1
|
Shah I, Gawron AJ, Byrne KR, Inadomi JM. Disparities in Colorectal Cancer Screening Among Asian American Populations and Strategies to Address These Disparities. Clin Gastroenterol Hepatol 2024; 22:679-683. [PMID: 38519261 DOI: 10.1016/j.cgh.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Ishani Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew J Gawron
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kathryn R Byrne
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - John M Inadomi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
2
|
Shah I, Gawron AJ, Byrne KR, Inadomi JM. Disparities in Colorectal Cancer Screening Among Asian American Populations and Strategies to Address These Disparities. Gastroenterology 2024; 166:549-552. [PMID: 38521575 DOI: 10.1053/j.gastro.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Affiliation(s)
- Ishani Shah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew J Gawron
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kathryn R Byrne
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - John M Inadomi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
3
|
Korn AR, Walsh-Bailey C, Correa-Mendez M, DelNero P, Pilar M, Sandler B, Brownson RC, Emmons KM, Oh AY. Social determinants of health and US cancer screening interventions: A systematic review. CA Cancer J Clin 2023; 73:461-479. [PMID: 37329257 PMCID: PMC10529377 DOI: 10.3322/caac.21801] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/19/2023] Open
Abstract
There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US-based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer-reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8-18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.
Collapse
Affiliation(s)
- Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Behavioral and Policy Sciences Department, RAND Corporation, Boston, MA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Margarita Correa-Mendez
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Meagan Pilar
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - April Y. Oh
- Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| |
Collapse
|
4
|
Abdul Latip SNB, Chen SE, Im YR, Zielinska AP, Pawa N. Systematic review of randomised controlled trials on interventions aimed at promoting colorectal cancer screening amongst ethnic minorities. ETHNICITY & HEALTH 2023; 28:661-695. [PMID: 36352539 DOI: 10.1080/13557858.2022.2139815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 10/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Significant disparities exist between different ethnic groups when it comes to participation in colorectal cancer (CRC) screening programmes. A variety of interventions have been proposed to improve participation rates of ethnic minorities for CRC screening. This systematic review aims to appraise the evidence available from published randomised controlled trials (RCTs) and to identify effective interventions aimed at promoting CRC screening amongst underserved ethnic minorities. DESIGN We searched EmBASE, Medline, PsychInfo, Scopus and CINAHL for RCTs that analysed interventions to promote CRC screening in all ethnic minorities. CRC screening was measured as documented or self-reported screening rates. The protocol of this study was registered prospectively on PROSPERO with the registration number CRD42020216384. RESULTS We identified 42 relevant RCT articles, out of 1805 articles highlighted by the initial search. All except one were conducted in the US. The most frequently studied ethnic groups were African-Americans (33%), East Asians (30%), and Hispanics/Latinos (23%). In total, 7/42 (16%) RCTs had multiple arms. Interventions mainly intended to educate (52%), provide patient navigation services (21%), or provide a combination of these interventions (19%). We demonstrate that combination methods are most effective. CONCLUSION Many RCTs, mostly in the US, have trialed interventions aimed to increase CRC screening uptake amongst ethnic minorities to varying success. We conclude that using a combination of methods with patient navigation, education, and cultural tailoring is most effective at increasing CRC screening uptake amongst ethnic minorities. This highlights that multiple factors may hinder CRC screening and finding a one-size-fits-all solution that can be reliably implemented among different cultures and countries may be complex.
Collapse
Affiliation(s)
- Siti Nadiah Binte Abdul Latip
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | | | - Yu Ri Im
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Agata P Zielinska
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Pawa
- Department of Colorectal Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| |
Collapse
|
5
|
Jin SW, Song CS. Predicting adoption of colorectal cancer screening among Korean Americans using a decision tree model. ETHNICITY & HEALTH 2023; 28:358-372. [PMID: 35138199 PMCID: PMC9360189 DOI: 10.1080/13557858.2022.2035693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/25/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Colorectal cancer screening (CRCS) rates remain suboptimal among Korean Americans despite recommendations from health organizations. Little is known about the mechanism underlying their CRCS adoption within complex systems. This study aimed to examine the multi-level predictors of CRCS adoption among Korean Americans using a decision tree model. METHODS A cross-sectional survey was performed to assess CRCS adoption and multiple levels of influence - individual (i.e. CRCS self-efficacy, CRCS attitudes, risk of colorectal cancer, psychological distress, health status), interpersonal (i.e. social support, social networks, CRCS recommendations), and organizational/community (i.e. health insurance, primary doctor, primary clinic) factors. A total of 433 Korean Americans aged 50-75 in a metropolitan area in the Southeastern U.S. completed a self-report questionnaire. To determine the important variables that predict CRCS adoption, the study generated a decision tree predictive model using R statistical software. RESULTS The results indicated that CRCS self-efficacy and CRCS attitudes at the individual level and CRCS recommendations and social support at the interpersonal level differentiate adopting or not adopting CRCS. Furthermore, CRCS recommendations (n = 138, 56%, prob = 0.64) and CRCS self-efficacy (n = 51, 21%, prob = 0.88) were the most powerful predictors of CRCS adoption. CONCLUSION The findings highlight the critical roles of CRCS recommendations from healthcare providers and family/friends and patients' confidence in performing screening-related tasks in influencing CRCS adoption among Korean Americans. Practice efforts should target individual and interpersonal characteristics when developing interventions for promoting CRCS among Korean Americans, especially who are not adherent to screening guidelines.
Collapse
Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 226 McCord Hall.
Memphis, TN 38152. Tel: 901-678-2616, Fax: 901-678-2981
| | - Christina Soyoung Song
- Department of Family and Consumer Sciences, Fashion Design and
Merchandising, Illinois State University, 126A Turner Hall, Campus Box 5060,
Normal, IL 61790. Tel: 309-438-5427
| |
Collapse
|
6
|
Interventions for cancer screening among Chinese Americans: A systematic review and meta-analysis. PLoS One 2022; 17:e0265201. [PMID: 35294463 PMCID: PMC8926258 DOI: 10.1371/journal.pone.0265201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background
Cancer is the leading cause of death among Chinese Americans (CAs). Although death rates of cancers can be significantly reduced by screening cancers at an early stage, cancer screening (CS) rates are low among CAs. Interventions on CS may increase the uptake rates of CS and help to decrease the death rates of cancers in CAs.
Objectives
This study aims to summarize the intervention methods on CS among CAs and compare effects of various intervention methods on the outcomes of CS, including knowledge levels of CS, intentions to complete CS, and actual completions of CS.
Methods
A systematic review and meta-analysis design was used. Keyword searching was conducted on PubMed, Google Scholar, PsycINFO, and CINAHL. Inclusion and exclusion criteria were applied. The PEDro scale was used to evaluate the quality of the studies. Data was analyzed using Review Manager Version 5.4 software. Random effect model and subgroup analyses were conducted.
Results
The search yielded 13 eligible studies. All of the reviewed interventions were culturally tailored. Systematic review results were categorized by intervention delivery objects, intervention led, intervention contact, intervention types, and intervention focus according to group consensus. Meta-analysis results showed that the interventions on CS had a positive effect on all outcomes, including a 1.58 (95% CI, 1.17–2.14; P = 0.003), 1.78 (95% CI, 1.27–2.48; P = 0.0007), and 1.72 (95% CI, 1.22–2.42; P = 0.002) effect on knowledge of CS, intentions to complete CS, and completions of CS, respectively, compared to the control group. The subgroup analysis suggested that physician-led, individual-based, face-to-face client-focused interventions with multiple components increased CS among CAs, with the OR ranging from 1.60 (95% CI, 1.08–2.39; P = 0.02) to 3.11 (95%CI, 1.02–9.49; P = 0.05).
Discussion
Interventions on CS significantly increased CAs’ knowledge of CS, intentions to complete CS, and completions of CS. Physician-led, individual-based, face-to-face client-focused interventions with multiple components should be utilized for CAs.
Collapse
|
7
|
Kim SB, Kang M. What are the effects of colorectal cancer screening interventions among Asian Americans? A meta-analysis. ETHNICITY & HEALTH 2022; 27:297-315. [PMID: 31906697 DOI: 10.1080/13557858.2019.1711024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: Great strides have been made to conduct intervention studies aimed at increasing colorectal cancer (CRC) screening rates that are informed by sound theoretical frameworks and conducted using rigorous methodologies; however, efforts are still gaining wave to understand the efficacy of theory-based interventions among Asian American (AA) population. The purpose of this study was to report the results of a meta-analysis conducted on the effects of CRC screening interventions.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to evaluate the CRC screening interventions. Literature search was performed on October 2018, and studies published in English and conducted in the United States were eligible for inclusion if they (1) conducted interventions with aims to increase CRC screening rates among AA and (2) utilized a randomized control trial or quasi-experimental study design, (3) reported quantitative screening rates following the intervention, and (4) included a comparison or control group for comparison. No publication year restriction was applied.Result: In total, 14 Odds Ratio (OR) from 16 studies were included in the meta-analysis. Overall, results indicated that AA participants who received the screening interventions aimed at improving screening were 1.78 times more likely to obtain a CRC screening at post-intervention compared to those in the control or comparison group, OR = 1.78 (1.44, 2.11).Conclusion: Understanding the efficacy of interventions designed to promote CRC screening among AA population is imperative to decrease CRC burden and mortality. Although research in this area is limited, this review sheds light on important socio-cultural strategies to developing a CRC screening intervention aimed at increasing screening rates among AA. Findings in this review demonstrate that improvement in screening can be achieved through a variety of ways, but the common feature across all the studies was the culturally responsive foundation of their respective interventions.
Collapse
Affiliation(s)
- Sophia B Kim
- Myron B. Thompson School of Social Work, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Minji Kang
- Center for Gendered Innovations in Science and Technology Researches (GISTeR), Korea Federation of Women's Science & Technology Associations, Seoul, Republic of Korea
| |
Collapse
|
8
|
Manne SL, Islam N, Frederick S, Khan U, Gaur S, Khan A. Culturally-adapted behavioral intervention to improve colorectal cancer screening uptake among foreign-born South Asians in New Jersey: the Desi Sehat trial. ETHNICITY & HEALTH 2021; 26:554-570. [PMID: 30394106 PMCID: PMC6500482 DOI: 10.1080/13557858.2018.1539219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Colorectal cancer (CRC) is the third most common cancer among Americans of South Asian (SA) descent and is a significant public health concern in SA communities. Rates of screening compliance among foreign-born SAs are very low. The goal of this study was to report on the development, acceptability, and preliminary impact of a culturally-targeted 1:1 intervention delivered in English, Hindi, and Urdu, called Desi-Sehat.Design: Ninety-three foreign-born SAs between the ages of 50 and 75 were recruited using community-based organization methods. Participants completed a baseline survey, participated in a 1:1 session with a community health educator, and a follow-up survey was administered four months after the baseline.Results: The acceptance rate was moderate (52.8%). Attendance at the intervention session was high. More than half of the population did not complete the follow-up survey (58.7%). Participant evaluations of the intervention were high. Intent-to-treat analyses indicate a 30% four month follow-up CRC screening uptake. There were significant increases in knowledge and significant reductions in perceived barriers to screening, worry about CRC screening tests, and worry about CRC. Effect sizes for significant changes were in the medium to large range.Conclusions: Desi Sehat was a well-evaluated and participation in the session was high, participant knowledge significantly increased, and screening barriers, worry about CRC, and worry about CRC screening tests declined significantly. Future studies should focus on enhancing recruitment and retention and include a randomized control design.
Collapse
Affiliation(s)
| | - Nadia Islam
- New York University School of Medicine, New York, NY,
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| | - Usman Khan
- Rutgers Robert Wood Johnson Medical School,
| | | | - Anam Khan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ,
| |
Collapse
|
9
|
Rogers EA, Chanthanouvong S, Saengsudham C, Tran V, Anderson L, Zhang L, Lee HY. Factors Associated with Reported Colorectal Cancer Screening Among Lao-American Immigrants in Minnesota. J Immigr Minor Health 2019; 22:375-382. [PMID: 31098763 DOI: 10.1007/s10903-019-00899-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Colorectal Cancer (CRC) is common in Lao Americans, but screening is suboptimal. To investigate CRC screening rates of Lao Americans in Minnesota, and how predisposing characteristics, enabling resources, and perceived need are associated with screening. We conducted a convenience-sample cross-sectional survey of 50-75-year-old Lao Americans, using step-wise multivariate logistic regression to identify factors associated with ever being screened. Of the 118 survey participants, 45% ever received CRC screening. In univariate regression, some enabling resources (having a primary care provider, higher self-efficacy in pursuing screening) and perceived needs (knowledge of who should be screened, higher number of chronic illnesses) were associated with screening. In multivariate logistic regression, the odds of ever being screened was 12.4 times higher for those with a primary care provider than for those without (p = 0.045). The findings reinforce a need for developing culturally tailored interventions focused on Lao-American immigrants to promote CRC screening.
Collapse
Affiliation(s)
- Elizabeth A Rogers
- Department of Medicine, UMN Applied Clinical Research Program, University of Minnesota, 717 Delaware St. SE, Ste 166, Minneapolis, MN, 55414, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | | | | | - Vilamone Tran
- Lao Assistance Center of Minnesota, Minneapolis, MN, USA
| | - Layne Anderson
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Lei Zhang
- Clinical and Translational Science Institute Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - Hee Yun Lee
- School of Social Work, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
10
|
Wu CS, Warmoth KM, Cheung B, Loh A, Young L, Lu Q. Successful Strategies for Engaging Chinese Breast Cancer Survivors in a Randomized Controlled Trial. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2019; 5:51-61. [PMID: 30923730 DOI: 10.1037/tps0000171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chinese immigrant breast cancer survivors face various challenges due to cultural and socioecological factors. Research efforts to develop culturally sensitive interventions have been limited by lack of knowledge regarding successful recruitment and implementation practices among Chinese immigrant populations. This paper documents strategies utilized during the development and implementation of a randomized controlled trial of a culturally sensitive psychosocial intervention for Chinese immigrant breast cancer survivors. In partnership with a community agency, we developed culturally and linguistically appropriate research materials, recruited participants from community channels, and conducted longitudinal data collection. Key strategies include building equitable research partnerships with community agencies to engage participants; being responsive to the needs of community agencies and participants; considering within-group diversity of the research population; utilizing recruitment as an opportunity for relationship-building with participants; and developing key strategies to promote retention. Successful participant engagement in cancer intervention research is the result of collaboration among breast cancer survivors, community leaders and agencies, and academic researchers. The engagement process for this study is novel because we have emphasized cultural factors in the process and taken a relational approach to recruitment and retention.
Collapse
Affiliation(s)
- Christine S Wu
- Department of Psychology, University of Houston; Houston, Texas
| | | | - Bernice Cheung
- Department of Psychology, University of Houston; Houston, Texas
| | - Alice Loh
- Herald Cancer Association; San Gabriel, California
| | - Lucy Young
- Herald Cancer Association; San Gabriel, California
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Psychology, University of Houston; Houston, Texas
| |
Collapse
|
11
|
Bellhouse S, McWilliams L, Firth J, Yorke J, French DP. Are community-based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta-analysis. Psychooncology 2017; 27:1089-1099. [DOI: 10.1002/pon.4575] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Sarah Bellhouse
- Christie Patient Centred Research Group, School of Oncology; The Christie NHS Foundation Trust; UK
| | - Lorna McWilliams
- Christie Patient Centred Research Group, School of Oncology; The Christie NHS Foundation Trust; UK
| | - Joseph Firth
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; UK
- NICM, School of Science and Health; University of Western Sydney; Australia
| | - Janelle Yorke
- Christie Patient Centred Research Group, School of Oncology; The Christie NHS Foundation Trust; UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences; University of Manchester; UK
| | - David P. French
- Manchester Centre for Health Psychology, School of Health Sciences; University of Manchester; UK
| |
Collapse
|
12
|
Huerta EE, Weeks-Coulthurst P, Williams C, Swain SM. Take care of your neighborhood. Breast Cancer Res Treat 2017; 167:225-234. [PMID: 28900788 DOI: 10.1007/s10549-017-4492-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 09/29/2022]
Abstract
PURPOSE Urban women in certain Washington, DC neighborhoods present with advanced breast cancer at high rates despite access to health insurance and health care. METHODS Through a two-phase intervention, community health workers (CHWs) educated and surveyed individuals regarding healthcare utilization and breast health and cancer awareness. In phase I, CHWs educated and administered a survey to 1092 women, of whom 95.1% had health insurance, in an attempt to explain the high rate of advanced breast cancer despite having health insurance. In phase II, a targeted CHW-administered intervention was designed based on data collected from the phase I survey, and provided to 658 women. Preintervention and postintervention surveys were administered to assess its impact on knowledge and beliefs about breast health and cancer screening. RESULTS During phase I, respondents most often identified personal factors (28.7%) and fear (27.7%) to explain the high rate of advanced breast cancer despite health insurance status. In phase II, the intervention improved perceptions of the safety and efficacy of mammograms with an absolute 15.4% increase in the respondents who believed that "A mammogram is the safest and most effective test available for finding early breast cancer." Perceived barriers discouraging mammograms were access (17.0%), pain (13.2%), and education (13.1%). CONCLUSIONS Among an urban population of predominantly insured women with high rates of advanced breast cancer at diagnosis, personal factors and fear were cited as the greatest barriers to breast cancer screening. Educational intervention by CHWs showed a positive impact on respondents' perceptions regarding mammogram safety and efficacy.
Collapse
Affiliation(s)
- Elmer E Huerta
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.
| | - Patricia Weeks-Coulthurst
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Courtney Williams
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA
| | - Sandra M Swain
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3800 Reservoir Road NW, Washington, DC, 20057, USA
| |
Collapse
|
13
|
Jo AM, Nguyen TT, Stewart S, Sung MJ, Gildengorin G, Tsoh JY, Tong EK, Lo P, Cuaresma C, Sy A, Lam H, Wong C, Jeong M, Chen MS, Kagawa-Singer M. Lay health educators and print materials for the promotion of colorectal cancer screening among Korean Americans: A randomized comparative effectiveness study. Cancer 2017; 123:2705-2715. [PMID: 28440872 DOI: 10.1002/cncr.30568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/05/2016] [Accepted: 12/13/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Korean American men and women. Although CRC screening is effective in reducing the burden of this disease, studies have shown that Korean Americans have low screening rates. METHODS The authors conducted a 2-arm cluster randomized controlled trial comparing a brochure (print) with a brochure and lay health educator (LHE) outreach (print + LHE) in increasing CRC screening rates among Korean American individuals. Self-administered written surveys at baseline and at 6 months assessed knowledge of CRC and its screening, ever screening, and being up to date with screening. RESULTS A total of 28 LHEs recruited 348 participants aged 50 to 75 years from their social networks. Significant percentages of participants reported not having health insurance (29.3%) or a usual source of care (35.6%). At 6 months postintervention, the print + LHE participants had a greater increase in knowledge compared with those in the print arm (P = .0013). In multivariable analyses, both groups had significant increases in ever screening (print plus LHE: odds ratio [OR], 1.60 [95% confidence interval (95% CI), 1.26-2.03] and print: OR, 1.42 [95% CI, 1.10-1.82]) and being up to date with screening (print plus LHE: OR, 1.63 [95% CI, 1.23-2.16] and print: OR, 1.40 [95% CI, 1.04-1.89]). However, these increases did not differ significantly between the study arms. Having insurance and having seen a provider within the past year were found to be positively associated with screening. CONCLUSIONS Compared with a brochure, LHE outreach yielded greater increases in knowledge but resulted in similar increases in CRC screening in a Korean American population with barriers to health care access. More work is needed to appropriately address logistical and system barriers in this community. Cancer 2017;123:2705-15. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Angela M Jo
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California
| | - Tung T Nguyen
- Department of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Susan Stewart
- Department of Public Health Sciences, University of California at Davis, Davis, California
| | - Min J Sung
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California
| | - Ginny Gildengorin
- Department of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California at San Francisco, San Francisco, California
| | - Elisa K Tong
- Department of Internal Medicine, University of California at Davis, Davis, California
| | - Penny Lo
- Hmong Women's Heritage Association, Sacramento, California
| | - Charlene Cuaresma
- Department of Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Angela Sy
- Department of Public Health, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Hy Lam
- Department of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Ching Wong
- Department of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Matthew Jeong
- Department of General Internal Medicine, University of California at San Francisco, San Francisco, California
| | - Moon S Chen
- Department of Internal Medicine, University of California at Davis, Davis, California
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
14
|
Trinh QD, Li H, Meyer CP, Hanske J, Choueiri TK, Reznor G, Lipsitz SR, Kibel AS, Han PK, Nguyen PL, Menon M, Sammon JD. Determinants of cancer screening in Asian-Americans. Cancer Causes Control 2016; 27:989-98. [PMID: 27372292 DOI: 10.1007/s10552-016-0776-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/10/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening. METHODS Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015. RESULTS Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs. CONCLUSIONS AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.
Collapse
Affiliation(s)
- Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA.
| | - Hanhan Li
- Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
| | - Christian P Meyer
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Julian Hanske
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Gally Reznor
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Stuart R Lipsitz
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Adam S Kibel
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Scarborough, ME, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
| | - Jesse D Sammon
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA, 02115, USA.,Vattikuti Urology Institute Center for Outcomes Research, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
15
|
Focella ES, Shaffer VA, Dannecker EA, Clark MJ, Schopp LH. Racial/Ethnic Differences in the Use of Primary Care Providers and Preventive Health Services at a Midwestern University. J Racial Ethn Health Disparities 2016; 3:309-19. [PMID: 27271072 DOI: 10.1007/s40615-015-0148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 11/24/2022]
Abstract
Many universities seek to improve the health and wellbeing of their faculty and staff through employer wellness programs but racial/ethnic disparities in health care use may still persist. The purpose of this research was to identify racial/ethnic disparities in the use of preventive health services at a Midwestern university. A record review was conducted of self-reported health data from University employees, examining the use of primary care and common screening procedures collected in a Personal Health Assessment conducted by the University's wellness program. Results show that there were significant racial/ethnic differences in the use of primary care and participation in screening. Notably, Asian employees in this sample were less likely to have a primary care provider and participate in routine cancer screenings. The observed racial/ethnic differences in screening behavior were mediated by the use of primary care. Together, these data show that despite equal access to care, racial and ethnic disparities in screening persist and that having a primary care provider is an important predictor of screening behavior. Results suggest that health communications designed to increase screening among specific racial/ethnic minority groups should target primary care use.
Collapse
Affiliation(s)
- Elizabeth S Focella
- School of Health Professions, University of Missouri, Columbia, MO, 65201, USA.
| | - Victoria A Shaffer
- School of Health Professions, University of Missouri, Columbia, MO, 65201, USA
| | - Erin A Dannecker
- School of Health Professions, University of Missouri, Columbia, MO, 65201, USA
| | - Mary J Clark
- School of Health Professions, University of Missouri, Columbia, MO, 65201, USA
| | - Laura H Schopp
- School of Health Professions, University of Missouri, Columbia, MO, 65201, USA
| |
Collapse
|
16
|
Leung DYP, Chow KM, Lo SWS, So WKW, Chan CWH. Contributing Factors to Colorectal Cancer Screening among Chinese People: A Review of Quantitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050506. [PMID: 27196920 PMCID: PMC4881131 DOI: 10.3390/ijerph13050506] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/02/2016] [Accepted: 05/11/2016] [Indexed: 02/01/2023]
Abstract
Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.
Collapse
Affiliation(s)
- Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Sally W S Lo
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
| |
Collapse
|
17
|
López-Torres Hidalgo J, Rabanales Sotos J, Simarro Herráez MJ, López-Torres López J, Campos Rosa M, López Verdejo MÁ. Effectiveness of three interventions to improve participation in colorectal cancer screening. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:315-22. [PMID: 27055722 DOI: 10.17235/reed.2016.4048/2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. METHODS We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. RESULTS A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written information group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. CONCLUSIONS Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals.
Collapse
|
18
|
Sentell T, Braun KL, Davis J, Davis T. Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. SPRINGERPLUS 2015; 4:432. [PMID: 26306294 PMCID: PMC4540711 DOI: 10.1186/s40064-015-1225-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023]
Abstract
Objectives Empirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities. Methods We analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21–65 (n = 15,210) and breast: ages 50–74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors. Results Low health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities. Conclusions Self-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.
Collapse
Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i, 1960 East-West Road, Biomed, D-104, Honolulu, HI 96822 USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i, 1960 East-West Road, Biomed, D-104, Honolulu, HI 96822 USA ; 'Imi Hale Native Hawaiian Cancer Network (U54CA153459), Papa Ola Lōkahi, 894 Queen Street, Honolulu, HI 96813 USA
| | - James Davis
- Biostatistics Core, John A. Burns School of Medicine, Medical Education Building, Suite 401, 651 Ilalo Street, Honolulu, HI 96813 USA
| | - Terry Davis
- Section of General Medicine, School of Medicine, Shreveport, Louisiana State University Health Sciences Center, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932 USA
| |
Collapse
|
19
|
Berkowitz SA, Percac-Lima S, Ashburner JM, Chang Y, Zai AH, He W, Grant RW, Atlas SJ. Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management. J Gen Intern Med 2015; 30:942-9. [PMID: 25678378 PMCID: PMC4471039 DOI: 10.1007/s11606-015-3227-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 01/07/2015] [Accepted: 01/26/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Improving colorectal cancer (CRC) screening rates for patients from socioeconomically disadvantaged backgrounds is a recognized public health priority. OBJECTIVE Our aim was to determine if implementation of a system-wide screening intervention could reduce disparities in the setting of improved overall screening rates. DESIGN This was an interrupted time series (ITS) analysis before and after a population management intervention. PARTICIPANTS Patients eligible for CRC screening (age 52-75 years without prior total colectomy) in an 18-practice research network from 15 June 2009 to 15 June 2012 participated in the study. INTERVENTION The Technology for Optimizing Population Care (TopCare) intervention electronically identified patients overdue for screening and facilitated contact by letter or telephone scheduler, with or without physician involvement. Patients identified by algorithm as high risk for non-completion entered into intensive patient navigation. MAIN MEASURES Patients were dichotomized as ≤ high school diploma (≤ HS), an indicator of socioeconomic disadvantage, vs. >HS diploma (> HS). The monthly disparity between ≤ HS and > HS with regard to CRC screening completion was examined. KEY RESULTS At baseline, 72% of 47,447 eligible patients had completed screening, compared with 75% of 51,442 eligible patients at the end of follow-up (p < 0.001). CRC screening completion was lower in ≤ HS vs. >HS patients in June 2009 (65.7% vs. 74.5%, p < 0.001) and remained lower in June 2012 (69.4% vs. 76.7%, p < 0.001). In the ITS analysis, which accounts for secular trends, TopCare was associated with a significant decrease in the CRC screening disparity (0.7%, p < 0.001). The effect of TopCare represents approximately 99 additional ≤ HS patients screened above prevailing trends, or 26 life-years gained had these patients remained unscreened. CONCLUSIONS A multifaceted population management intervention sensitive to the needs of vulnerable patients modestly narrowed disparities in CRC screening, while also increasing overall screening rates. Embedding interventions for vulnerable patients within larger population management systems represents an effective approach to increasing overall quality of care while also decreasing disparities.
Collapse
Affiliation(s)
- Seth A Berkowitz
- Division of General Internal Medicine, Medical Services, Massachusetts General Hospital, Boston, MA, USA,
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Pinheiro LC, Wheeler SB, Chen RC, Mayer DK, Lyons JC, Reeve BB. The effects of cancer and racial disparities in health-related quality of life among older Americans: A case-control, population-based study. Cancer 2014; 121:1312-20. [DOI: 10.1002/cncr.29205] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/24/2014] [Accepted: 11/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Laura C. Pinheiro
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Stephanie B. Wheeler
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Ronald C. Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jessica C. Lyons
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Bryce B. Reeve
- Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| |
Collapse
|