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Urban Latino African American Cancer (ULAAC) Disparities Project at Centinela Freeman Regional Medical Center. Michael L. Steinberg, MD, FACR Principal Investigator David Khan, MD Co-Principal Investigator Nicole Harada Clinical Research Coordinator. Our Team. Principal Investigator - PowerPoint PPT Presentation
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Urban Latino African American Urban Latino African American Cancer (ULAAC) Disparities Project Cancer (ULAAC) Disparities Project at Centinela Freeman Regional at Centinela Freeman Regional Medical CenterMedical Center
Michael L. Steinberg, MD, FACRMichael L. Steinberg, MD, FACRPrincipal InvestigatorPrincipal Investigator
David Khan, MDDavid Khan, MDCo-Principal InvestigatorCo-Principal Investigator
Nicole HaradaNicole HaradaClinical Research CoordinatorClinical Research Coordinator
Our TeamOur Team
Principal InvestigatorPrincipal Investigator
– Michael Steinberg, MDMichael Steinberg, MD
Co-Principal InvestigatorsCo-Principal Investigators
– David Khan, MD, Radiation Oncologist, CF David Khan, MD, Radiation Oncologist, CF
– David Huang, MD, Radiation Oncologist, CFDavid Huang, MD, Radiation Oncologist, CF
– Nell Forge, PhD, MPH, Assoc. Behavioral Scientist, RANDNell Forge, PhD, MPH, Assoc. Behavioral Scientist, RAND
– Allen Fremont, MD, PhD, Assoc. Natural Scientist, RANDAllen Fremont, MD, PhD, Assoc. Natural Scientist, RAND
– Oscar Streeter, MD, Radiation Oncologist, USCOscar Streeter, MD, Radiation Oncologist, USC
– Mack Roach, MD, Radiation Oncologist, UCSFMack Roach, MD, Radiation Oncologist, UCSF
Cancer Disparities Research Cancer Disparities Research Partnership (CDRP) Program Partnership (CDRP) Program
Program Steering CommitteeProgram Steering CommitteeJanuary 20, 2006January 20, 2006Miami, FloridaMiami, Florida
Project Overview Project Overview
Status of Clinical TrialsStatus of Clinical Trials
12 Trials Open12 Trials Open
– 10 RTOG Sponsored Trials10 RTOG Sponsored Trials
– 1 Community-Based Trial1 Community-Based Trial
– 1 Device Trial1 Device Trial
Trials OpenTrials OpenName of TrialName of Trial Name of SponsorName of Sponsor Date openedDate opened
2003-02 DCIS2003-02 DCIS CYTYC (formerly Proxima)CYTYC (formerly Proxima) 11/30/200411/30/2004
RTOG 0229RTOG 0229 National Cancer InstituteNational Cancer Institute 12/29/200412/29/2004
RTOG 98-13RTOG 98-13 National Cancer InstituteNational Cancer Institute 12/24/200412/24/2004
Prostate Patient Profiles Prostate Patient Profiles Project (PProject (P44))
Louis Warschaw Prostate Cancer Center Louis Warschaw Prostate Cancer Center @ Cedars Sinai@ Cedars Sinai
09/08/200509/08/2005
RTOG 0315RTOG 0315 National Cancer InstituteNational Cancer Institute 12/07/200412/07/2004
RTOG 0320RTOG 0320 National Cancer InstituteNational Cancer Institute 01/05/200501/05/2005
RTOG 0413RTOG 0413 National Cancer InstituteNational Cancer Institute 09/19/200509/19/2005
RTOG 0232RTOG 0232 National Cancer InstituteNational Cancer Institute 11/04/200511/04/2005
RTOG 0247RTOG 0247 National Cancer InstituteNational Cancer Institute 12/15/200412/15/2004
RTOG 98-04RTOG 98-04 National Cancer InstituteNational Cancer Institute 12/07/200412/07/2004
RTOG 0215RTOG 0215 National Cancer InstituteNational Cancer Institute 10/10/200510/10/2005
RTOG 0321RTOG 0321 National Cancer InstituteNational Cancer Institute 11/22/200511/22/2005
Trials in DevelopmentTrials in Development
Melatonin TrialMelatonin Trial
Glutamine TrialGlutamine Trial
HDR as MonotherapyHDR as Monotherapy
Accrual to Clinical TrialsAccrual to Clinical Trials
120
1015
0
20
40
60
80
100
120
140
Patients Screened Eligible Enrolled
Clinical Trial QuestionnaireClinical Trial Questionnaire
Reasons for Declining Clinical TrialsReasons for Declining Clinical Trials
1 1
2
1
0
0.5
1
1.5
2
2.5
Lack of PCPSupport
PersonallyOverwhelmed
PreferredTraditionalTreatment
Problem withinsurance
Gender/Ethnicity of Patients of Gender/Ethnicity of Patients of Clinical TrialClinical Trial
1
4
3
2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
African AmericanFemale
African AmericanMales
CaucasianFemales
Latino Males
Publications and Presentations Publications and Presentations
““Implementing a Lay Patient Navigator Program to Reduce Barriers for Minority Patients Access to Cancer Care and Clinical Trials: Essential Steps and Initial Challenges”
Manuscript in review
““OMH OMH National Leadership Summit on Eliminating Racial Disparities in National Leadership Summit on Eliminating Racial Disparities in HealthHealth
January 9-11, 2006 Washington, D.C.January 9-11, 2006 Washington, D.C.
Lay Patient Navigator PresentationLay Patient Navigator Presentation
“Prophylactic Post-Operative Antibiotics for Prostate Brachytherapy”
presentation at the 2006 ASCO Prostate Cancer Symposium at February 2006
“California Cancer Reach 2010 Conference” May 2006 presentation on Patient Navigation
Update on Partnership RelationsUpdate on Partnership Relations
Centinela Freeman Centinela Freeman
USCUSC
UCSFUCSF
RANDRAND
USC/Norris Cancer Comprehensive CenterUSC/Norris Cancer Comprehensive Center
Mentoring InstitutionMentoring Institution– Guidance and oversight in clinical trial infrastructure Guidance and oversight in clinical trial infrastructure
– Collaboration of clinical trialsCollaboration of clinical trials
MammoSite TrialMammoSite Trial
P53 Trial ( in development )P53 Trial ( in development )
High Risk Prostate Cancer ( in development )High Risk Prostate Cancer ( in development )
– Collaboration of tumor boards and case conferencesCollaboration of tumor boards and case conferences
Weekly Combined Tumor Boards (Telesynergy)Weekly Combined Tumor Boards (Telesynergy)
USC School of Social WorkUSC School of Social Work
Intern Training in Social Service Management of Intern Training in Social Service Management of Cancer the Patient and NavigationCancer the Patient and Navigation
Developed Personal Health Record for Patients Developed Personal Health Record for Patients
Support Group DevelopmentSupport Group Development
Program Enlarging in 2006/2007Program Enlarging in 2006/2007
University of California, San FranciscoUniversity of California, San Francisco
Primary RTOG Site Primary RTOG Site
Guidance and oversight in clinical trial Guidance and oversight in clinical trial infrastructureinfrastructure
Rand CorporationRand Corporation
Providing Evaluation Component of the Program Providing Evaluation Component of the Program
Program Development Recommendations Program Development Recommendations
Focus Groups with Stakeholders (Community Focus Groups with Stakeholders (Community Advisory Board Members, ULAAC Project Staff, Advisory Board Members, ULAAC Project Staff, Patient Navigators, Community Physicians)Patient Navigators, Community Physicians)
Navigator Focus Groups Navigator Focus Groups
ACTION: multi-system collaboration NIH grantACTION: multi-system collaboration NIH grant
Compliance Compliance
ClinicalClinical
Regulatory Regulatory
AdministrativeAdministrative
Compliance ProcessCompliance Process
Outside AuditOutside Audit
Update on Telesynergy/TelemedicineUpdate on Telesynergy/Telemedicine
– Tumor BoardsTumor BoardsUSC – Every MondayUSC – Every MondayCFHS – Every WednesdayCFHS – Every Wednesday
– Training SessionsTraining SessionsULAAC Navigator Training ProgramsULAAC Navigator Training Programs
– MeetingsMeetingsInvestigator Meeting – QuarterlyInvestigator Meeting – QuarterlyMedical Advisory Board – QuarterlyMedical Advisory Board – QuarterlyULAAC – Every WednesdayULAAC – Every Wednesday
– Clinical TrialsClinical TrialsCollaboration with other CDRP sitesCollaboration with other CDRP sitesPatient consent Patient consent
Navigator Training ProgramNavigator Training Program
46
39
7
0
5
10
15
20
25
30
35
40
45
50
Signed up for training Completed training No-Show
Navigator Training OutlineNavigator Training Outline
The 6-hour training program takes place over three days:The 6-hour training program takes place over three days:
– Day OneDay One
Brief introduction to the project Brief introduction to the project
The role of the navigator developed by examination of The role of the navigator developed by examination of the barriers to health care existing in the community the barriers to health care existing in the community
Vignettes and anecdotes of a typical patient Vignettes and anecdotes of a typical patient
Navigator Training OutlineNavigator Training Outline
–Day TwoDay Two
Discussion of the navigator/patient relationship, including initiating Discussion of the navigator/patient relationship, including initiating contact, offering services and empowering the patientcontact, offering services and empowering the patient
Recordkeeping is demonstrated at length, with emphasis on the Recordkeeping is demonstrated at length, with emphasis on the research nature of the project and the importance of adequate research nature of the project and the importance of adequate chartingcharting
Appropriate use of the Intake Form, Hours and Mileage Form, the Appropriate use of the Intake Form, Hours and Mileage Form, the S.O.A.P. Form, and the Medications ListS.O.A.P. Form, and the Medications List
The biology of cancer and common types of treatment are discussed The biology of cancer and common types of treatment are discussed
Overview of clinical trials presented by one of the co-investigating Overview of clinical trials presented by one of the co-investigating physicians, including information on the benefits of trials physicians, including information on the benefits of trials participation to patients and the communityparticipation to patients and the community
Navigator Training OutlineNavigator Training Outline
– Day ThreeDay Three
Presentation on the Emotional aspects of cancer, sensitizing Presentation on the Emotional aspects of cancer, sensitizing the trainees to the fears and uncertainties cancer patient may the trainees to the fears and uncertainties cancer patient may face face
Presentation on the Barriers to trials participation in this Presentation on the Barriers to trials participation in this community are gathered from the participants’ point of view community are gathered from the participants’ point of view
Discussion about the benefits to trials enrollment are Discussion about the benefits to trials enrollment are reaffirmed as the trainees learn how to appropriately speak to reaffirmed as the trainees learn how to appropriately speak to their assigned patients about participation. their assigned patients about participation.
HIPAA presentation on patient confidentialityHIPAA presentation on patient confidentiality
Navigator TrainingNavigator Training
17
14
8
0
2
4
6
8
10
12
14
16
18
Group 1 Group 2 Group 3
Three training programs were conducted during the months of March (Group 1), June (Group 2), and September (Group 3), 2005. A total of 39 Navigators were trained.
Active NavigatorsActive Navigators
10
6
3
0
2
4
6
8
10
12
Group 1 Group 2 Group 3
Ethnicity of Active NavigatorsEthnicity of Active Navigators15
4
0
2
4
6
8
10
12
14
16
African Americans Latinos
Navigators Who Are SurvivorsNavigators Who Are Survivors
1
7
1
2
1
0
1
2
3
4
5
6
7
8
Esophageal Breast Colon Prostate Lung
Patient Navigation DataPatient Navigation Data152
93
3
56
0
20
40
60
80
100
120
140
160
Approached Accepted PendingDisposition
Declined
Reasons for Declining NavigationReasons for Declining Navigation42
12
1 10
5
10
15
20
25
30
35
40
45
Strong SupportSystem
Felt it was notneeded
MedicalBackground
Wanted noinformation at all
Patient Navigator Case LoadPatient Navigator Case Load
10
6
3
0
2
4
6
8
10
12
1-3 Patients 4-6 Patients 7-10 Patients
Chart Audit: “Barriers to Care”Chart Audit: “Barriers to Care”
Barriers to Care: Chart AuditBarriers to Care: Chart Audit
PT PT ID#ID#
DxDx BarriersBarriers Navigator Navigator AssignedAssigned
Date of Date of ReviewReview
Date Date closedclosed
Days Days openopen
Resources Resources IdentifiedIdentified
Did ULAAC Did ULAAC staff assist staff assist Navigator?Navigator?
009009 ColonColon 1. Transportation1. Transportation RJHRJH 04/29/0504/29/05 04/30/0504/30/05 22 Taxi Taxi voucher voucher programprogram
NoNo
2. Financial2. Financial RJHRJH 04/29/0504/29/05 04/30/0504/30/05 22 Beckstrand Beckstrand Cancer Cancer
FoundationFoundation
NoNo
6 Most Common Barriers6 Most Common Barriers
50
118
117 9
0
10
20
30
40
50
60
1
Transportation Fear of Cancer
Lack of Caregiver Financial Difficulties
Language Difficulties Lack of Psychosocial Support
Assessment and Effectiveness of Assessment and Effectiveness of Quality AssuranceQuality Assurance
Navigator Focus Groups (Rand source protected feedback)Navigator Focus Groups (Rand source protected feedback)
Patient Satisfaction Survey, compatibility and does the Patient Satisfaction Survey, compatibility and does the navigation process meet patient needs (patient perception of navigation process meet patient needs (patient perception of effectiveness) effectiveness)
Clinical Trials Questionnaire Clinical Trials Questionnaire
Telephone interviews with patientsTelephone interviews with patients
Compliance interviews (5%)Compliance interviews (5%)
CHALLENGES AND CHALLENGES AND OPPORTUNITIESOPPORTUNITIES
Evaluation of effect on trialsEvaluation of effect on trials
Pushing navigation earlier in the process of care (surgeons, Pushing navigation earlier in the process of care (surgeons, primary care, screening) primary care, screening)
Using army of navigators in community outreachUsing army of navigators in community outreach
Using navigator for disaster preparednessUsing navigator for disaster preparedness
Testimonial method in training and in presentation of clinical Testimonial method in training and in presentation of clinical trials trials
CHALLENGES AND CHALLENGES AND OPPORTUNITIESOPPORTUNITIES
Ongoing Evaluation Will Provide Practical Information Ongoing Evaluation Will Provide Practical Information
– Elimination of barriers to care Elimination of barriers to care
– Quality assessmentQuality assessment
– Effects of navigation on accrual to clinical trialsEffects of navigation on accrual to clinical trials
Spawned from the ULAAC Grant Spawned from the ULAAC Grant
– Cancer CommitteeCancer Committee
– ACoS Accreditation with 7 commendationsACoS Accreditation with 7 commendations
– Tumor Boards case conferences weeklyTumor Boards case conferences weekly
– Community Outreach and health screeningsCommunity Outreach and health screenings
– Navigators outreach educating the community Navigators outreach educating the community about the benefits of clinical trials about the benefits of clinical trials
– Development of a Spanish Support GroupDevelopment of a Spanish Support Group
Media CoverageMedia Coverage
La Opinion article, November 11, 2005La Opinion article, November 11, 2005
– To Navigate Services in a Health System: The Patient Navigator To Navigate Services in a Health System: The Patient Navigator Program Helps Sort Through Obstacles that Make it Difficult to Program Helps Sort Through Obstacles that Make it Difficult to Treat CancerTreat Cancer
Inglewood Today article, October 12, 2005Inglewood Today article, October 12, 2005
– Taking Care of Business: The Urban Latino African American Taking Care of Business: The Urban Latino African American Cancer (ULAAC) Disparities ProjectCancer (ULAAC) Disparities Project
KCAL 9 news station (CBS)– December 7, 2005 2:00 PM, 3:00 PM, KCAL 9 news station (CBS)– December 7, 2005 2:00 PM, 3:00 PM, and 4:00 PM news ULAAC: New cancer Program Helps Patients and 4:00 PM news ULAAC: New cancer Program Helps Patients Navigate SystemNavigate System
http://cbs2.com/video/[email protected]://cbs2.com/video/[email protected]
Centinela Freeman Community Centinela Freeman Community FoundationFoundation
Mission Statement:Mission Statement:
“ “The mission of the Centinela Freeman Community The mission of the Centinela Freeman Community Foundation is to enhance the health and healthcare Foundation is to enhance the health and healthcare of South and Southwest Los Angeles by developing of South and Southwest Los Angeles by developing
and supporting healthcare education, medical and supporting healthcare education, medical research, and programs which improve access to research, and programs which improve access to healthcare for the citizens of our community.”healthcare for the citizens of our community.”
Centinela Freeman Community Centinela Freeman Community FoundationFoundation
Leveraging Off Previous Community Based Foundations … Formed New Leveraging Off Previous Community Based Foundations … Formed New FoundationFoundation
Establishing Infrastructure to Support Access to Care and Clinical Establishing Infrastructure to Support Access to Care and Clinical Research in the CommunityResearch in the Community
Current ActivitiesCurrent Activities
– Recruited Executive Director Recruited Executive Director
– Diabetes Screening/Navigator ProgramDiabetes Screening/Navigator Program
– Cancer Screening ProgramCancer Screening Program
– High School Sports Trainer FundingHigh School Sports Trainer Funding
– Nursing AcademyNursing Academy
– Low cost insurance supplement collaboration Low cost insurance supplement collaboration
““Still Too Separate, Not Yet Equal”Still Too Separate, Not Yet Equal” … A. Epstein… A. Epstein
Describing And Explaining Disparities Is Much Describing And Explaining Disparities Is Much Easier Than Devising Strategies To Reduce Easier Than Devising Strategies To Reduce Disparities Disparities