Prostate cancer imposes a disproportionate burden on African American men. This population has a 63% higher incidence rate than white men, and they tend to be diagnosed with more aggressive disease and report more side effects from treatment. They also die at twice the rate as white men.
Part of the problem is disparities in treatment. African American men are often either under treated (which means they don’t receive sufficient treatment) or over treated (which can result in serious side effects that affect their quality of life). These disparities are amplified among African American men who are low-income, many of whom have low health literacy and receive care in low resource “safety net” settings, as opposed to comprehensive cancer centers.
Nynikka Palmer, DrPH, sees these disparities in treatment and survivorship as being fundamentally rooted in disparities in health communication. To establish more parity, Palmer -- an assistant professor with a primary appointment in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital (ZSFG) and secondary appointments in Urology and Radiation Oncology -- is developing a novel peer mentoring program to help get the patients the information they need in a form they can use. Her experience and commitment were recognized in October when it was announced that she had received an NCI K-Award to support her work.
“We understand the importance of this research,” says Peter R. Carroll, MD, MPH Professor and Chair, Department of Urology. “We remain committed to long-term support to increase patient empowerment and provide high quality of care for all people with urologic conditions.”
“I want to eliminate disparities”
Palmer has been focusing on cancer communication and cancer disparities in underserved communities since working on her master’s degree in public health at Emory University. She continued that work while earning her doctorate in public health (University of Texas at Houston) and doing her post-doctoral work at Wake Forest School of Medicine.
Her current research focuses on pairing African American prostate cancer survivors with newly diagnosed African American patients to help them navigate not only the healthcare system, but also treatment decision-making.
“I don’t mean getting from place to place in the building,” Palmer explains, “but actually navigating the whole healthcare process, from screening to diagnosis and a resolution.” Such peer navigation has already been implemented and studied for breast cancer patients. Palmer is likely the first to propose such a program for African American prostate cancer patients.
Key to the program’s success is the use of peers from similar backgrounds. “Prostate cancer treatment options are hard to communicate,” Palmer says, “because of the many tradeoffs between treatment decisions and quality of life.” Yet many African American prostate cancer patients have low health literacy. To mitigate what she describes as this “perfect storm of complex treatment options and constraints in communication,” Palmer wants to use the concept of African American brotherhood to anchor the peer navigation in a culturally responsive context. “This will help foster trust and empowerment,” she explains, “which will optimize communication with the patient and improve quality of care.”
“It wouldn’t work to have a white medical student as a peer navigator to an African American man,” Palmer adds. “Peers need to know what this experience is like, a working knowledge of what’s about to happen, and an ability to communicate in a way that resonates with the new patient.”
“My patients are the face of this problem”
By providing culturally meaningful interventions, Palmer hopes that African American men will get appropriate and high-quality care that will lead to improved outcomes, such as quality of life, satisfaction with care, and survival.
“There is no one-size fits all communication,” she says. “We need to meet the needs of this population in a way that empowers patients and gets them engaged.
The five-year grant will allow Palmer to take an ethnographic approach to further explore treatment decision-making among African American safety net patients. It will allow her to develop a model for peer navigation and a protocol for implementing it, as well as piloting a randomized controlled trial on its feasibility, acceptability, and impact on the treatment chosen. Once that phase is done, Palmer hopes to secure another five-year grant to implement the program in public hospitals in the Bay Area.
“Working on health disparities is my passion, and getting this award means I can do the research I love,” Palmer says. “But it’s also important on other levels. The biggest is that it gives me an opportunity to make changes in how patients receive care. I want to put into practice what we know to be true so that we can begin to eliminate disparities.
“My patients are the face of this problem,” she adds. “They shouldn’t have to suffer because they are too poor to afford the best hospital, or because they have low health literacy. My goal is to completely eliminate these disparities. I want to change how we provide care to underserved and vulnerable patients.”