual screening including mammography, breast cancer worry, and risk perceptions. This proposal has potential to provide valuable insight on a high-impact outcome (mammography) based on a theoretically-driven, low-intensity intervention. This study distinguishes itself in at least two ways: 1) it investigates health risk assessment among a diverse group of women not necessarily selected for risk status; and 2) it has high practical significance by using a clinical setting. The intervention may lead to early detection, prevention, and a reduction of the burden of breast cancer
|
0.958 |
2009 — 2010 |
Bodurtha, Joann Norma |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Enabling Family Communication About Cancer - Do You Know Your Kin Facts? @ Virginia Commonwealth University
DESCRIPTION (provided by applicant): Despite medical and technological advances, cancer health disparities continue to occur in prevention, diagnosis, and outcomes. Family health history (FH) is among the strongest known predictors of cancer (CA) and is the most powerful, publicly accessible screen for genetic CA risk. To fill the gap in practical interventions for necessary family communication, we propose to develop and evaluate a clinically integrated intervention to improve patient-family communication about CA risk and prevention. Using the Kin Fact Program (Keeping Information about Family Cancer Tune-up Program), a research assistant (RA) will work 1-on-1 with 245 adult women, recruited over the course of 2 years from annual gynecology visits at the VCU Women's Health Clinic within a randomized trial. The RA will help participants draw a family tree, identify biological kin, and document information about biological family who have had breast cancer (BC) or colon cancer (CC). In this 20-30 minute session, the assistant will: (a) provide risk information and appropriate health recommendations;(b) identify family information needed to complete the FH;(c) coach woman in communication skills to obtain information, and (d) develop, with her, a plan for collection and follow-up on this data gathering. Another 245 women randomized to the control arm will receive standard care. We will test for differences between the intervention and control groups on the primary outcome of family communication about CA. We will also assess the intervention impact on CA-related genetic knowledge and risk-reduction behaviors at 1, 6, and 14 months after the intervention, using written baseline surveys and structured follow-up phone interviews. About 45% of the VCU Women's Health Clinic patients are African-American and about 1/3 are under-insured. By integrating the model within an urban women's health safety-net clinic, this project addresses cancer control and prevention research challenges of racial diversity, inclusive practices, and clinical translation. Our long-term objectives are to: improve public health, specifically related to BC and CC, by maximizing genetic risk assessment through FH collection and communication, eliminate disparities in who benefits from familial risk information, and identify successful methods for enabling women to be effective FH and cancer prevention communicators. Specific aims: 1. Assess the effect of the Kin Fact program on communication about FH of BCs and CCs. We will investigate race/ethnicity and education as effect modifiers. 2. Assess change differences (intervention vs. control) in reported family communication contexts and their mediator effects on communication outcomes. 3. Assess change differences (intervention vs. control) in critical knowledge about CA-related genetic information (knowledge of the genetic component to cancer, in general and also their specific individual risks and capacity to identify resources). 4. As a secondary aim we will examine health behavior differences (intervention vs. control) (e.g. clinical breast exams, mammograms, colonoscopy, USPSTF practices, etc.) for the subset of participants to whom these screening behaviors apply. PUBLIC HEALTH RELEVANCE: Twenty-first century public health approaches to cancer prevention and control need to incorporate genetic information, family health history being the most accessible. The higher death rates from all cancers in African Americans compared to Caucasians demand efforts to explore disparities in family understanding of cancer risk. It is critical to understand ways to improve communication about cancer risk and prevention among family members through accessible interventions in women's primary care, and to ensure the interventions are equitably effective.
|
0.958 |