Community-based Participatory Research: Providers, Patient, and Community in Partnership to Improve Health Disparities

To the Editor: Rust and Cooper¹ present a case for improving health disparities through practice-based research and 12 strategies to close the gap on health outcomes disparities. Community-based participatory research (CBPR) complements cooperative grants in select regions and forms a fundamental basis for these strategies. CBPR promotes the conduct of research in “real world, limited resource, high-disparity primary care practice settings” called for in the article.

CBPR and cooperative grants through the National Cancer Institute (NCI) combine principle and practice to yield significant improvements in access to care and standard of care protocols for cancer patients. NCI's Cancer Disparities Research Partnership (CDRP) (www3.cancer.gov/rrp/CDRP/index.html) links community cancer centers with comprehensive cancer centers to create the triangulation-based care by providers, patient, and community that Rust and Cooper emphasize. The CDRP program was initiated in response to an Institute of Medicine Report in 1999 outlining significant discrepancies between the level of care received in community hospitals versus large academic medical centers.

Current CDRP sites include Rapid City, SD; Wilmington, NC; Inglewood, CA; McKeepsport, PA; and Pascagoula, MS. The program in Rapid City, SD (Walking Forward), addresses cancer disparities for nearly 60,000 American Indians (AIs) who suffer from some of the highest cancer death rates in the nation.^2–4 We are researching methods to improve cancer treatment and outcomes for AIs in western South Dakota. This program consists of patient navigation, clinical trials, surveys to evaluate barriers to access, and a molecular study (ATM [ataxia telangiectasia mutated] gene) to assess a potential molecular reason for increased treatment induced toxicities. To date, more than 1400 AIs have been enrolled in these studies over a period of 3 years. The phase II clinical trials use tomotherapy and brachytherapy to shorten the overall treatment time.^5,6 In addition, more than 70 clinical trials are open through the cooperative group mechanism.

The Walking Forward program works with AIs on 3 reservations and in the Rapid City community. All 4 sites employ Community Research Representatives (CRRs) who serve as a bridge between the cancer center and the communities being served. CBPR is more than a principle to be followed for the CRRs; it is where they live and work. Multiple barriers have been identified, leading to interventions promoting cancer education and screening in hopes of diagnosing patients with earlier stages of cancer.

Because of the overwhelming success of the Walking Forward program in navigating patients, our cancer center has implemented a similar program for all patients. One navigator assists breast cancer patients through the continuum of cancer care. A second navigator works with the general population of cancer patients. It is a significant step for responsive patient services to an underserved rural population that reflects disparate access and outcomes to cancer care.

Rust and Cooper challenge us to meet the need of disparities in research in the community setting by providing 12 strategies to move forward. The CDRP model paired with community-based participatory research promotes an investment in health care that is responsive to community needs and provides significant improvement in access and standard of care.