The Greensboro Cancer Care and Racial Equity Study (CCARES) is a CBPR project that seeks to move the fields of public health and health care forward in understanding how differences in communication and care function within a local medical community to impact breast cancer treatment and the continuity of care, especially for African American women.
Topic area(s): Health Disparities; Cancer Prevention and Control; Women, Children and Minorities

Purpose

The objective of this study is to investigate the complexities in the system of care within a NC local medical community, including nuances of communication and the mechanics of care referral, to help explain how  deviations from reasonable breast cancer care obtained by African American patients, as compared to White patients, are potentially associated with racial disparities in breast cancer mortality.

Project Description

The Greensboro Cancer Care and Racial Equality Study (CCARES) utilizes a Community-Based Participatory Research (CBPR) approach to address racial disparities in breast cancer mortality. The Moses Cone Health System (MCHS), located in Greensboro, North Carolina, has joined this project with the commitment of working with local health care providers to help identify elements of the care process that potentially could be altered to maximize outcomes for all members of the community.  With this backdrop, CCARES addresses the following research questions:

  1. Are there deviations in reasonable breast cancer care that are influenced by a patient’s race?
  2. If present, what factors contribute to the deviations from reasonable breast cancer care among African American patients?
  3. Do protocols exist to reduce deviations from reasonable breast cancer care that measure quality of the care offered and identify and pursue dropouts from the breast cancer care continuum?

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 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 the structure and climate of a local medical community that may or may not contribute to disparities in health care outcomes.

Two Study Aims were identified.

  • 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 Moses Cone breast cancer registry for 2001 and 2002. An Expert Review Panel will be convened to describe the 2001-2002 standards of reasonable breast cancer care protocols for women presenting with stages 1-4, respectively, and review summarized breast cancer registry data for African American and White women to characterize the respective patters of adherence to or deviation from standards of reasonable breast cancer care protocols.
  • Identify factors that contribute to adherence to or deviation from obtaining reasonable breast cancer 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.

Funding

  • Source: National Cancer Institute
  • Dates of funding: September 1, 2006 – August 31, 2008
  • Current Status: Disseminated

Key Contacts

Principal Investigator: Eugenia Eng, DrPH

Co- Investigator: Michael Yonas, DrPH

Research Associate: Brandolyn White, MPH

Publications

Yonas MA, Jones N, ENG E, Vines A, Aronson RE, Griffith DM, White B, DuBose M. The art and science of integrating undoing racism with CBPR: Challenges of pursuing NIH funding to investigate cancer care and racial equity. Journal of Urban Health, 83(6):1004-1012, 2006.