Abstract B13: Lessons learned from implementing a prostate cancer risk assessment program for underserved high-risk men: The Prostate REACH Project

Abstract

Abstract Background: Prostate cancer disproportionately affects Black men. Black men are 60% more likely to be diagnosed with prostate cancer and 2.4 times more likely to die from prostate cancer compared to White men. Therefore, prostate cancer risk assessment programs are important to assess risk, discuss risks and benefits of screening, and provide screening services. However, Black men may encounter barriers to participation in these programs such as lack of health insurance, difficulty with travel to clinic, and challenges with navigating the medical system. To address these barriers, the Prostate Cancer Risk, Education and Assessment in the Community with Help (REACH) project was developed as a community-based extension of a comprehensive prostate cancer risk assessment program (PRAP) at Fox Chase Cancer Center (FCCC). This is a pilot project to evaluate the feasibility and acceptability of a community-based risk assessment program. Methods: Developing the REACH project infrastructure included: 1) choosing a clinic site; 2) establishing patient access procedures; 3) establishing navigator services; 4) developing procedures for subsidy fund use; and 5) recruitment and promotion. Given the challenges of establishing a community site, we chose to utilize our mobile mammography van as the screening venue. Evaluation measures included recruitment and participation rates, utilization of patient navigation services, as well as patient satisfaction. A self-administered survey assessed the distance travelled to receive screening services, whether or not they utilized patient navigator services, the importance of having a community screening site in their decision to participate (5-point Likert scale), the importance of having a patient navigator to assist (5-point Likert scale), satisfaction with any patient navigation services provided (5-point Likert scale), and overall satisfaction with the program (5-point Likert scale). Results: As of April 2011, 35 men have called regarding the program. Of these, 20 were eligible and 13 men have received prostate cancer risk assessment services through Prostate REACH. Twelve participants were screened on the van and one patient at the FCCC PRAP clinic. The majority of participants are Black men. The mean age at enrollment is 48.6 years (range 36–64 years). Approximately 69% of participants received patient navigation services. The patient navigator contacted each participant on average three times to address barriers. Insurance issues were the most common barrier (88%) addressed by the navigator. Support issues (emotional and caregiver) also were addressed. All participants completed the user survey following their screening. Nearly 70% of men travelled five miles or less to be screened, and 54% reported that they utilized patient navigation services (slightly under the 69% who actually did receive some navigation). The majority of participants thought having a community screening location and a patient navigator was important for participation. The majority of participants were quite a bit to extremely satisfied with the overall REACH program (Mean=4.85, SD=0.38). Conclusions: The REACH experience highlights specific implementation challenges faced in expanding access to prostate cancer risk assessment to underserved men. Patient navigation services may be essential to participation among underserved populations. Future research should explore various recruitment strategies to increase participation. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B13.