Annual Report to Stakeholders 2011-2012 - Siteman Cancer Center ...

PROGRAM FOR THE 

ELIMINATION OF CANCER 

DISPARITIES (PECAD) 

Annual Report to Stakeholders 2011-2012 

Moving Forward and Branching Out: 

Broadening PECaD’s Impact 

Published June 2012

TABLE OF CONTENTS 

Program for the Elimination of Cancer Disparities (PECaD) 

About PECaD……………………………………………………………………3 

Introduction………….………………………………………………………….5 

Leadership Updates………………………………………………………….7 

Community Partnership Updates……………………………..……..11 

Outreach and Education Updates……………………………………13 

Quality Improvement and Research Updates…………….…….21 

Training Program Updates……………………………………...………31 

Conclusion...……..……………………………………………………………33 

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ABOUT THE PROGRAM FOR THE ELIMINATION OF 

CANCER DISPARITIES (PECAD) 

Annual Report to Stakeholders 

The purpose of this report is to provide our stakeholders with a summary of the 

progress made toward the elimination of cancer disparities in our region and our 

communities. This report provides updates for ongoing work within PECaD from the 

beginning of the second grant in September 2010 through April 2012. 

Who We Are 

The mission of the Siteman Cancer Center’s Program for the Elimination of Cancer 

Disparities (PECaD) is to create a national model for eliminating local and regional 

disparities in cancer education, prevention and treatment. Working through a 

community advisory committee and cancer site-specific community partnerships, 

PECaD develops outreach and education, quality improvement and research, and 

training strategies that foster healthy communities and environments less burdened 

by cancer disparities. 

Program Director 

PECaD Staff 

Graham A. Colditz, MD, DrPH 

Niess-Gain Professor, Chief, Division of Public Health Sciences, 

Department of Surgery, Washington University School of Medicine; 

Associate Director of Prevention and Control, Siteman Cancer 

Center; and Deputy Director, Institute for Public Health at 

Washington University in St. Louis 

Victoria Anwuri, MPH – Project Manager 

Jackie Bernstein, MPH – Program Coordinator 

Matthew Brown, MPH – Research Study Coordinator 

Kimberly Carter, PhD – Research Assistant 

Karen Collins, PhD – Siteman Cancer Center Health Behavior, Communication & 

Outreach Core, CSO Liaison 

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Sara Figueroa – Public Health Technician 

Sierra Johnson, MSW – Program Coordinator 

Meera Muthukrishnan, MPH – Research Assistant 

Amy Ostendorf – Marketing and Communications 

Jewel Stafford, MSW – Liaison from Goodman Lab 

Jennifer Tappenden, RHIA – Data Manager 

Acknowledgements 


We wish to acknowledge and thank the members of our Disparities Elimination 

Advisory Committee, cancer site-specific community partnerships and many 

community organizations for their dedication and collaboration to eliminate cancer 

disparities in our region. 

Funding 

PECaD is funded by the National Cancer Institute at the National Institutes of Health 

(U54 CA153460), the Foundation for Barnes-Jewish Hospital, Washington University 

School of Medicine, and the Siteman Cancer Center. PECaD receives additional 

funding for specific programs and projects. 

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INTRODUCTION 


From 1990 to 2007, cancer death rates decreased by about 22% in men and 14% in 

women, translating to the avoidance of 898,000 deaths from cancer. However, not 

all segments of the U.S. population have benefited equally from this progress. 

Cancer-related health disparities remain. For example, death rates in persons with 

lower socioeconomic status showed little or no decrease. The decreases in cancer 

death rates in minorities were slower compared to those of whites. As a result, the 

gap in mortality rates between segments of the U.S. population has continued to 

widen. Minorities and people with low socioeconomic status have the highest rates of 

both new cancers and cancer deaths. 

The Program for the Elimination of Cancer Disparities (PECaD) of the Siteman Cancer 

Center at Barnes-Jewish Hospital and Washington University School of Medicine was 

established in 2003 with institutional funds in response to known excess cancer 

burden within the region and the state, particularly for minority and medically 

underserved populations. We work with community partners to develop outreach and 

education, quality improvement and research, and training strategies that will foster 

healthy communities and environments less burdened by cancer disparities. PECaD 

has worked with numerous community organizations and provider groups and has 

harnessed resources from national and local funders to build and expand 

collaborations and strengthen institutional infrastructure to address cancer 

disparities. 

Some progress is being made to reduce cancer disparities in Missouri. For example, 

the five-year mortality rate in Missouri for all cancer sites fell on average slightly 

faster for African Americans than whites (1.6% per year compared to 0.8% per year) 

from 2004 to 2008. This is important because in order to show reduction in disparity, 

populations that experience the disparity must catch up or outperform the 

advancements in the non-disparity population. A similar positive trend was shown for 

lung cancer death from the early 1990s to 2008 in Missouri. However, smoking rates 

have been on the rise recently among minorities, which promises to cause excess 

lung cancer death and disparity in the future. In the St. Louis region, although still 

excessive, disparity between African Americans and whites for colorectal cancer 

improved from 1996 to 1998 and 2003 to 2005. 

Despite these incremental successes for the region, there is more work to be done. 

In 2011, PECaD extended program activities to additional areas with high cancer 

mortality rates including St. Clair County, Illinois (which includes East St. Louis, 

Illinois) and southeastern Missouri. These areas have some of the highest cancer 

mortality rates in the state. This past year (2011-2012), we have made great strides 

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to advance our mission in our target geographic areas — St. Louis City and north St. 

Louis County, East St. Louis and St. Clair County in Illinois, and the southeastern 

Missouri Bootheel. The accomplishments described in this report related to 

community education and outreach, research and training – our key program areas – 

have expanded our impact, reach and potential to reduce cancer health disparities in 

our region. 

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LEADERSHIP UPDATES 

Disparities Elimination Advisory Committee Overview 


Our community advisory committee, the Disparities Elimination Advisory Committee 

(DEAC), serves as our executive body. The DEAC is chaired jointly by an academic 

representative and a community representative. Our leadership structure also 

includes our Internal Scientific Leadership Team, which has community 

representation as well. The Leadership Team works to translate and mold 

recommendations and insights from our DEAC into programmatic approaches for our 

research, community outreach and training programs. Both the DEAC and the 

Internal Scientific Leadership Team work closely with community partners and our 

official cancer community partnerships to shape our cancer site-specific 

programmatic strategies. 

Current DEAC Membership 

Academic and Community Co-Chairs 


Maranda Witherspoon, MPPA – Program Officer, Missouri Foundation for Health 

Community Members 

Leon Ashford, PhD – Community Advocate & Prostate Cancer Survivor; Retired 

Professor 

Mikki (Mary) Brewster, MSW – Community Advocate & Breast Cancer Survivor; 

Retiree of St. Louis Public School District 

Pamela Jackson, RN, BSN, MA – Community Volunteer & Advocate 

Sherrill Jackson, RN, CPNP, MSA – President, The Breakfast Club; Certified Pediatric 

Nurse Practitioner, Betty Jean Kerr People’s Health Centers, Inc. 

Veronica Richardson, RN, MSN, MBA – Vice President of Quality Improvement, Grace 

Hill Neighborhood Health Centers 

Donald Suggs, DDS – Founder & Owner, St. Louis American Newspaper 

Academic/Institutional Members 

Brenda Battle, RN, MBA – Director, Center for Diversity & Cultural Competence, 

Barnes-Jewish Hospital 

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Sarah Gehlert, PhD, MSW, MA – E. Desmond Lee Professor of Racial and Ethnic 

Diversity, Washington University George Warren Brown School of Social Work 

Lannis Hall, MD, MPH – Director of Radiation Oncology, Siteman Cancer Center at 

Barnes-Jewish St. Peters Hospital; Assistant Professor, Washington University 

School of Medicine 

Matthew Kreuter, PhD, MPH – Professor and Director, Health Communication 

Research Laboratory and Center for Cultural Cancer Communication, 

Washington University George Warren Brown School of Social Work 

Nancy Mueller, MPH – Associate Director, Institute for Public Health, Washington 

University in St. Louis 

Academic/Institutional Members (Non-Voting) 

Margaret Barton-Burke, PhD, RN – Staff Scientist, Siteman Cancer Center; Professor 

of Oncology Nursing, University of Missouri, St. Louis 

Bettina Drake, PhD, MPH – Assistant Professor, Division of Public Health Sciences, 

Department of Surgery, Washington University School of Medicine 

Melody Goodman, PhD – Assistant Professor, Division of Public Health Sciences, 

Department of Surgery, Washington University School of Medicine 

Aimee James, PhD, MPH, MA – Assistant Professor, Division of Public Health 

Sciences, Department of Surgery, Washington University School of Medicine 

Karen Kharasch – Executive Director of Research and Business Administration, 

Siteman Cancer Center 

Vetta Sanders Thompson, PhD – Associate Professor, Washington University George 

Warren Brown School of Social Work 

Molly Tovar, EdD – Director, Kathryn M. Buder Center for American Indian Studies, 

Brown School of Social Work, Washington University 

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New Community Co-Chair Elected 


Effective May 2012, the DEAC has a new community cochair. 

Maranda Witherspoon has agreed to lead the group 

with the academic co-chair, Dr. Graham Colditz. The 

community co-chair role is an important one. This DEAC 

leader provides input, plans and co-leads the quarterly 

meetings. Additionally, the community co-chair represents 

the DEAC at the PECaD Internal Leadership Team meetings 

and at regional and national conferences related to the 

elimination of cancer health disparities. 

Ms. Witherspoon brings a tremendous amount of expertise and insight as program 

officer for the Missouri Foundation for Health, the state’s largest health care 

foundation. Previously, Ms. Witherspoon was an epidemiologist with the City of St. 

Louis Health Department. She holds a master’s degree in public policy and 

administration. Ms. Witherspoon, who has been a member of the DEAC for four years, 

will serve up to two years as community co-chair, a part-time volunteer position. 

Ms. Witherspoon succeeds Mikki Brewster, a breast cancer survivor who served as 

community co-chair from 2010 to 2012. The entire PECaD team wishes to extend our 

gratefulness to Ms. Brewster for the dedication, passion and valuable insight she 

provided during her time as community co-chair. We look forward to Ms. Brewster’s 

continued involvement with the DEAC. 

Partner Representation Survey 

Leadership Updates 

PECaD strives to have balanced representation on its various committees and 

partnerships from a diverse group of organizations, community members and 

academic members. To ensure this was happening and per the recommendation of 

the DEAC, we conducted an assessment and reported the results to DEAC 

membership during the January 18, 2012 meeting. Our assessment revealed 

balance within the DEAC and in our community partnership groups between 

community and academic members; in fact, community members outnumbered 

academic members in all cases. Overall, 68% of people in PECaD-related groups 

represent community members with one group reaching 81% community 

membership. Our assessment of the types of organizations involved with PECaD was 

largely tilted to the side of health-related organizations compared to non-health- 

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related organizations. This is a logical observation, but perhaps points to a need to 

continue looking for ways to involve non-health organizations in our efforts. 

Evaluation of Program Reach and Implementation 

In this second round of NCI funding for PECaD, we have developed a framework for 

evaluation within and across our Community Outreach and Education, Research and 

Training Programs. We are using a computer database system to evaluate and track 

our reach and implementation over the course of the funding to adjust our short- and 

long-term goals toward reducing health disparities in the region. All activities and 

events related to PECaD are reported along with information about the target 

audience, number of people reached, linkage to PECaD and more. The database is 

maintained by program staff and measures are in place to ensure quality and 

consistency of the data. 

Commitment to Community Engagement Principles 

In early 2011, mid-way into our first year of the second round of funding, PECaD's 

internal leadership conducted a survey to evaluate its adherence to and 

implementation of community-based participatory approaches and community 

engagement principles. The online survey was sent to people who have worked or are 

currently working with PECaD in a collaborative and significant way to achieve 

program objectives, including cancer survivors, volunteers, researchers at academic 

institutions, and employees from local advocacy and health care organizations. Thirty 

percent of respondents classified themselves as an employee or volunteer at a 

community-based organization, 26% as a healthcare professional, 34% as an 

academic researcher, and 10% as a cancer survivor or caregiver. 

In the survey, we asked how satisfied respondents were with their influence in 

PECaD. Seventy percent reported they are satisfied or very satisfied with their level of 

influence. This held true for all respondent classifications. Overall, 79% of 

respondents rated the program as highly effective in upholding elements essential to 

community engagement and community-based participatory approaches. These 

results also held true in general for all respondent classifications. Length of 

involvement in the program was steady; some respondents were new to PECaD and 

others have been involved since the very beginning of the program in 2003. The 

survey also revealed some areas for improvement. Because of the program’s fast 

growth, respondents feel that can be difficult to keep track of everything going on. 

Respondents also want PECaD to share invitations to attend various 

academic/clinical presentations on campus. PECaD is working to implement these 

insightful suggestions. 

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COMMUNITY PARTNERSHIP UPDATES 

Overview 

PECaD’s site-specific cancer community partnerships foster ongoing dialogue with 

community stakeholders, including individuals and community organizations in the 

region. Each partnership works to refine program strategies that are designed to 

reduce and ultimately eliminate cancer disparities. The partnerships create an 

avenue through which community cancer needs and priorities can be reflected in the 

implementation of PECaD activities. 

Members of each partnership consist of cancer survivors and advocates, 

representatives from community health care organizations, representatives of 

community-based organizations, and academic faculty members and staff. 

Partnership members meet regularly to review progress and refine goals and projects 

as needed. 

We currently have three site-specific community partnerships — breast cancer, 

colorectal cancer and prostate cancer. Each group has actively participated in 

notable activities that have advanced PECaD’s mission. 

Breast Cancer Community Partnership 

Community Partnership Updates 

After much success in past years of working with community partners to expedite 

care pathways along the breast cancer care continuum for underserved women in St. 

Louis, the Breast Cancer Community Partnership spent much of this year thinking 

strategically about next steps and goals for reducing local and regional disparities. 

With faculty experts, the partnership is seeking additional funding to build on 

preliminary work in the Bootheel region of Missouri. The group is also in early 

discussion with stakeholders in the Joanne Knight Breast Health Center at the 

Washington University School of Medicine and the Siteman Cancer Center about 

strategies to translate best practices that work in the metro region to work effectively 

in the Bootheel. 

Colorectal Cancer Community Partnership 

The Colorectal Cancer Community Partnership has been involved in a variety of 

activities that raise awareness about colorectal cancer, including the annual Undy 

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5000 run/walk hosted by the local Gateway Chapter of the Colon Cancer Alliance. 

Some members, such as Yolanda Austin whose close friend died of colon cancer, hit 

the pavement to spread the word about the importance of screening for prevention 

and early detection. The group is also working to identify resources for colorectal 

cancer and, with providers and community members, to raise awareness of pathways 

to such resources. Finally, the group continues to provide input, as needed, to 

PECaD’s main research study, the randomized control trial led by Dr. Aimee James. 

Prostate Cancer Community Partnership 

The Prostate Cancer Community Partnership continued its goal to reduce disparities 

in prostate cancer outcomes, especially among African Americans who experience 

the heaviest burden from the disease. The group was also actively involved in 

PECaD’s pilot project (2010-2012) to assess barriers to minority participation in 

tissue research. For this project, partnership members provided direction to help plan 

recruitment and project implementation strategies; some members even helped 

review and code de-identified focus group transcripts. The group has focused some 

discussion on the new U.S. Preventative Services Task Force recommendations for 

prostate cancer screening with the PSA blood test. Physician experts provided 

members with their insights about the guidelines and what they mean for groups at 

high risk of developing prostate cancer. The members drafted a response from the 

partnership, which was disseminated in the January 2012 PECaD newsletter. Faculty 

and staff in the partnership have also led the development of an evaluation project to 

understand the screening-related follow-up activities of men that have participated in 

community prostate cancer screening events. 

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OUTREACH AND EDUCATION UPDATES 

The overall goals of PECaD’s Community Outreach and Education Program are to: 

• Engage in and extend effective outreach efforts that promote cancer 

prevention messages in the community 

• Identify medically underserved parts of the community and related barriers to 

quality cancer care 

• Enhance community health and access to quality cancer care and health 

information 

Media outreach continues to be an important way we communicate cancer 

education, prevention and screening messages to our target audiences in Missouri 

and Illinois most heavily burdened by cancer disparities. The scope of this outreach 

has grown to broaden the impact of our work and incorporate new platforms, 

including radio and outdoor campaigns. These approaches complement the Your 

Disease Risk online tool and the 8 Ways to Prevent Cancer campaign that promote 

wellness and cancer prevention across the community served by Siteman. 

Print Campaign 

Targeted Media Outreach 

Our longstanding relationship with the St. Louis American newspaper continues. 

Since 2010 and through February 2013, we have run a cancer prevention and 

screening campaign that provides readers with a glimpse into a local resident’s 

cancer journey. Each story runs twice per month — once in the Health Matters section 

of the paper and once in the general circulation. Starting in 2012, the artwork 

includes new line of text that shares more information about PECaD. Our goal is to 

build awareness among our target audiences about what PECaD is and its strong 

legacy of work in St. Louis communities. The text reads: 

“The Program for the Elimination of Cancer Disparities (PECaD) at the Siteman Cancer Center is 

working to eliminate local and regional disparities in cancer education, prevention and treatment 

through community outreach, research and training.” 

Accompanying each story is an Ask the Doctor column on the same topic that 

provides in-depth cancer education and prevention information and local community 

resources. The St. Louis American prints 70,000 copies each week and is read by 

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nearly 244,000 people in St. Louis City, St. Louis County, St. Charles and portions of 

Illinois. Seventy-five percent of the readership is African American. 

PECaD also published an eight-page cancer prevention insert in the January 12, 

2012, issue of the St. Louis American. This insert included a summary of the survivor 

stories and educational columns from the prior year, a summary of cancer prevention 

resources, and information about PECaD’s mission and goals. The insert can be 

found on our website under Outreach and Education. 

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Radio Campaign 


Rich with expert clinicians and researchers who are passionate about ending health 

disparities and preventing cancer, we wanted to better engage our target audiences 

in discussion about cancer. PECaD began a radio-based education campaign with 

Clear Channel Radio in 2011. It focuses on increasing community awareness of 

cancer prevention and control strategies, early detection of cancer, research, 

community cancer resources, and related topics. In 2011, twenty-four live interviews 

with experts aired on the show Health Connections with Rose Troupe on the first and 

third Sunday of every month. The show was played twice each Sunday on Majic 

104.9 FM and Hallelujah AM 1600. In 2012, twenty-four live interviews will feature 

experts and several weekly promos and cancer infomercials will promote the 

interview topics. 

Interview topics include: 

• Prostate cancer: Talk to a health care provider about your risk of prostate 

cancer and to see if a screening test is right for you (Dr. Bettina Drake) 

• Colorectal cancer: It’s preventable (Dr. Vetta Sanders Thompson) 

• Your Disease Risk online health assessment tool (Dr. Graham Colditz) 

• How patients can become engaged in the process of making decisions about 

their health (Dr. Mary Politi) 

• How your environment can influence your health: Breast cancer case study 

(Dr. Sarah Gehlert) 

• Perspectives in health equity and equality: The importance of academiccommunity 

partnerships and the role of community in improving health in 

African-American communities (Dr. Melody Goodman) 

• Eight ways to stay healthy and prevent cancer (Dr. Erika Waters) 

Recorded audio from all interviews is available in the Outreach and Education section 

of our website. We replay these interviews in some of our face-to-face education 

sessions and encourage others to do the same. 

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PECaD Newsletter 


The PECaD newsletter, STL Connection, is our main way to communicate program 

updates and direction with over 400 community and academic partners. We use it to 

share ongoing activities and highlight community and academic partner efforts to 

eliminate cancer disparities. Moving forward, we are exploring options to make this 

an electronic newsletter with continued focus on our current community and 

academic partners, but also expanding the reach to other interested parties, 

including: media; potential funders; policymakers; community groups and partners 

that we have yet to engage; and others in the region with ties to cancer disparities. 

Our newsletters are archived online under Resources. 

Outdoor Transit Campaign 

PECaD has an exciting new outreach project that will expand its reach to target 

audiences. Starting in summer 2012, PECaD will begin its first outdoor transit 

campaign. The focus of this campaign will be cancer prevention messages that relate 

to lifestyle/behavior choices, anti-smoking and cancer screenings. The campaign will 

also incorporate messaging about what PECaD is and how we are working with 

community partners to end cancer disparities. The educational signage will appear in 

four places: inside Metro buses; inside Metro train cars; on the side of Metro buses; 

and in the Metro bus shelters in key zip codes. The campaign will target key zip codes 

and high-poverty areas in North St. Louis City and County wherein Metro bus riders 

are nearly 70% African American. The campaign gives us the opportunity to 

communicate strong prevention messages in areas of excessive burden and cancer. 

The educational signage will appear for three, four-week periods spread out in 2012 

and 2013. To measure our impact and track reach, the call-to-action for each run will 

be a Cancer Prevention Kit that people can call the Siteman Cancer Center to 

request. Each kit will contain a printed Your Disease Risk assessment tool, an 8 

Ways to Prevent Cancer informational brochure, a list of Federally-Qualified Health 

Centers (which are trusted health care providers in the target area), and more. 

Above: Bus and train interior poster 

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Above: Bus exterior poster 

Above: Bus and train outdoor shelter poster 

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Building on the Capacity of Community Partners for Cancer Education 

Faith-Based Outreach 

In 2011, we formalized our outreach program working with faith-based organizations 

to promote cancer health and wellness. This effort builds upon Faith Communities 

Joined for Health (FCJH), a consortium which began in 2008 with community partners 

and faculty at the George Warren Brown School of Social Work. Our goal is to help 

churches and other faith-based organizations incorporate cancer prevention into 

health ministries and to encourage use of evidence-based programming such as 

Body & Soul, a faith-based health curriculum. PECaD's community health educator 

works collaboratively with the FCJH consortium and faith-based groups to provide 

technical assistance, ongoing monitoring of cancer prevention programs, plan church 

workshops, and implement Body & Soul trainings. 

With FCJH, we have hosted workshops for churches focused on cancer health and 

wellness. The purpose of the workshops is to equip churches that have or are 

building health ministries with state-of-the-art cancer prevention information for their 

programs. We also focus on linking community partners to information about local 

cancer prevention resources and research. The first workshop in November 2011 

took place at the Regional Arts Commission in St. Louis. In addition to engaging 

churches in self-directed cancer programming and activities, we held a Grant Writing 

101 session. This session provided attendees with little or no grant experience a 

better understanding of the grant writing process. Following this session, four 

churches/faith-based groups applied for PECaD partnership grants of $250 per year 

to support cancer prevention and control activities. Another church workshop was 

held in April 2012, which focused on cancer basics, connection to NCI messaging 

and materials, and awareness of community resources. 

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City of St. Louis Public Libraries 


This project, a collaboration between PECaD, 

the Washington University School of 

Medicine Becker Medical Library and the 

City of St. Louis Public Library (SLPL), stems 

from PECaD’s goal of enhancing channels to 

deliver comprehensive, up-to-date and 

accurate cancer health information to the 

community. Building on the libraries’ 

strength of providing free resources to the 

public, the collaboration bolsters the 

libraries’ capacity to offer sources of credible 

health information. We have worked with 

library partners to set up cancer information 

kiosks at these SLPL branch locations: 

Schlafly, Carpenter, Buder and Julia Davis. The kiosks include local cancer resource 

materials, cancer education and prevention information. The library partners also 

wanted to support understanding of cancer health information sources among library 

personnel, so we are working with the partners to develop cancer health information 

trainings and forums for library branch managers, librarians and front desk staff. 

Designated PECaD and Becker Medical Library staff will provide ongoing technical 

assistance and engagement to plan additional SLPL cancer prevention activities. 

Addressing the Cancer Continuum in the Bootheel 

Since conducting a needs assessment in the Bootheel, the southeast region of 

Missouri, in 2010 (supported by a grant from Komen St. Louis), PECaD has added 

cancer education and outreach in this area of the state as a priority. The needs 

assessment found that the area performed poorly on several breast health measures 

when compared with other parts of the state. While still in the planning and 

exploration stage, we have worked to maintain relationships built in this region. 

Siteman Prevention and Control faculty who are affiliated with PECaD have begun 

pursuing partnerships with Bootheel health care providers with the goal of 

understanding and improving access to care in the region. PECaD is also actively 

seeking opportunities to support collaboration with providers, public health agencies, 

patients and advocates in the Bootheel on potential education, outreach and 

research efforts. Proposed initiatives include rural care coordination/navigation, 

further evaluation of regional data, and building on success of the Bootheel Needs 

Assessment, improve understanding to reduce relevant barriers. 

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The St. Louis Regional Breast Navigator Workgroup 


The St. Louis Regional Breast Navigator Workgroup was established in 2010 in 

response to interest expressed at meetings of PECaD’s Breast Cancer Community 

Partnership and based on the following recommendation from the St. Louis 

Integrated Health Network’s (IHN) Breast Cancer Referral Initiative: 

“Key contact persons at each organization (breast navigator or referral coordinator at each community 

health center, community-outreach-navigator(s) at the breast health center(s), and the utilization 

management nurse at ConnectCare) to meet quarterly to enhance communication, improve 

processes, share suggestions, and provide support in the effort to facilitate all breast health referrals 

from the safety-network.” – Excerpt from IHN Breast Cancer Referral Initiative Recommendations 

The workgroup is a unique partnership among safety-net navigators. These dedicated 

breast navigators work one-on-one with large panels of patients on a daily basis 

within their organizations. Empowered by each other, the navigators use workgroup 

meetings to identify collective concerns and develop potential solutions. This 

enhances their ability to serve as change agents in the broader community as well as 

in their own organizations. As such, navigators have tremendous impact on the 

health and empowerment of uninsured and underinsured women in the region. They 

have shared and implemented process improvements, shared best practices and 

connected each other to resources. 

The workgroup is facilitated by Heidi Miller, MD, a safety-net primary care provider at 

Family Care Health Centers. The charge of the workgroup is: 

• To improve communication between regional safety-net providers 

• To develop more effective and efficient processes for breast cancer screening, 

referral, diagnosis, treatment, and follow-up/survivorship in the region 

PECaD has supported the goals of this coalition by nurturing its development and 

underwriting all activities of the workgroup including administrative and logistical 

support, securing facilitator time, and fostering movement and progress on 

discussion topics for the purpose of aiding the groups’ advancement and charge. 

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QUALITY IMPROVEMENT AND RESEARCH 

UPDATES 

A sytems-level intervention to increase colorectal cancer screening in 

community health centers (2010 – present) 

Overview 

Colorectal cancer (CRC) is the second-leading cause of cancer death in the United 

States. Despite compelling evidence that screening and early detection reduces CRC 

incidence (new diagnosis) and mortality (death), less than 50 percent of adults are 

up-to-date with CRC screening recommendations. CRC screening rates are also low in 

the local region. PECaD Colorectal Cancer Community Partnership members have 

identified low screening rates as a priority to reducing significant CRC cancer 

disparities in screening, stage of diagnosis and survival. 

Purpose and Design 

This project works with safety-net health centers in St. Louis City and St. Louis County 

in Missouri, in East St. Louis/St. Clair County in Illinois, and in the Bootheel region of 

Missouri. This project tests the effectiveness of community health center-selected 

systems-level, evidence-based interventions for increasing rates of CRC screening. 

The control condition will be usual care, but the study uses a cluster randomized 

delayed start so, in concordance with community partner wishes, clinics in the control 

group will have access to the intervention after the intervention clinics. 

The primary outcome of this study will be CRC screening adherence measured by 

self-report surveys of a random sample of health center patients. The evaluation is 

informed by a chart audit to assess screening referral and completion, and interviews 

with physicians, staff and administrators at the health centers. This study was 

developed and is being conducted adhering to principles of community-based 

participatory research (CBPR) working with the PECaD Colorectal Cancer Community 

Partnership. 

Progress 

PECaD Research 

The project team has enrolled the first set of local health clinics and has prepared 

several intervention proposals for them based on staff interviews. The centers have 

been presented with their intervention proposals, and the project team is waiting for 

their final selections before proceeding. Additional health centers across Missouri 

have expressed interest in participating in the project, and plans are in place to enroll 

some of these clinics in summer 2012. As implementation of the intervention begins 

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on a rolling basis, follow-up data will be collected and the project team will begin 

preliminary data and manuscript preparation. 

Funding 

National Cancer Institute at the National Institutes of Health (U54 CA153460) 

Project Staff 

Aimee James, PhD, MPH, MA (Primary Investigator, Washington University) 

Graham Colditz, MD, DrPH (Co-Investigator, Washington University) 

Jean Wang, MD, PhD (Co-Investigator, Washington University) 

Yan Yan, MD, PhD (Co-Investigator, Washington University) 

Colorectal Cancer Community Partnership (Collaborators) 

Matthew Brown, MPH (Research Study Coordinator) 

Contact Information 

Aimee James, PhD, MPH 

314-454-8300 

jamesai@WUSTL.EDU 

Assessing barriers to participation in tissue research (2010 – present) 

Overview 

Biospecimens are materials taken from the human body, such as tissue, blood, 

plasma and urine. They contain DNA, proteins and other molecules important for 

understanding disease progression. When patients have a biopsy, surgery or other 

procedure, and they give permission, a small amount of the specimen removed can 

be stored and used later for research. 

Over the past several years, the National Cancer Institute has undertaken an 

intensive process to establish guiding principles for the collection, storage, retrieval 

and distribution of biospecimens for research. Biorepositories, or biobanks, are 

libraries where biospecimens are stored and made available for scientists to study 

for clinical or research purposes. A high priority for biorepositories is to protect the 

privacy and sanctity of personal and medical information. 

Biorepositories have the potential to improve treatments and therapies for a number 

of conditions, many of which are more prevalent among minorities and underserved 

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populations. Minorities, compared to nonminority groups, however, have lower 

participation rates in medical research, which includes biospecimen collection for 

research purposes. Broad inclusion of diverse people in medical research is essential 

to assuring that emerging care standards for prevention, diagnosis and treatment are 

equally effective for all sectors of society. Therefore, we must understand reasons for 

nonenrollment in biorepositories and address them in order to increase minority 

participation in research. 

Purpose 

Over several years, the PECaD Prostate Cancer Community Partnership has worked 

to identify reasons for prostate cancer disparities in the local community and to 

develop strategies to address them. The partnership identified a need to improve the 

participation rates of minorities in biorepositories for several reasons, including: 

• The immense racial disparity observed in prostate cancer incidence (new 

diagnosis) and mortality (death) rates 

• An increased interest among scientists and clinicians for high-quality prostate 

cancer biorepositories 

• The potential such repositories can have on understanding prostate cancer 

disparities 

For this project, the partnership collaborated with clinical researchers to identify 

barriers to minority participation and develop strategies to increase minority 

participation in an existing prostate cancer study at the Siteman Cancer Center that 

involved the collection of biospecimens for a prostate cancer-related biorepository. 

The prostate cancer study had experienced difficulty recruiting African-American men. 

Using a community-based participatory research (CBPR) approach, the partnership 

worked with the study team to develop a study to identify barriers and challenges 

related to the recruitment of African-American men biospecimen collection for 

research and identify strategies to improve current recruitment methods. 

Status 

The team completed 15 focus groups with 72 African-American men. A focus group 

analysis looked at the demographic, social and health background of the sample. The 

analysis revealed the men’s thoughts on participation in biorepository research fall 

into three core themes; results will be published soon. 

The project team has also written a methodology paper for peer-review that describes 

the recruitment process, challenges and lessons learned. This article will add to the 

growing body of literature on engagement and recruitment of ethnic minority groups, 

specifically African Americans, in health studies. 

23


Moving forward, the project team will continue to share their expertise on 

biorepository recruitment across programs and clinical groups at Washington 

University School of Medicine and research studies within Siteman. 

Funding 


Project Staff 

Bettina Drake, PhD, MPH (Primary Investigator, Washington University) 

Sarah Gehlert, PhD (Co-Investigator, Washington University) 

Vetta Sanders Thompson (Co-Investigator, Washington University) 

Graham Colditz, MD, DrPH (Co-Investigator, Washington University) 

Prostate Cancer Community Partnership (Collaborators) 

Kimberly Carter, PhD (Research Assistant) 


Bettina Drake, PhD, MPH 

314-747-4534 

drakeb@WUSTL.EDU 

Using Photovoice to engage community members about colorectal cancer 

screening (2011 – present) 

Overview 

Colorectal cancer (CRC) is the second leading cause of cancer death in the United 

States. Many racial/ethnic minority groups and those who are low income or 

uninsured have lower rates of screening, later stages at diagnosis and poorer 

survival. Promoting CRC screening in underserved populations can help reduce these 

disparities. Community engagement methods are one way to address CRC 

disparities. PECaD’s Colorectal Cancer Community Partnership has been working to 

identify and address reasons for CRC disparities in our community. Community 

partners, in collaboration with academic researchers, identified a need to understand 

motivations among patients seeking CRC screening, to promote awareness of early 

detection and to hear the voices in our community. 

24

Purpose 


In this project, we use community-based participatory research approaches to 

develop CRC screening promotion messages and conduct formative research that will 

guide future effort and intervention to eliminate CRC disparities. We use Photovoice 

methodology to learn more about what people think about colorectal cancer 

screening and early detection by collecting photographs and narratives about the 

impact of colorectal cancer on people's lives. Our emphasis is on lower income and 

under or uninsured individuals, and the unique challenges of colorectal cancer in 

that context. 

Photovoice is a participant-driven approach in which community members are 

provided cameras so they can capture relevant images to the health issue (i.e. CRC). 

Photographs are printed, and participants discuss the images’ meaning in the 

community context, culminating in a presentation of selected images and 

accompanying narratives back to the community. Photovoice is a powerful tool for 

obtaining community perspectives and engaging community members in health 

issues. At the end of this study, we will have community-selected images and 

narratives that we can build upon for future community-based studies and outreach 

to promote CRC screening. 

Status 

The project team worked with PECaD’s Colorectal Cancer Community Partnership to 

get feedback on proposed study recruitment materials and processes. The team is 

currently recruiting study participants. 

Funding 

National Cancer Institute at the National Institutes of Health (R21 CA147794) 

Project Staff 

Aimee James, PhD, MPH, MA (Primary Investigator, Washington University) 

Jean Hunleth, PhD, MPH (Postdoctoral Research Fellow, Washington University) 

Colorectal Cancer Community Partnership (Collaborators) 


Aimee James, PhD, MPH 

314-454-8300 

jamesai@wustl.edu 

25


Community Research Fellows Training Program (2012 – present) 

Background 

Community-based participatory research (CBPR) approaches are often used by 

universities to engage community stakeholders and address priority public health 

concerns. Engaging community members in the research process is often the missing 

link to improving the quality and outcomes of health promotion activities, disease 

prevention initiatives and research studies. CBPR is particularly useful for increasing 

community research capacity to address a broad array of public health concerns. 

Participating in comprehensive evidence-based public health research training can 

prepare community members for collaborative work with academic researchers and 

empower them as equal partners in the research process. 

Overview 

The purpose of this project is to promote the role of racial/ethnic and other 

underserved populations in the research enterprise by increasing the capacity for 

community-based participatory research between researchers at Washington 

University in St. Louis, community-based organizations and community health 

workers serving the St. Louis Greater Metropolitan area to address health disparities. 

This project has three main research goals: 

• To enhance community knowledge and understanding of research and create 

a pool of trained community members who can serve on Institutional Review 

Boards and community research advisory boards. We will recruit a 

multidisciplinary faculty and cohort of community fellows to participate in a 

semester-long comprehensive public health and research methods training 

course for community members adapted from a previous community fellows 

training program led by Dr. Melody Goodman. 

• To develop community-based participatory research pilot projects that 

address health disparities in the St Louis Greater Metropolitan Area. Through 

a series of experiential workshops, fellows will learn grant writing, program 

evaluation and the IRB process. Fellows that complete the training program 

will be eligible to apply for funding in collaboration with Washington University 

researchers for CBPR pilot projects in response to the Community Fellows 

Request for Proposals (RFP). The RFP will solicit proposals for pilot CBPR 

projects that align with the PECaD mission to reduce breast, prostate, 

colorectal and lung cancer disparities. 

• We will conduct a comprehensive evaluation of the Community Research 

Fellows Training program using semi-structure interviews and quantitative and 

qualitative evaluation to assess participant knowledge and satisfaction with 

the training program. 

26

Progress 

This project is scheduled to begin September 1, 2012. 

Funding 



Project Staff 

Melody S. Goodman, PhD (Principal Investigator, Washington University) 

Jewel Stafford, MSW (Project Manager, Washington University) 


Melody S. Goodman, PhD 

314-362-1183 

goodmanm@wustl.edu 

Community–based participatory approach to improving breast cancer services 

for women living in St. Louis (2011 – present) 

Overview 

The ultimate goal of this community-based participatory research project is to 

decrease the disparity in breast cancer mortality that exists in St. Louis. Identifying 

gaps in the breast cancer treatment of African-American women living in North St. 

Louis will help to explain their disproportionate rates of mortality compared to white 

women. Armed with this knowledge, we will work toward the ultimate goal of 

remedying this disparity. This objective can only be achieved if we are able to foster 

the infrastructure for a strong, balanced and effective collaboration between two 

worlds, namely community stakeholders and academic researchers. Four local 

organizations are co-leading this project as community partners: Betty Jean Kerr 

People’s Health Centers; Committed Caring Faith Communities; Christian Hospital; 

and Women’s Wellness Program of the Saint Louis Effort for AIDS. 

Purpose 

This project incorporates both a research aim and a community outreach aim. 

27


• Research Aim: Use a variety of information to understand disruptions in the 

course of breast cancer treatment as a possible explanation of excessive 

breast cancer mortality in north St. Louis. Sources of information include the 

Missouri Cancer Registry, in-depth interviews with women diagnosed with 

breast cancer while living in sections of north St. Louis and focus groups with 

breast cancer providers. 

• Community Outreach Aim: Enhance community trust by listening to 

community voices, having an established presence in the community and 

offering resources to community members and organizations. This includes 

town hall meetings and community presentations at schools, churches and 

other organizations where we will share research findings on breast cancer 

and listen to community feedback and discussion. 

Progress 

The project team has completed focus groups with community members from 

eight zip codes in North St. Louis. Transcripts have been analyzed to inform the 

scientific approach. Soon, the team will conduct a series of focus groups with non- 

MD health care professionals that provide services in and for the eight zip codes. 

To establish a presence in the community, the project team opened the Community 

Partnership Center, a drop-in center and office that will serve as home base for 

primary project staff. Community members are encouraged to visit the office for 

connection to health and cancer prevention information. The CPC is located in North 

St. Louis at 3335 Union Blvd., St. Louis, MO 63115. 

The first Town Hall Meeting is scheduled for summer 2012 at Centennial Christian 

Church. These gatherings provide a platform for the project team to hear from and 

engage with community members about health care in St. Louis. 

Funding 

Susan G. Komen For The Cure: Vulnerable Community Grant 

Project Team 

Sarah Gehlert, PhD (Principal Investigator, George Warren Brown School of Social Work) 

Dwayne Butler (Principal Investigator, CEO of Betty Jean Kerr People's Health Clinic) 

Ron McMullen (Principal Investigator, President of Christian Hospital) 

Cheryl Oliver (Principal Investigator, CEO of Saint Louis Effort for AIDS) 

Rev. Isaac McCullough (Principal Investigator, President of Committed Caring Faith Communities) 

Graham Colditz, MD, DrPH (Principal Investigator, Washington University) 

Melody Goodman, PhD (Project Statistician, Washington University) 

Bettina Drake, PhD (Co-Investigator, Washington University) 

28


Victoria Anwuri, MPH (Co-Investigator, Washington University) 

Sierra Johnson, MSW (Project Coordinator, George Warren Brown School of Social Work) 


Sarah Gehlert, PhD 

314-935-3434 

sgehlert@wustl.edu 

ARRA-funded patient navigation for breast cancer screening (2009-2011) 

Overview 

The purpose of this American Recovery and Reinvestment Act (ARRA) project was to 

build on community partnerships to advance the elimination of breast cancer 

disparities in the St. Louis region. This project draws upon PECaD’s ongoing, 

collaborative relationship with the Betty Jean Kerr People’s Health Centers (PHC), a 

local federally-qualified health center and member of the St. Louis Integrated Health 

Network (IHN). The IHN was formed based upon a recommendation of the St. Louis 

Regional Health Commission that existing health care providers in the St. Louis 

region form a permanent regional network to integrate and coordinate services to 

better serve our citizens. 

Background 

The PECaD Breast Cancer Community Partnership and Disparities Elimination 

Advisory Committee identified gaps in cancer screening and treatment in local 

underserved communities. Prior to the collaboration between PHC and PECaD on this 

project, PHC had capacity to conduct mammograms at only one of its three locations. 

However, they had secured a second mammography unit from another institution 

which was to be placed at their second largest and fastest growing location (North St. 

Louis site). Despite the need for these services, PHC did not have the resources to 

start providing mammography services in North St. Louis. To address this potential 

gap in services, PHC and PECaD worked together to obtain ARRA funds and 

implement a patient navigation program in an area of high need within the St. Louis 

safety net. Funds were awarded for the patient navigation project on September 30, 

2009, and the project was able to initiate mammography and navigation services at 

the North St. Louis location on October 1, 2009. The ARRA project provided funding 

to hire a patient navigator, a mammogram technologist and a data coordination 

29


assistant for the north St. Louis county location. This new patient navigator focused 

specifically on boosting use of breast cancer screening and timely diagnosis and 

treatment for the north county site. These positions/roles have been sustained post- 

ARRA funding by PHC. 

Results 

During the two project years, mammograms overall increased at PHC, including the 

North St. Louis location. At the North St. Louis location, of women that were identified 

by the patient navigator as being eligible and overdue for a mammogram (by 

American Cancer Society guidelines), 94.8% received navigation services. Of the 

women navigated, 94.5% got a mammogram during the study period. 

The results of this study were presented at several academic meetings and 

community events, including the American Association of Cancer Research’s The 

Science of Cancer Disparities Conference in 2010, the Missouri Cancer Summit in 

2011, and at a breast health retreat sponsored by Siteman. 

Funding 

National Cancer Institute at the National Institutes of Health (U01 CA114594-05S2 and U54 

CA153460) 

Project Team 

Graham Colditz, MD, DrPH (Principal Investigator, Washington University) 

Bettina Drake, PhD (Co-Investigator, Washington University) 

Victoria Anwuri, MPH (Project Manager, Washington University) 

Jennifer Tappenden, RHIA (Data Manager, Washington University) 

Lawrence Pruitt (Program Coordinator, Betty Jean Kerr People’s Health Center) 

Shivon Tannan (Program Coordinator, Betty Jean Kerr People’s Health Center) 



314-454-7939 

colditzg@wustl.edu 

30

TRAINING PROGRAM UPDATES 


A significant change since 2010 is the formalization of a training program for 

postdoctoral research associates within PECaD. The goal of the Transdisciplinary, 

Community-Based Participatory Research Training Program is to produce 

accomplished researchers capable of using the tools of community-based, clinical 

and basic research to establish independent research programs in the service of 

underserved patients and communities. Under the leadership of Dr. Sarah Gehlert, 

the program is focused on cross-training academic and community partners 

in transdisciplinary community-based participatory research (CBPR) approaches. 

Trainees work with a primary mentor and other mentors as appropriate. Specialized, 

individual programs of study are designed to expose each scholar to the spectrum of 

perspectives on cancer and disparities. Professional development activities for the 

scholars include a Research Methods Workshop Series, Transdisciplinary Journal 

Club, Works in Progress and other development seminars. 

The two current postdoctoral research associates, listed below, brings the total to 

fourteen research professionals who have trained with PECaD. A new postdoctoral 

fellow is slated to begin training in August 2012. 

Venera Bekteshi, PhD 

Dr. Bekteshi's research addresses barriers to cancer screening services among 

immigrants and minorities with the goal of aiding global efforts to reduce the 

disproportionate cancer-related mortality burden on this community. She works with 

Dr. Sarah Gehlert as her primary mentor. Dr. Bekteshi has accepted a faculty position 

within the School of Social Work at the University of Illinois at Urbana-Champaign and 

will finish her postdoctoral training in June 2012. 

Jean Hunleth, PhD, MPH 

Dr. Hunleth is interested in addressing health inequities in the St. Louis region and 

globally through community-engaged and contextually-rich research. The goal is to 

identify and interrupt the social and economic processes that underpin disparities in 

cancer-related mortalities. She works with Dr. Aimee James as her primary mentor. 

The training program also helps fulfill PECaD’s goal to present information on 

community-based participatory research approaches to a wide audience of 

stakeholders through a number of activities. For example, Dr. Sarah Gehlert 

presented on community-based research ethics to clinical research scholars during a 

Responsible Conduct of Research course at the School of Medicine. Drs. Bettina 

Drake and Gehlert presented on health disparities to MPH students in their Practice 

31


of Medicine course. During the summer of 2012, we will offer a course for community 

stakeholders entitled Research: Does It Make a Lick of Sense through the new 

Community Partnership Center in North St. Louis (associated with the Komen 

project). Community residents who complete the course will be given a certificate and 

asked to help teach subsequent courses, thus fostering and building a legacy of 

community-driven cancer research education. 

Setting up the transdisciplinary postdoctoral training program has given PECaD the 

opportunity to make new connections within several disciplinary infrastructures on 

the Washington University campuses. We have begun to build a strong foundation 

between faculty open to interdisciplinary training and mentoring, including those 

practicing public health, epidemiology, translational medicine, biostatistics and social 

work. A training manual has been developed to guide both postdocs and mentors 

through the process, including program goals, objectives, and a detailed timeline for 

gauging progress of the Individual Development Plan (IDP) process. 

32

CONCLUSION 


The causes of disparities in cancer prevention, diagnosis, treatment and survival are 

great and complex. There is no magic-bullet solution to end cancer disparities. 

Rather, a host of factors interacting with each other and interacting with individuals, 

communities, populations and society all contribute to the problem. But there is good 

news. More than half of the cancer occurring today is preventable. In a recent article 

in Science Translational Medicine (a peer-reviewed journal of the American 

Association for the Advancement of Science), Dr. Graham Colditz and others describe 

eight obstacles to applying knowledge that we already have to prevent cancer and 

ultimately eliminate cancer disparities. This knowledge spans the gamut from the 

lifestyle and behavior choices that we make everyday in our personal lives to societal 

factors that inhibit health-promoting activities to policy factors that impact access to 

care and the cancer research agenda. PECaD’s work with community partners to 

understand and address these factors is part of the solution to ending cancer 

disparities. We hope our work will expedite solutions to some of the challenges to 

cancer prevention. 

33

For more information about PECaD, 

call 314-747-4611 or email 

PECaD@wudosis.wustl.edu. 

To learn more about the Siteman Cancer Center, 

call 1-800-600-3606 or visit 

www.siteman.wustl.edu.

Annual Report to Stakeholders 2011-2012 - Siteman Cancer Center ...

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