Psychologic predictors of cancer information avoidance among older adults: the role of cancer fear and fatalism

Fatalistic Cancer Beliefs and Information Seeking in Formerly Incarcerated African-American and Hispanic Men: Implications for Cancer Health Communication and Research

African-American and Hispanic men are disproportionately affected by cancer experiencing higher rates of cancer-related morbidity and mortality for many cancers (but not all). These challenges may be magnified for a subpopulation of African-American and Hispanic men who have been incarcerated. A survey assessing demographics, incarceration experience, psychosocial, behavioral, and cancer health information seeking was administered to 230 previously incarcerated men aged 35 years and older. Data analysis was performed to assess the association between fatalism, perceived susceptibility, and health information seeking in this population. This study revealed the following: the majority of the participants (68.7%) held the fatalistic belief: "When I think of cancer, I automatically think of death." Second, the fatalistic belief, "There's not much you can do to lower your chances of getting cancer," is more prevalent among those who perceived a higher risk of developing cancer. Third, older participants (those between 55 and 70 years old) and widowed are less likely to think of death when they think of cancer. In addition, those who use the Internet to look for health or medical information (i.e., engaging in health information seeking) are less likely to agree with the fatalistic belief: "It seems like everything causes cancer." Given the high incidence of certain cancers among African-American and Hispanic men and the vulnerability of those involved in the criminal justice system, our findings highlight the importance of understanding perceived susceptibility to cancer, fatalistic beliefs about cancer, and information seeking in formerly incarcerated men.

Agency and fatalism in older Appalachian women's information seeking about gynecological cancer

Researchers consider older women in rural Appalachia to have low levels of agency and high levels of fatalism regarding decision making about cancer treatment. Using the life course perspective, we examined older women's agency with information seeking about gynecological cancer. Semistructured interviews with 20 White women living in central Appalachia revealed four trajectories: Surrendering Control, Accepting Death, Self-Care, and Advocacy, each with its own forms of agency. Some women experienced personal transformation, increased self-efficacy, and a passion for community empowerment. Fatalism was not understood apart from placing trust in medical expertise. We implore researchers to further explore rural expressions of agency.

Cancer-Related Information Seeking and Scanning Behaviors among Older Chinese Adults: Examining the Roles of Fatalistic Beliefs and Fear

Effective communication in health information plays an important role in health promotion and cancer prevention. Cancer-related information acquisition can happen via active and purposeful seeking, but may also happen less purposely via the routine use of media and interactions with other people (called scanning). We examined seeking and scanning behaviors regarding cancer prevention in older Chinese adults, identified commonly used sources of information of such behaviors, and examined their associations with fatalistic beliefs and cancer fear. A convenience sample of 224 community-dwelling adults aged ≥60 were recruited between May and July in 2013 in Hong Kong. Results suggested that cancer information scanning (79.5%) was more common than information seeking (30.4%) among our participants. Health professional was the most popular source for both scanning (78.7%) and seeking (58.8%) behaviors regarding cancer information. Fatalistic beliefs was significantly and negatively associated with seeking behaviors (OR = 0.50) but not scanning behaviors, and cancer fear showed no relationship with either behavior. This study shows that the cancer information seeking and scanning behaviors were still suboptimal in this age group and adds to the knowledge regarding the associations between fatalistic beliefs and fear with cancer information seeking and scanning behaviors among older Chinese adults.

Understanding middle-aged and older adults' first associations with the word "cancer": A mixed methods study in England

Objective

Cancer is still widely feared and often associated with death. Fatalistic beliefs adversely affect help‐seeking for cancer symptoms and engagement in cancer prevention. This study aims to understand middle‐aged and older adults' first association with the word “cancer” and their relationship with sociodemographic factors, cancer fear, and cancer information avoidance.

Methods

We conducted a cross‐sectional survey of 1464 community‐based adults aged 50 to 70 living in England in April 2015. First associations with cancer were measured qualitatively and analysed using content analysis. We used binary logistic regression to analyse associations between the most common first association of cancer and sociodemographic characteristics, cancer fear, and cancer information avoidance.

Results

Cancer was most commonly associated with “death” (26%). Respondents with lower levels of education, living in the Midlands or North of England where cancer mortality is higher, or with close friends or family members with a cancer history, were more likely to associate cancer with death. Cancer fear was significantly associated with death associations, but cancer information avoidance was not.

Conclusions

Despite improved cancer outcomes, middle‐aged and older adults often associate cancer with death. Further efforts to decrease fatalistic associations in this age group may be needed.

Fatalism and exposure to health information from the media: examining the evidence for causal influence

Fatalistic attitudes have a negative impact on a broad variety of health behaviors and behavioral determinants of health. A growing body of research has documented an association between media exposure and fatalism; however, scholarship has not been able to ascertain the causal direction. This review synthesizes the current state of the literature. A major finding is that most studies purporting to assess the relationship between media exposure and fatalism use conflated measures of fatalism. Among those that use an appropriate measure, there is some evidence that increased exposure to media increases fatalism. Although there is a substantive theoretical rationale for such effects, more research is needed to make a definitive claim and to explain the mechanism for such effects.

Fear of cancer and older people's beliefs about cancer treatment in Poland

Throughout Europe and the United States, more than 60% of all cancer incidents occur in older people. Therefore, the aim of this study was to understand the level of fear people have regarding cancer and older people's beliefs about cancer pain, cancer treatment, and the curability of cancer. We conducted a survey in 2012, in which the sample was comprised of 910 adult residents of Wroclaw, Poland, to ascertain the beliefs people have about cancer and the degree of fear people have with respect to cancer. The majority of the respondents reported having a high level of fear, and this level of fear increased with age. Moreover, the oldest people (65 years and above) expressed fatalistic beliefs with respect to cancer. Our observations may guide health promotion campaigns and cancer prevention programs.

What impact do questionnaire length and monetary incentives have on mailed health psychology survey response?

Objectives

Response rates to health‐related surveys are declining. This study tested two strategies to improve the response rate to a health psychology survey mailed through English general practices: (1) sending a shortened questionnaire and (2) offering a monetary incentive to return a completed questionnaire.

Design

Randomized controlled trial.

Methods

Adults (n = 4,241) aged 45–59 years, from four General Practices in South‐East England, were mailed a survey on attitudes towards bowel cancer screening. Using a 2 × 4 factorial design, participants were randomized to receive a ‘short’ (four A4 pages) or a ‘long’ (seven A4 pages) questionnaire, and one of four monetary incentives to return a completed questionnaire – (1) no monetary incentive, (2) £2.50 shop voucher, (3) £5.00 shop voucher, and (4) inclusion in a £250 shop voucher prize draw. Age, gender, and area‐level deprivation were obtained from the General Practices.

Results

The overall response rate was 41% (n = 1,589). Response to the ‘short’ questionnaire (42%) was not significantly different from the ‘long’ questionnaire (40%). The £2.50 incentive (43%) significantly improved response rates in univariate analyses, and remained significant after controlling for age, gender, area‐level deprivation, and questionnaire length. The £5.00 (42%) and £250 prize draw (41%) incentives had no significant impact on response rates compared to no incentive (38%).

Conclusions

A small monetary incentive (£2.50) may slightly increase response to a mailed health psychology survey. The length of the questionnaire (four pages vs. seven pages) did not influence response. Although frequently used, entry into a prize draw did not increase response. Achieving representative samples remains a challenge for health psychology.

Does psychosocial stress exacerbate avoidant responses to cancer information in those who are afraid of cancer? A population-based survey among older adults in England

OBJECTIVE

Communication of cancer information is an important element of cancer control, but cancer fear may lead to information avoidance, especially when coping is low. We examined the association between cancer fear and cancer information avoidance, and tested whether this was exacerbated by psychosocial stress.

DESIGN

Cross-sectional survey of 1258 population-based adults (58-70 years) in England.

MAIN OUTCOME MEASURES

Cancer fear (intensity and frequency), perceived psychosocial stress and cancer information avoidance. Control variables were age, gender, ethnicity, marital status and education.

RESULTS

A quarter (24%) of respondents avoided cancer information. Ordinal logistic regression analyses showed main effects of psychosocial stress (OR = 1.17, 95% CI 1.07-1.29) and cancer fear: cancer information avoidance was lowest in those with no cancer fear (13%), followed by those with moderate (24%; OR = 2.15, 95% CI: 1.49-3.12), and high cancer fear (35%; OR = 3.90, 95% CI: 2.65-5.73). In the adjusted model, the interaction between cancer fear and stress was significant (OR = 1.14, 95% CI 1.004-1.29, p < .05): 40% of those with high fear/high stress avoided cancer information compared with 29% with high fear/low stress.

CONCLUSION

Cancer fear and psychosocial stress interact to produce disengagement with cancer-related information, highlighting the importance of affective processes to cancer control efforts.

Cigarette graphic health warning labels and information avoidance among individuals from low socioeconomic position in the U.S

PURPOSE

Although graphic health warning labels (GHWs) on cigarette packs have influenced cessation behaviors in other countries, no U.S. studies have explored the impact of avoidance of GHW content among individuals from low socioeconomic position (SEP). The purpose of this study was to determine the predictors of intention to avoid GHWs, and how avoidance impacts cessation intention, in a low SEP sample in the U.S.

METHODS

Data come from low SEP smokers (n = 541) involved in a field experiment. The participants responded to questions pre- and post viewing of GHWs assessing SEP, intention to avoid them, emotional reactions, and intention to seek health information or quit smoking. Backwards stepwise logistic regression determined the predictors for intention to avoid GHWs. Simple and adjusted logistic regression analyzed the association between avoidance and its main predictors and outcomes of intentions to seek information or quit smoking.

RESULTS

Predictors for avoidance included being somewhat addicted to cigarettes (OR 2.3, p = 0.002), younger than 25 (OR 2.6, p = 0.008), and having medium (OR 3.4, p < 0.001) or high (OR 4.7, p < 0.001) levels of negative emotional reaction to the labels. Intention to avoid GHWs was positively associated with the intent to look for health information about smoking (OR 2.2, p = 0.002). Higher levels of negative emotional reaction were positively associated with cessation behaviors, with high negative emotional reaction associated with nine times the odds of quitting (p < 0.001).

CONCLUSIONS

Results indicate avoidance of GHWs does not detract from the labels' benefit and that GHWs are an effective means of communicating smoking risk information among low SEP groups.

Messages of Hope: Helping Family Members to Overcome Fears and Fatalistic Attitudes Toward Cancer

This qualitative study explored strategies family members of African-American cancer patients used to overcome their fears and fatalistic attitudes toward cancer. Twenty-four family members were recruited through criterion purposeful sampling. Data were collected and analyzed using open-ended interviews and thematic analysis. Fears and fatalistic attitudes could be traced to personal experiences with cancer and information being communicated within their networks. Strategies used to overcome fears and fatalistic attitudes toward cancer included an awareness of advances in cancer treatments, information obtained from their health-care providers, and faith in God. Family members supported the patient through efforts of encouraging them to talk about what they were going through, to be strong, to maintain a positive environment and normalcy, and to use spirituality as a source of strength. Family members also suggested that health-care providers and researchers tailor intervention studies to consider that the patient is a part of a larger family system and that the entire family needs support to overcome long-held fears and fatalistic attitudes toward cancer. These findings suggest that despite advances in cancer care and widespread media coverage to change perceptions about cancer, fears and fatalistic attitudes toward cancer persist and likely influence the family members' ability to optimally support the cancer patient. At the time of diagnosis, both patient and the entire family unit should be educated of advances in cancer care, that cancer is no longer a death sentence, and supported to overcome fears and fatalistic attitudes.

The effect of women's breast cancer fear and social support perceptions on the process of participating in screening

INTRODUCTION

Social support and fear have been shown to be important factors affecting women's participation in breast cancer screening. This study aimed to determine the effect of women's perceived breast cancer fear and social support on participating in the breast cancer screening process, and to investigate the relationship between the perception of breast cancer fear and social support.

METHODS

This is a descriptive study, carried out in a state hospital on 198 women. The data were collected through a Socio-Demographic Data Form, Multidimensional Scale of Perceived Social Support (MSPSS), and Breast Cancer Fear Scale (BCFS) by the researchers by means of face-to-face interview.

RESULTS

There was no statistically significant difference between the women's perceptions of social support and breast cancer fear and screening behaviors ( p > 0.05). It was found that the mean BCFS score of those who had a family history of breast cancer was high, and the MSPSS score was lower ( p < 0.05). There was a quite weak and statistically insignificant positive relationship between the women's BCFS scores and perceived social support ( r = 0.08, p > 0.05), friend support ( r = 0.04, p > 0.05) and support from a special person ( r = 0.14, p > 0.05).

CONCLUSION

We found no statistically significant difference between breast cancer fear, social support and the women's screening behavior. However, breast cancer fear and the effect of social support on screening attitude may be important. Nurses and other health workers should particularly focus on social support and breast cancer fear in their health education programs. Formative research into the use of social support to promote positive empowering messages should be carried out and incorporated in future health promotion campaigns to improve the breast cancer screening process.

PATI: Patient accessed tailored information: A pilot study to evaluate the effect on preoperative breast cancer patients of information delivered via a mobile application

OBJECTIVES

The information needs of cancer patients are highly variable. Literature suggests an improved ability to modulate personalised stress, increased patient involvement with decision making, greater satisfaction with treatment choices and reduced anxiety levels in cancer patients who have access to information. The aim of this project was to evaluate the effects of a mobile information application on anxiety levels of patients undergoing surgery for breast cancer.

MATERIALS AND METHODS

An application was developed for use with Apple iPad containing information on basic breast cancer biology, different treatments used and surgical techniques. Content and face validity studies were performed. A randomized control trial was designed, with a 1:2 allocation. Data collected include basic demographics and type of surgery. Questionnaires used included: the HADS, Mini-MAC, information technology familiarity and information satisfaction.

RESULTS

A total of 39 women participated. 13 women had access to an iPad containing additional information and 26 women acted as controls. The mean age was 54 and technology familiarity was similar among both groups. Anxiety and depression scores at seven days were significantly lower in control patients without access to the additional information provided by the mobile application (p = 0.022 and 0.029 respectively).

CONCLUSION

Anxiety and depression in breast cancer patients is both multifactorial and significant, with anxiety levels directly correlating with reduced quality of life. Intuitively, information should improve anxiety levels, however, we have demonstrated that surgical patients with less information reported significantly lower anxiety. We advise the thorough testing and auditing of information initiatives before deployment.

Education differences in cancer fatalism: The role of information-seeking experiences

Cancer fatalism is the belief that cancer is uncontrollable and lethal. Individuals with less education are more likely to hold fatalistic beliefs about cancer, but the mechanism accounting for the relationship is unknown. We tested whether negative health information seeking experiences explain this relationship. Structural equation modeling was used to test this relationship across three datasets from the Health Information National Trends Survey. Across all datasets, the model showed good fit: Cycle 1 (coefficient of determination = .11, comparative fit index = .96, root mean square error of approximation = .047), Cycle 2 (coefficient of determination = .06, comparative fit index = .96, root mean square error of approximation = .046), and Cycle 3 (coefficient of determination = .08, comparative fit index = .95, root mean square error of approximation = .052). The link between lower education level and higher cancer fatalism was partially mediated by negative health information seeking experiences.

The associations between objective numeracy and colorectal cancer screening knowledge, attitudes and defensive processing in a deprived community sample

We examined associations between numeracy and sociocognitive factors associated with colorectal cancer screening uptake (n = 964). Nearly half (45.7%) of the respondents incorrectly answered a numeracy question (low numeracy). Low numeracy respondents were less knowledgeable about colorectal cancer (p < .001), less positive towards screening (emotional, p < .001 and practical, p = .001) and less likely to intend to participate in screening (p = .001). They also reported greater defensive processing of cancer information (p = .001). Sociocognitive factors fully mediated the relationship between numeracy and screening intention. Addressing numeracy issues may reduce inequalities in CRC screening participation, but communication strategies could be limited by the tendency process cancer information defensively.

Cancer Fatalism, Literacy, and Cancer Information Seeking in the American Public

Information seeking is an important behavior for cancer prevention and control, but inequalities in the communication of information about the disease persist. Conceptual models have suggested that low health literacy is a barrier to information seeking, and that fatalistic beliefs about cancer may be a mediator of this relationship. Cancer fatalism can be described as deterministic thoughts about the external causes of the disease, the inability to prevent it, and the inevitability of death at diagnosis. This study aimed to examine the associations between these constructs and sociodemographic factors, and test a mediation model using the American population-representative Health Information and National Trends Survey (HINTS 4), Cycle 3 (n = 2,657). Approximately one third (34%) of the population failed to answer 2/4 health literacy items correctly (limited health literacy). Many participants agreed with the fatalistic beliefs that it seems like everything causes cancer (66%), that one cannot do much to lower his or her chances of getting cancer (29%), and that thinking about cancer makes one automatically think about death (58%). More than half of the population had "ever" sought information about cancer (53%). In analyses adjusted for sociodemographic characteristics and family cancer history, people with limited health literacy were less likely to have ever sought cancer information (odds ratio [OR] = 0.63; 0.42-0.95) and more frequently endorsed the belief that "there's not much you can do . . ." (OR = 1.61; 1.05-2.47). This fatalistic belief partially explained the relationship between health literacy and information seeking in the mediation model (14% mediation). Interventions are needed to address low health literacy and cancer fatalism to increase public interest in cancer-related information.

Who Avoids Cancer Information? Examining a Psychological Process Leading to Cancer Information Avoidance

Although cancer information avoidance (CIA) is detrimental to public health, predictors of CIA have not been fully investigated. Based on uncertainty management theory, this study viewed CIA as a response to uncertainty related to the distress associated with cancer information and illustrated the psychological process leading to CIA. Given the current information context, it was hypothesized that cancer information overload (CIO), accompanied by confusion and stress about cancer information, causes CIA. As trait anxiety is a strong predictor of CIO, it was also hypothesized that trait anxiety has an indirect effect on CIA through CIO. Study 1 tested this relationship in a U.S. sample (N = 384); the results showed that CIO was positively associated with CIA and that trait anxiety indirectly influenced CIA through CIO. Whereas Study 1 tested the relationship with cross-sectional data in the general cancer context, Study 2 replicated Study 1 with 3-wave longitudinal data in the context of a specific cancer (i.e., stomach cancer) in South Korea (N = 1,130 at Wave 1, 813 at Wave 2, and 582 at Wave 3). Trait anxiety at Wave 1 predicted CIO at Wave 2, which in turn increased CIA at Wave 3, suggesting that some people are inherently inclined to avoid cancer information due to their trait anxiety, which results in confusion about cancer information.

An Exploratory Study on the Information Needs of Prostate Cancer Patients and Their Partners

The aim of this study is to explore the information needs of men with prostate cancer and their partners retrospectively at various points in the treatment process. An online questionnaire was used to collect information from men with prostate cancer and their partners about information needs, and when these developed. Readers of a Prostate Care Cookbook and members of a Prostate Cancer Charity were invited to participate: 73 men with prostate cancer and 25 partners completed the questionnaire. Responses showed that participants develop their information needs close to diagnosis. Less educated men with prostate cancer and partners developed their needs closer to the time after diagnosis than those with higher education. Partners develop an interest on information related to treatment and interaction earlier than patients. Patients prioritised treatment and disease-specific information. Patients and partners differ in how their information needs develop. Medical information is prioritized by patients as opposed to practical information by partners. Health care provision can be tailored to meet the different needs of prostate cancer patients and their partners at different times in the treatment process.

Evaluating the impact of a community-based cancer awareness roadshow on awareness, attitudes and behaviors

Improving public awareness of cancer and encouraging health behavior change are important aspects of cancer control. We investigated whether a community-based roadshow was an effective way of communicating with the public about cancer and encouraging behavior change. Data were from 1196 people who completed questionnaires at a Cancer Research UK Cancer Awareness Roadshow in 2013. Of these, 511 (43%) completed questionnaires immediately before their visit (pre-visit group) and 685 (57%) completed questionnaires immediately after their visit (post-visit group). Among the post-visit sample, 217 (32%) were retained after two months. Self-reported data were available on risk factor and symptom awareness, help-seeking barriers, use of healthcare services and health behaviors. Compared with the pre-visit sample, the post-visit group had greater awareness of cancer risk factors and was more positive about aspects of help-seeking but awareness of potential symptoms was similar. Most effects were maintained over two months. Intentions to eat more fruit and vegetables and to exercise more were comparable between the groups but more people in the post-visit sample intended to quit smoking. At 2-month follow-up, smoking prevalence had significantly reduced but fruit and vegetable consumption decreased and there was no change to physical activity. User of weight loss services and general practitioner visits were high at follow-up and largely attributed to the Roadshow. The Cancer Research UK Roadshow appears to improve risk factor awareness, promote positive attitudes towards help-seeking and increase smoking cessation. This approach could be a useful building block for additional cancer prevention and control strategies.

Emotional responses to the experience of cancer 'alarm' symptoms

OBJECTIVE

To qualitatively explore associations between emotional responses to experience of cancer 'alarm' symptoms and help-seeking in a community sample of adults.

METHOD

Interviewees (n = 62) were recruited from a community sample (n = 2042) of adults aged ≥50 years, who had completed a health survey that included a list of cancer alarm symptoms. Participants who had reported an alarm symptom both at baseline and 3-month follow-up (n = 271), and who had consented to contact (n = 215), constituted the pool for invitations to interview.

RESULTS

Over a third of participants (37%) described an emotional response to their symptom experience. In all these cases, there was evidence of awareness of the risk of cancer. Emotional responses were usually either classified as mild ('worry') or severe ('fear'). Worry was often described in the context of a desire to seek medical help, either to rule out cancer or to minimise patient delay. In contrast, the 'fear' group described associations with death, the perceived incurability of cancer, and the consequence of a cancer diagnosis. Where the emotional reaction was fear, medical contact was seen as something to be avoided either because it had no value or because it was preferable not to be told a diagnosis.

CONCLUSION

In this community sample, worry about the possibility of cancer was associated with help-seeking, either for reassurance or as part of a 'sensible' strategy to deal with the risk. In contrast, fear was associated with avoiding help-seeking or even thinking about cancer, which could lead to prolonged help-seeking intervals.

Health information seeking and scanning among US adults aged 50–75 years: Testing a key postulate of the information overload model

Past research has found that older US adults (aged 50–75 years) exhibit high levels of cancer information overload and cancer worry; however, no study to date has examined whether these perceptions are related to information seeking/scanning. To explore this relationship, older adults ( N = 209, Mage = 55.56, SD = 4.24) were recruited to complete a survey measuring seeking, scanning, cancer information overload, and cancer worry. Most participants were high-scan/seekers (40.2%) followed by low-scan/seekers (21.1%), high-scan/no seekers (19.6%), and low-scan/no seekers (19.1%). Low-scan/no seekers had significantly higher cancer information overload compared to all other groups, consistent with the postulate that overload and seeking/scanning are negatively related. Low-scan/no seekers and high-scan/seekers both exhibited higher cancer worry severity, consistent with past research suggesting that cancer worry explains high levels of activity/inactivity.

Cancer fear and fatalism among ethnic minority women in the United Kingdom

Background:

Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism.

Methods:

A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure.

Results:

Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21–0.45, all P<0.05) or feel particularly afraid (ORs 0.11–0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97–3.03, all P<0.05). Lower acculturation (ORs 4.30–17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined.

Conclusions:

In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection.

Impact of gender on decisions to participate in faecal immunochemical test-based colorectal cancer screening: a qualitative study

OBJECTIVE

Faecal immunochemical tests (FITs) are increasingly being used in population-based colorectal cancer-screening programmes. Uptake of FIT is lower in men than women; however, the reasons for this are not well understood. We aimed to explore gender differences in influences on decisions to participate in FIT screening.

METHODS

This is a qualitative study using in-depth face-to-face interviews of four groups of screening invitees (male and female screening users and male and female screening non-users), purposively sampled from the database of a population-based FIT screening programme. Recruitment continued until saturation was reached. Interviews were audio recorded and transcribed verbatim. Thematic analysis using the framework approach was employed with the theoretical domains framework guiding analysis.

RESULTS

Forty-seven screening invitees were interviewed. Six theoretical domains influenced screening uptake: 'environmental context and resources', 'beliefs about capabilities', 'beliefs about consequences', 'emotions', 'social influences' and 'knowledge'. Male non-users were often fatalistic, less knowledgeable and misinformed about cancer and FIT screening compared with other groups. Female non-users expressed negative attitudes, beliefs and emotions towards FIT screening, cancer, social influences and the medical profession and were over-confident about their health.

CONCLUSIONS

Negative attitudes and emotions to screening dominated non-user decision-making but differed by gender. Opportunities to improve uptake in men and women exist. Greater national discussions on the benefits of FIT screening, and development of screening materials tackling negative attitudes and beliefs while recognising male/female differences, may improve screening uptake. Copyright © 2016 John Wiley & Sons, Ltd.

Selective Exposure to Health Information: The Role of Headline Features in the Choice of Health Newsletter Articles

This study investigated how content and context features of headlines drive selective exposure when choosing between headlines of a monthly e-mail health newsletter in a naturalistic setting over a period of nine months. Study participants received a monthly e-mail newsletter and could freely open it and click any headline to read the accompanying article. In each e-mail newsletter, nine headlines competed with each other for selection. Textual and visual information of the headlines was content-analyzed, and clickstream data on the headlines were collected automatically. The results showed that headlines invited more frequent audience selections when they provided efficacy-signaling information in an imperative voice, when they used a moderate number of negative emotion words, when they presented negative thumbnail images while mentioning cancer or other diseases, and when they were placed higher in position.

The salience of cancer and the "survivor" identity for people who have completed acute cancer treatment: a qualitative study

PURPOSE

Globally, there are nearly 33 million persons who have survived 5 or more years after a diagnosis of cancer [1]. We explore the salience of cancer in such people's self-concept as an important element for creating patient-centered care for those living with a cancer history.

METHODS

Our data are responses to a free-listing exercise and subsequent qualitative interviews with 53 individuals aged between 45 and 74 who were diagnosed with non-Hodgkin's lymphoma or breast or prostate cancer at least 3 years prior and had completed acute treatment. Participants lived in the Baltimore-Washington region of the USA.

RESULTS

Cancer was not necessarily salient to participants' current self-concept, and espousal of a "survivor" identity is complex. We construct a typology of seven contrasting meanings of "survivor" based upon participants' narratives (factual, beaten, functional, temporary, adversity, passage of time, and lucky or blessed) and present interviewees' rationales as to why they did or did not adopt a survivorship identity.

CONCLUSIONS

We examine the complexity of "survivorship" as an identity and people's affiliation with it, as well as how this relates to other salient and fluid elements of people's sense of self within a life course perspective.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding how cancer factors into people's self-concept throughout the life course is important for designing effective, patient-centered programs that acknowledge diverse experiences and expectations and possible changes with the passage of time.

Fatalistic Beliefs About Cancer Prevention Among Older African American Men

OBJECTIVES

Evidence suggests that minority groups are more likely to exhibit fatalistic beliefs about cancer prevention (FBCP), which are defined as confusion, pessimism, and helplessness about one's ability to prevent cancer. This study examines the socioeconomic and psychosocial predictors of FBCP among older African American men (AAM).

METHODS

AAM (N = 1,666) enrolled in Medicare and participating in a longitudinal study on patient navigation were surveyed. Measures included three FBCP constructs, namely demographic items and physical and mental health variables. Binary logistic regression was performed.

RESULTS

The average participant was 73.6 years old; 76.5% felt helpless, 44.2% were confused, and 40.7% were pessimistic about the ability to prevent cancer. As education increased, so did all three FBCP. Being downhearted was predictive of confused and helpless beliefs.

DISCUSSION

It is critical for health practitioners to understand how psychosocial and economic challenges influence beliefs that may impede cancer prevention efforts for older AAM.

A Three-Factor Cancer-Related Mental Condition Model and Its Relationship With Cancer Information Use, Cancer Information Avoidance, and Screening Intention

Cancer-related affect and cognition, such as cancer fear, cancer worry, and cancer risk perception, are important predictors of cancer prevention and communication behaviors. However, they have not been clearly conceptualized in cancer communication literature, and in particular, the role of affect (i.e., cancer fear) in cancer prevention and communication has not been fully investigated. The present study developed a 3-factor cancer-related mental condition model encompassing affective (cancer fear), cognitive (cancer risk perception), and affective-cognitive (cancer worry) conditions. Two studies were conducted. Study 1 developed the model with Sample 1 (U.S. undergraduates, N = 309), and subsequently validated the model with Sample 2 (Korean general population, ages 40 years or older, N = 1,130). Study 2, using Sample 2, tested the model's relationship with cancer information use, cancer information avoidance, and screening intention. While Sample 1 participants were asked about cancer in general, Sample 2 participants were asked specifically about stomach cancer. Thus, the model derived from the specific sample in a general context was confirmed via the general sample in a specific context. The results showed that both cancer worry and cancer risk perception are positively associated with cancer information use and screening intention, but they are negatively associated with cancer information avoidance. Cancer fear was positively associated with cancer information use, but it was also positively related to cancer information avoidance. Moreover, cancer fear was negatively associated with screening intention. Although the three components of the model are positively related to one another, they function differently in the cancer context.

Fear of cancer is associated with cancer information seeking, scanning and avoiding: a cross-sectional study among cancer diagnosed and non-diagnosed individuals

BACKGROUND

Nowadays, there is an abundance of health and cancer information in the mass media. Because of this high amount of information, it is possible for individuals to find or incidentally encounter cancer information, but it is also possible to be overloaded by this information and, consequently, to avoid it. Previous studies have indicated that fear of cancer could be both positively and negatively related to behaviours such as screening, help-seeking and information avoidance.

OBJECTIVE

The aims of this study were (1) to assess the relationship between fear of cancer and cancer information acquisition and avoiding behaviour, (2) to examine whether this relationship was curvilinear, and (3) to determine whether this relationship was moderated by being diagnosed with cancer or not.

METHOD

Six hundred and twenty-one cancer diagnosed and 1387 non-diagnosed individuals were recruited through a convenience sample in Flanders (Belgium) and filled in a standardised survey questionnaire.

RESULTS

The results showed a positive linear association between fear of cancer and information seeking, scanning and avoiding. Being diagnosed with cancer or not did not moderate this relationship.

CONCLUSION

Fear of cancer is positively associated with cancer information acquisition and avoiding behaviour. This suggests that fear of cancer predicts different behaviours in different individuals.

Identifying social characteristics of health-related information seeker: a gender-specific approach for cancer survivors

While health information-seeking behavior as an indicator of health communication of patients including cancer survivors has been researched, few studies have focused on how socioeconomic position and media use combine to influence health-related information seekers. This study examined social characteristics of health information-seeking behavior taking into account an individual's socioeconomic position and their media use in Korea, a developed country. The data for this study came from a survey of 1,010 respondents drawn from a nationally representative sample in the Republic of Korea. We conducted multivariate logistic regression analyses for gender-specific effects. We found that men who reported high household income were one and half times more likely to seek health information than those with low income status. We also found that women who performed Internet searches by computer at home were almost two times more likely to seek health information than those who did not. Similar results were found for men as well. Our analyses revealed that socioeconomic position and media use are associated with health information-seeking behavior by gender. Studies on information seekers may bring us more effective health promotion and relevant intervention for people with chronic conditions including cancer survivors.

Attitudes towards colorectal cancer (CRC) and CRC screening tests among elderly Malay patients

BACKGROUND

Colorectal cancer (CRC) is the third most common malignancy in Malaysia, where data are limited regarding knowledge and barriers in regard to CRC and screening tests. The aim of the study was to assess these parameters among Malaysians.

MATERIALS AND METHODS

The questionnaires were distributed in the Umra Private Hospital in Selangor. The questionnaire had four parts and covered social-demographic questions, respondent knowledge about CRC and colorectal tests, attitude towards CRC and respondentaction regarding CRC. More than half of Malay participants (total n=187) were female (57.2%) and 36.9% of them were working as professionals.

RESULTS

The majority of the participants (93.6%) never had a CRC screening test. The study found that only 10.2% of the study participants did not consider that their chances of getting CRC were high. A high percentage of the participants (43.3%) believed that they would have good chance of survival if the cancer would be found early. About one third of the respondents did not want to do screening because of fear of cancer, and concerns of embarrassment during the procedure adversely affected attitude to CRC screening as well. Age, gender, income, family history of CRC, vegetable intake and physical activity were found to be significant determinants of knowledge on CRC.

CONCLUSIONS

The major barriers identified towards CRC screening identified in our study were fear of pain and embarrassment. The findings have implications for understanding of similarities and differences in attitude to CRC amongst elderly patients in other cultural/ geographic regions.

Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain

BACKGROUND

It is necessary to raise a positive attitude towards cancer information to improve disease prevention and control.

OBJECTIVE

To identify social factors, health characteristics and cancer-related perceptions and knowledge associated with a positive attitude towards cancer information.

DESIGN

We ran multivariate logistic regression models to analyse population-based data from OncoBarómetro-2010, a Spanish representative survey on perceptions and knowledge, related to cancer, conducted among 7938 people aged 18 years or more.

MEASUREMENT

Attitudes towards cancer information. A positive attitude includes feeling motivated to keep informed, to have screening tests or to change lifestyle. A negative attitude includes feeling indifference, concern, frustration or fear.

RESULTS

38.3% of the studied population reported having received information related to cancer (within the last 6 months). Among those, 31.5% expressed a negative attitude towards cancer information. People more likely to have a positive attitude towards cancer information (reference category: negative attitude) were people aged 35-74 (ref: aged 18-34) (P < 0.001) and cancer survivors (ref: those who had not had cancer) (OR: 3.05; 95% CI: 1.73-5.38). The likelihood of a positive attitude increased with the level of education (P < 0.001). The variables negatively associated with a positive attitude towards cancer information were poor self-rated health status (ref: fair) (OR: 0.63; 95% CI: 0.42-0.95) and high self-perceived risk of developing cancer (ref: low) (OR: 0.75; 95% CI: 0.60-0.92).

CONCLUSIONS

These findings have potential to inform programmes designed to promote cancer prevention behaviours. Policies should target population groups with low socio-economic groups, those with poor self-rated health and individuals with high self-perceived risk of cancer. Further, in order to increase knowledge of cancer symptoms, we need to focus on individuals with unhealthy lifestyles.

Fatalistic beliefs and completion of the HPV vaccination series among a sample of young Appalachian Kentucky women

PURPOSE

Uptake and completion of the 3-dose human papillomavirus (HPV) vaccine is important for the primary prevention of cervical cancer. However, HPV vaccination rates among adolescent females and young women remain low in certain geographic areas of the United States, including Appalachia. Although greater fatalistic beliefs have been previously associated with lower rates of preventive cancer behaviors among adults, little research exists on the impact of fatalism on HPV vaccination behaviors, especially among younger individuals. Therefore, the purpose of this study was to examine the association between fatalistic beliefs and completion of the full HPV vaccine series among young women, ages 18-26, in Appalachian Kentucky.

RESULTS

Data from this study were from a baseline survey completed by 344 women randomized into a communication intervention trial focused on increasing adherence to the 3-dose HPV vaccine series. Principal components analysis was used to construct 2 fatalism-related subscales from 8 survey questions.

FINDINGS

In a controlled analysis, 1 subscale--"lack of control over cancer"--was significantly associated with not completing the full HPV vaccine series. In a rural area that experiences higher rates of cervical cancer, poverty, limited access to health care, and negative cancer-related attitudes and experiences, fatalism may be common, even among young people.

CONCLUSION

Future educational and interventional research addressing fatalistic beliefs in a culturally sensitive manner may be warranted to improve HPV vaccination behaviors and impact cancer disparities among Appalachian women.

Is seeking health information online different from seeking general information online?

Increasing use of the Internet for health information delivery has created considerable discussion among digital divide scholars (i.e. how online information delivery benefits those individuals in higher socioeconomic brackets more than their counterparts). Because it is health information, we need to integrate how patients seek out online information. This study included patients’ information-seeking behaviour along with digital divide scholars’ constructs (i.e. literacy and computer skills). Using 1617 observations from the 2010 Pew Internet and American Life Project, this study found that individuals with a significant number of health problems, who are likely to be in a lower income bracket, are proactive online health information seekers; however, they are less likely to search general information. This finding adds value to existing research revealing that usefulness, which has been overlooked in online health information seeking, is important and should be a part of the research model.

The structure and demographic correlates of cancer fear

Background

Cancer is often described as the ‘number one’ health fear, but little is known about whether this affects quality of life by translating into high levels of worry or distress in everyday life, or which population groups are most affected. This study examined the prevalence of three components of cancer fear in a large community sample in the UK and explored associations with demographic characteristics.

Methods

Questions on cancer fear were included in a survey mailed to a community sample of adults (n = 13,351; 55–64 years). Three items from a standard measure of cancer fear assessed: i) whether cancer was feared more than other diseases, ii) whether thinking about cancer caused discomfort, and iii) whether cancer worry was experienced frequently. Gender, marital status, education, and ethnicity were assessed with simple questions. Anxiety was assessed with the brief STAI and a standard measure of self-rated health was included.

Results

Questionnaire return rate was 60% (7,971/13,351). The majority of respondents agreed or strongly agreed that they feared cancer more than other diseases (59%), and felt uncomfortable thinking about it (52%), and a quarter (25%) worried a lot about cancer. All items were significantly inter-correlated (r = .35 to .42, p’s < .001), and correlated with general anxiety (r = .16 to .28, p’s < .001) and self-rated health (r = -.07 to -.16, p’s < .001). In multivariable analyses including anxiety and general health, all cancer fear indicators were significantly higher in women (ORs between 1.15 and 1.48), respondents with lower education (ORs between 1.40 and 1.66), and those with higher general anxiety (ORs between 1.50 and 2.11). Ethnic minority respondents (n = 285; 4.4%) reported more worry (OR: 1.85).

Conclusions

More than half of this older adult sample in the UK had cancer as greatest health fear and this was associated with feeling uncomfortable thinking about it and worrying more about it. Women and respondents with less education or from ethnic minority backgrounds were disproportionately affected by cancer fear. General anxiety and poor health were associated with cancer fear but did not explain the demographic differences.

Measuring dispositional cancer worry in China and Belgium: a cross-cultural validation

Dispositional cancer worry (DCW) is the uncontrollable tendency to dwell on cancer independent of relevant stimuli (e.g., diagnosis of the disease). Past research has suggested that DCW has two underlying dimensions: severity and frequency. Available measures of DCW severity and frequency were translated and validated in two countries: China and Belgium. Participants (N = 623) completed translated scales, as well as measures of general dispositional worry, cancer fear, and perceived risk. In both locations, DCW measures were reliable (Cronbach's alphas ranged from .78 - .93) and demonstrated strong convergent, divergent, and concurrent validity. Severity and frequency factors loaded as expected in exploratory factor analysis. Future research should pursue longitudinal tests of DCW's predictive validity and explore DCW in theoretical models predicting the relationship between worry and cancer prevention and early detection behaviors.

Personal cancer knowledge and information seeking through PRISM: the planned risk information seeking model

This study retested PRISM, a model of risk information seeking, and found that it is applicable to the context of cancer risk communication. The study, which used an online sample of 928 U.S. adults, also tested the effect of additional variables on that model and found that the original model better fit the data. Among the strongest predictors of cancer information seeking were seeking-related subjective norms, attitude toward seeking, perceived knowledge insufficiency, and affective risk response. Furthermore, risk perception was a strong predictor of an affective risk response. The authors suggest that, given the robustness across studies, the path between seeking-related subjective norms and seeking intention is ready to be implemented in communication practice.

Adapting Champion's Breast Cancer Fear Scale to colorectal cancer: psychometric testing in a sample of older Chinese adults

PURPOSE

Colorectal cancer (CRC) is the most common type of cancer in both men and women, and older adults are more susceptible to this disease. Previous studies suggest that cancer fear may be a key predictor of participation in cancer screening. Yet there is a lack of validated measuring tools of fear relating to CRC for the Chinese older adult population. This study aims to test the psychometric properties of the Chinese version of the Colorectal Cancer Fear Scale (CRCFS), adapting from the Champion's Breast Cancer Fear Scale.

METHODS

The CRCFS was developed by altering the wording 'breast cancer' to 'colorectal cancer'. Interviewer-administered surveys were carried out with a convenience sample of 250 community-dwelling adults aged at least 60 years old without a history of cancer. A subsample of 40 participants completed the scale again at one-month.

RESULTS

Confirmatory factor analysis revealed that the one-factor model provided excellent fits to the overall data, and two randomly split samples. Cronbach's alpha of the scale was 0.95 and test-retest reliability was 0.52. Positive and significant correlations of CRC Cancer Fear with CRC-related susceptibility, severity and barriers were observed. A non-linear relationship with benefits was found.

CONCLUSIONS

The findings provide support for the psychometric properties of a Chinese version of the Champion Cancer Fear with an adaption to CRC in a sample of community dwelling older Chinese adults. The scale provides a useful tool to assess CRC-related fear, which interventions should address in order to improve screening rates among older Chinese adults.

Do high risk patients alter their lifestyle to reduce risk of colorectal cancer?

BACKGROUND

Colorectal cancer (CRC) may be reduced by healthy lifestyle behaviours. We determined the extent of self-reported lifestyle changes in people at increased risk of CRC, and the association of these reports with anxiety, risk and knowledge-based variables.

METHODS

We randomly selected 250 participants who had undergone surveillance colonoscopy for family history of CRC. A telephone interview was conducted, recording demographics and family history. Self-reported lifestyle change due to thoughts about CRC across a range of dietary and lifestyle variables was assessed on a four-point scale. Participants' perceptions of the following were recorded: risk factor knowledge, personal risk, and worry due to family history. General anxiety was assessed using the GAD-7 scale. Ordinal logistic regression was used to calculate adjusted results.

RESULTS

There were 148 participants (69% response). 79.7% reported at least one healthy change. Change in diet and physical activity were most frequently reported (fiber, 63%; fruit and vegetables, 54%; red meat, 47%; physical activity, 45%), with consumption of tobacco, alcohol, and body weight less likely (tobacco, 25%; alcohol, 26%; weight 31%). People were more likely to report healthy change with lower levels of generalized anxiety, higher worry due to family history, or greater perceived knowledge of CRC risk factors. Risk perception and risk due to family history were not associated with healthy changes.

CONCLUSIONS

Self-reported lifestyle changes due to thoughts about CRC were common. Lower general anxiety levels, worries due to family history, and perceived knowledge of risk factors may stimulate healthy changes.

Acceptance of a community-based navigator program for cancer control among urban African Americans

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations.

[Perception of risk factors for cancer in the Spanish population]

OBJECTIVE

To analyze the perception of the Spanish population of risk factors for cancer.

METHODS

Data were extracted from the OncoBarometro 2010 survey. Multivariate logistic models were applied to analyze the perception of the population on the importance of various risk factors: smoking, alcohol, sun, food, weight, sexually transmitted diseases, family history, radiation exposure, exposure to toxic substances and air pollution. The answers were rated on a 0 to 10 scale and were converted to low (0-6) and high (7-10) categories. The measure of association used was the prevalence ratio (PR).

RESULTS

The greatest importance was assigned to smoking (high importance: 83.1%), whereas the least importance was assigned to weight (26.5%). In general, the probability of perceiving risk factors as important was lower among men (PR sun: 0.87; PR sexually transmitted diseases: 0.78) and increased among people who received professional advice on cancer prevention (PR alcohol: 1.11; PR sun: 1.18; PR food; 1.31; PR weight: 1.92). In particular, knowledge of symptoms and extreme fear of cancer were associated with perceiving smoking as an important risk factor, whereas a high perceived vulnerability to cancer was associated with perceiving exposure to toxic substances, pollution and smoking as important risk factors.

CONCLUSIONS

Greater awareness is required of the association of cancer with overweight and sexually transmitted diseases. The recommendations given by health professionals on cancer prevention are key to increasing the population's awareness of risk factors for cancer.

Examining patterns of association with defensive information processing about colorectal cancer screening

To reduce negative psychological affect from information or behavior that is inconsistent with one's positive self-concept, individuals use a variety of defensive strategies. It is unknown whether correlates differ across defenses. We examined correlates of four levels of defensive information processing about colorectal cancer screening. Cross-sectional surveys were completed by a convenience sample of 287 adults aged 50-75 years. Defenses measures were more consistently associated with individual differences (especially avoidant coping styles); however, situational variables involving health-care providers also were important. Future research should examine changes in defenses after risk communication and their relative impact on colorectal cancer screening.

Class, race and ethnicity and information avoidance among cancer survivors

BACKGROUND

Information seeking may increase cancer survivors' ability to make decisions and cope with the disease, but many also avoid cancer information after diagnosis. The social determinants and subsequent communication barriers that lead to avoidance have not been explored. The purpose of this study is to examine the influence of social determinants on information avoidance among cancer survivors.

METHODS

We examined how health information avoidance is associated with structural and individual factors in a mail-based survey of 519 cancer survivors. Factor analysis was conducted to determine barriers to obtaining cancer information, and multivariable logistic regression models by gender were run to analyze social determinants of avoidance from an intersectional approach.

RESULTS

Participants who were younger, female, had greater debt and lower income, and had difficulty finding suitable information were more likely to avoid information. The probability of information avoidance increased when survivors reported barriers to information use or comprehension.

CONCLUSION

These results indicate that survivors' information avoidance may be driven, in part, by social determinants, particularly among those at the intersection of multiple social status categories. Customized strategies are needed that maximize the likelihood that information will be used by vulnerable groups such as those from a lower socioeconomic position.

Improving awareness of cancer clinical trials among Hispanic patients and families: audience segmentation decisions for a media intervention

Clinical trials hold great promise for cancer treatment; yet, Hispanic cancer patients have low rates of clinical trial participation. Lack of awareness and knowledge of clinical trials and language barriers may account for low participation rates. Patient education through audiovisual materials can improve knowledge of and attitudes toward clinical trials among Hispanic populations. In this study, 36 Hispanic cancer patients/survivors and caregivers in Florida and Puerto Rico participated in focus groups to aid in developing a Spanish-language DVD and booklet intervention designed to increase knowledge about clinical trials. Focus group results showed (a) low levels of knowledge about clinical trials, (b) uncertainty about why a physician would expect a patient to make a choice about treatment, and (c) desire for family participation in decision making. Respondents expressed various preferences for aspects of the DVD such as showing extended family in the DVD and physician explanations about key terms. On the basis of these preferences, the authors developed a creative brief for a DVD. The content of the DVD was reviewed by Hispanic community leaders and key stakeholders. A final DVD was created, in Spanish, using Hispanic patients and physicians, which contained the information deemed important from the focus groups and stakeholder interviews. The DVD is complete with companion booklet and currently undergoing a randomized control trial.

Reconceptualizing efficacy in substance use prevention research: refusal response efficacy and drug resistance self-efficacy in adolescent substance use

The purpose of this study is to utilize the Extended Parallel Process Model (EPPM) to expand the construct of efficacy in the adolescent substance use context. Using survey data collected from 2,129 seventh-grade students in 39 rural schools, we examined the construct of drug refusal efficacy and demonstrated relationships among response efficacy (RE), self-efficacy (SE), and adolescent drug use. Consistent with the hypotheses, confirmatory factor analyses of a 12-item scale yielded a three-factor solution: refusal RE, alcohol-resistance self-efficacy (ASE), and marijuana-resistance self-efficacy (MSE). Refusal RE and ASE/MSE were negatively related to alcohol use and marijuana use, whereas MSE was positively associated with alcohol use. These data demonstrate that efficacy is a broader construct than typically considered in drug prevention. Prevention programs should reinforce both refusal RE and substance-specific resistance SE.

Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions

PURPOSE

Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement.

PATIENTS AND METHODS

Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey.

RESULTS

Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects.

CONCLUSION

A range of factors appears to influence patients' chemotherapy decision making, including, but not limited to, survival benefits and treatment toxicity. For older patients, balancing the risks and benefits of treatment may be made more complex by the impact of emotional motivators, greater health concerns, and conflicts between their need for understanding and their information and decision-making preferences. Through greater understanding of perceived barriers to treatment and unique motivators for treatment choice, physicians may be better able to support older patients to make informed decisions about their care.

Screening for colorectal cancer: how can we maximize uptake?

SUMMARY Screening for colorectal cancer is being introduced in a number of countries, yet uptake remains low. The rationalistic model of screening participation explains low uptake in terms of deficient knowledge and high cost. There is evidence to support this view and remedial actions produce anticipated effects up to a point. However, differential uptake among specific groups suggests that the individual decision to participate in screening is idiosyncratic, and understanding decisions requires interpretation in terms of message framing, reference points, the use of simplifying heuristics and affective or emotional reaction. As these aspects of decisions originate from fundamental personal characteristics, they may be difficult to combat. When decision determinants, such as fear and herding, are manipulated, consequences for uptake can be contradictory.