Addressing Disparities for Veterans and African Americans Through Peer Navigation for Testing and Genetic Evaluation: The ADVANTAGE Study
Abstract
Rationale: African American males have some of the highest rates of development and death from prostate cancer in the U.S. While the role of genetic testing for prostate cancer is rapidly expanding with increasing guidelines and growing treatments based on genetic results (precision medicine), African American men typically represent fewer than 15% of those who seek and complete genetic testing. Genetic test results can provide vital information regarding the aggressive nature of prostate cancer, inform options for targeted therapy in men with metastatic prostate cancer, and inform active surveillance discussions in men with early-stage prostate cancer. However, African American males may engage less frequently in genetic testing due to lack of awareness or understanding, cultural beliefs, financial and access-to-care limitations, fear of discrimination, and distrust in the healthcare system, which applies across health care settings including academic, community, and Department of Veterans Affairs (VA). Furthermore, genetic evaluation is a multi-step, complex process involving intake of family history, attending a detailed pretest genetic counseling session, making an informed decision for genetic testing, and receiving genetically based recommendations. In the current era of COVID-19, much of healthcare transitioned to telehealth, adding a layer of technologic complexity to the process. These issues may hinder African American men from engaging with and completing genetic testing. Novel strategies in the patient-care setting are needed to enhance engagement and genetic testing for African American men to benefit from precision medicine. The ADVANTAGE Study builds upon a first-in-field genetic testing program for men with prostate cancer and links with a strong African American peer health educator network in the Philadelphia region – which has a high percentage of African Americans and exceeds the national average for prostate cancer mortality. The study will train peer navigators regarding the genetic evaluation process, telehealth, cultural issues, and healthcare system challenges of genetic testing for prostate cancer. Peer navigation (where African American men with prostate cancer will receive five time points of support from peer navigators) will then be compared to the usual clinical care (where patients have to independently complete genetic counseling and genetic testing) and feasibility of peer navigation will be assessed. Furthermore, men’s experience with each process will be assessed and compared. The ADVANTAGE study will also lead a national conversation addressing disparities in prostate cancer genetic testing by hosting a national roundtable consensus meeting. The meeting will promote national policies to increase engagement of African American men in genetic testing across practice settings including academic, community, and VA setting. The roundtable will help refine peer navigation. The ADVANTAGE Study is the first study in the U.S. dedicated to studying peer navigation to help African American males regarding prostate cancer genetic testing. Objective and Aims: To evaluate the feasibility of peer-navigated genetic evaluation and assess men’s experience with the prostate cancer genetic evaluation process. Aim 1. Develop a peer-based navigation program for African American men with PCA. Five African American men with prostate cancer will be trained as peer navigators, including training in prostate cancer genetics, genetic counseling, telehealth, cultural barriers, health system barriers, and impact on care. Aim 2. Conduct a pilot study of peer-navigated genetic evaluation vs. standard clinical care with 50 African American men per arm and assess the feasibility of completing genetic testing with peer navigation and men’s experience (decisional conflict, satisfaction, prostate cancer genetics knowledge, and distrust of the healthcare system). Aim 3. Develop a national
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110142
Entities
People
- Veda N Giri
Organizations
- Thomas Jefferson University
- United States Army