title: Mobilizing social support networks to improve cancer screening: the COACH randomized controlled trial study design.
abstract: BACKGROUND
  Disadvantaged populations face many barriers to cancer care, including limited support in navigating through the complexities of the healthcare system. Family members play an integral role in caring for patients and provide valuable care coordination; however, the effect of family navigators on adherence to cancer screening has not previously been evaluated. Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients.
  
  
  METHODS
  Guided by principles of community based participatory research (CBPR), "Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors (COACH)" is a community-based randomized controlled trial to assess the effectiveness of a trained participant-designated coach (support person or care giver) in navigating cancer-screening for older African American adults, 50-74 years old. Participants are randomly assigned as dyads (participant+coach pair) to receiving either printed educational materials only (PEM--control group) or educational materials plus coach training (COACH--intervention group). We defined a coach as family member, friend, or other lay support person designated by the older adult. The coach training is designed as a one-time, 35- to 40-minute training consisting of: 1) a didactic session that covers the role of the coach, basic facts about colorectal, breast and cervical cancers (including risk factors, signs and symptoms and screening modalities), engaging the healthcare provider in cancer screening, insurance coverage for screening, and related healthcare issues, 2) three video skits addressing misconceptions about and planning for cancer screening, and 3) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened. The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings (for breast, cervix or colorectal cancer) between the control and intervention groups.
  
  
  CONCLUSIONS
  Building on trusted patient contacts to encourage cancer screening, COACH is a highly sustainable intervention in a high-risk population. It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants' existing support networks. If effective, the intervention could have a high impact on health care disparities research across multiple diseases.
  
  
  BACKGROUND
  ClinicalTrials.gov ( NCT01613430 ). Registered June 5, 2012.
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA. ombah1@jhmi.edu.
authors.forename: Olive
authors.initials: O
authors.lastname: Mbah
authors.affiliation: Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, USA. fordjean@einstein.edu.
authors.forename: Jean G
authors.initials: JG
authors.lastname: Ford
authors.affiliation: Medical Oncology Department, Cancer Center of Sun Yat-sen University, Guangzhou, China. qiumzh@sysucc.org.cn.
authors.forename: Miaozhen
authors.initials: M
authors.lastname: Qiu
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA. jwenzel@jhu.edu.|Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA. jwenzel@jhu.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wenzel
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lbone1@jhu.edu.
authors.forename: Lee
authors.initials: L
authors.lastname: Bone
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jbowie2@jhu.edu.
authors.forename: Janice
authors.initials: J
authors.lastname: Bowie
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA. aelmi@jhmi.edu.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmi
authors.affiliation: Community Ministry of Prince George's County, Upper Marlboro, MD, USA. jaslade@verizon.net.
authors.forename: Jimmie L
authors.initials: JL
authors.lastname: Slade
authors.affiliation: Maxwell Enterprises, Baltimore, MD, USA. mtowson2k0@yahoo.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Towson
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. adobs@jhmi.edu.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Dobs
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D054626:Consumer Health Information / Q000379:methods*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D012107:Research Design; D012944:Social Support