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Promoting Breast Cancer Surveillance among African American Survivors
Breast Cancer Disparities
Background: Breast cancer survivors are at considerable risk for local breast cancer recurrence and at higher risk to develop a second primary breast cancer compared to never-diagnosed women. The American Society of Clinical Oncology recommends that survivors undergo regular breast cancer surveillance following primary treatment as cancers detected early are associated with a better prognosis. However, rates of such surveillance among African Americans (AAs) are reportedly lower than that of White survivors. Survivors in Spirit (SIS) is an intervention developed to address this problem and is being evaluated in an ongoing funded randomized controlled trial. SIS is a live educational presentation made to survivors in group settings and conducted by lay health educators. Preliminary findings support its positive impact on variables related to surveillance and reveal that survivors attending SIS presentations evaluate them favorably. However, problems in implementation of SIS include difficulty assembling appropriate audiences of survivors as demonstrated by a ?no-show? rate of 56% and the cost/labor-intensiveness of assembling teams of lay educators for presentations. These problems can be addressed by converting SIS into a DVD (digital video disc) that is more easily disseminated to individual survivors. Objective /Hypotheses: We hypothesize that, from pre-test to post-test, the viewing of the SIS-DVD will result in 1) increased knowledge about recurrence and post-treatment surveillance, 2) increased perceived benefits and decreased perceived disadvantages of surveillance, and 3) increased intention to adhere to surveillance guidelines. Specific Aims: Aim 1: To develop a DVD intervention based on SIS to promote post-treatment breast cancer surveillance among AA breast cancer survivors that is guided by focus group input. Aim 2: To conduct a pilot evaluation of the cognitive and psychological impact of the SIS-DVD intervention using standardized questionnaires. Aim 3: To disseminate results of the SIS-DVD evaluation via educational seminars primarily targeting AA breast cancer survivors. Study Design: After initial production of the SIS-DVD, we will conduct two focus groups of AA breast cancer survivors to obtain feedback using standard focus group methods. Once this feedback is analyzed, these results will guide the final edit of the SIS video to be used in the questionnaire component of the project. In this component, 60 AA breast cancer survivors will be a recruited through physician referral. These participants will complete a standardized pre-test, view the SIS-DVD and then complete a standardized post-test. Potential Outcomes and Benefits of the Research: The proposed project will address the absence of surveillance education programs specific to AA survivors and has the potential to increase early detection in this group. It will also provide a model intervention strategy that may be replicated in other ethnic populations.
Breast cancer survivors are at considerable risk for breast cancer recurrence and at elevated risk for developing a new breast cancer compared to undiagnosed women. Regular breast cancer surveillance (i.e., annual mammography, regular physical examinations, pelvic/pap tests, and breast self-exam) following the completion of primary treatment is associated with the early detection of recurrence and may be associated with lower mortality. Unfortunately, studies show racial differences in post-treatment breast cancer surveillance such that rates among African American survivors are lower than that of Whites. In response to this problem, an intervention called Survivors in Spirit (SIS) was developed to increase post-treatment breast cancer surveillance in this population. SIS, which is currently being evaluated in an ongoing funded randomized controlled trial at Mount Sinai School of Medicine, was originally developed as a live presentation to be conducted by teams of trained lay health educators and presented to breast cancer survivors in group settings. Preliminary data support its efficacy in increasing knowledge about breast cancer recurrence and surveillance and impacting other relevant variables. Also, 100% of survivors attending SIS presentations reported that presentations were well-organized and that they felt good about their ability to use what they learned. However, two problems have emerged during the implementation of the funded SIS evaluation: 1) difficulty in the continual assembling of audiences of survivors appropriate for SIS presentations as demonstrated in a ?no-show? rate of 56%, and 2) the high cost and labor-intensiveness of assembling teams of lay health educators for SIS presentations. These are problems important to address in order to disseminate SIS beyond the research context. The conversion of SIS into a DVD (digital video disc) directly addresses these problems by making SIS content available to individual survivors in an easily disseminated form. Therefore, the specific objectives of this study are 1) to develop a DVD based on SIS to promote post-treatment breast cancer surveillance among African American breast cancer survivors that is guided by focus group input; 2) to conduct a pilot evaluation of the cognitive and psychological impact of the SIS-DVD intervention using standardized questionnaires; and 3) to disseminate results of the SIS-DVD evaluation via educational seminars targeting African American breast cancer survivors as well as health professionals and cancer patient advocates/educators. The proposed project has the potential to further address the absence of post-treatment surveillance education programs targeting African American survivors, increase actual surveillance in this group, and provide a model intervention strategy that may be replicated in other ethnic populations.