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Owosela BO, Steinberg RS, Leslie SL, Celi LA, Purkayastha S, Shiradkar R, Newsome JM, Gichoya JW. Identifying and improving the "ground truth" of race in disparities research through improved EMR data reporting. A systematic review. Int J Med Inform 2024; 182:105303. [PMID: 38088002 DOI: 10.1016/j.ijmedinf.2023.105303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Studies about racial disparities in healthcare are increasing in quantity; however, they are subject to vast differences in definition, classification, and utilization of race/ethnicity data. Improved standardization of this information can strengthen conclusions drawn from studies using such data. The objective of this study is to examine how data related to race/ethnicity are recorded in research through examining articles on race/ethnicity health disparities and examine problems and solutions in data reporting that may impact overall data quality. METHODS In this systematic review, Business Source Complete, Embase.com, IEEE Xplore, PubMed, Scopus and Web of Science Core Collection were searched for relevant articles published from 2000 to 2020. Search terms related to the concepts of electronic medical records, race/ethnicity, and data entry related to race/ethnicity were used. Exclusion criteria included articles not in the English language and those describing pediatric populations. Data were extracted from published articles. This review was organized and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews. FINDINGS In this systematic review, 109 full text articles were reviewed. Weaknesses and possible solutions have been discussed in current literature, with the predominant problem and solution as follows: the electronic medical record (EMR) is vulnerable to inaccuracies and incompleteness in the methods that research staff collect this data; however, improved standardization of the collection and use of race data in patient care may help alleviate these inaccuracies. INTERPRETATION Conclusions drawn from large datasets concerning peoples of certain race/ethnic groups should be made cautiously, and a careful review of the methodology of each publication should be considered prior to implementation in patient care.
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Affiliation(s)
- Babajide O Owosela
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Rebecca S Steinberg
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Sharon L Leslie
- Emory University, Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Leo A Celi
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Saptarshi Purkayastha
- Indiana University-Purdue University Indianapolis, Department of BioHealth Informatics, Indianapolis, IN, USA
| | - Rakesh Shiradkar
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Janice M Newsome
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA
| | - Judy W Gichoya
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA.
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Frierson GM, Pinto BM, Denman DC, Leon PA, Jaffe AD. Bridging the Gap: Racial concordance as a strategy to increase African American participation in breast cancer research. J Health Psychol 2017; 24:1548-1561. [DOI: 10.1177/1359105317740736] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lack of African American females in breast cancer research has been receiving substantial attention. This study seeks to identify research perceptions and motivating factors needed to increase racial/ethnic minority participation in breast cancer research. A total of 57 African American women (Σ = 47.8 years), from Rhode Island and Texas, completed a questionnaire and focus group. While many participants were not breast cancer survivors, they reported knowledge of their racial group’s risk for breast cancer. One major finding that could be seen as both a facilitator and barrier is racial concordance between participant and researcher. Cultural sensitivity and trust building is recommended to increase minority participation.
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Marmarà D, Marmarà V, Hubbard G. Health beliefs, illness perceptions and determinants of breast screening uptake in Malta: a cross-sectional survey. BMC Public Health 2017; 17:416. [PMID: 28482828 PMCID: PMC5422914 DOI: 10.1186/s12889-017-4324-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/27/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Women's beliefs and representations of breast cancer (BC) and breast screening (BS) are salient predictors for BS practices. This study utilized the health belief model (HBM) and common-sense model (CSM) of illness self-regulation to explore factors associated with BS uptake in Malta and subsequently, to identify the most important predictors to first screening uptake. METHODS This cross-sectional survey enrolled Maltese women (n = 404) ages 50 to 60 at the time of their first screening invitation, invited to the National Breast Screening Programme by stratified random sampling, with no personal history of BC. Participants responded to a 121-item questionnaire by telephone between June-September 2015. Data were analyzed using descriptive statistics, chi-square tests and logistic regression. RESULTS There is high awareness of BC signs and symptoms among Maltese women (>80% agreement for 7 out of 8 signs), but wide variation about causation (e.g., germ or virus: 38.6% 'agree', 30.7% 'disagree'). 'Fear' was the key reason for non-attendance to first invitation (41%, n = 66) and was statistically significant across all subscale items (p < 0.05). Most items within HBM constructs (perceived barriers; cues to action; self-efficacy) were significantly associated with first invitation to the National Breast Screening Programme, such as fear of result (χ2 = 12.0, p = 0.017) and life problems were considered greater than getting mammography (χ2 = 38.8, p = 0.000). Items within CSM constructs of Illness Representation (BC causes; cyclical cancer timeline; consequences) were also significantly associated, such as BC was considered to be life-changing (χ2 = 18.0, p = 0.000) with serious financial consequences (χ2 = 13.3, p = 0.004). There were no significant associations for socio-demographic or health status variables with uptake, except for family income (χ2 = 9.7, p = 0.047). Logistic regression analyses showed that HBM constructs, in particular perceived barriers, were the strongest predictors of non-attendance to first invitation throughout the analyses (p < 0.05). However, the inclusion of illness representation dimensions improved the model accuracy to predict non-attendance when compared to HBM alone (65% vs 38.8%). CONCLUSIONS Interventions should be based on theory including HBM and CSM constructs, and should target first BS uptake and specific barriers to reduce disparities and increase BS uptake in Malta.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland, UK.
- Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Street, Msida, MSD, 2090, Malta.
| | - Vincent Marmarà
- Department of Mathematics, University of Stirling, Stirling, FK94LA, Scotland, UK
- Department of Management, University of Malta, Msida, Malta
| | - Gill Hubbard
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland, UK
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Bodewes AJ, Kunst AE. Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands. BMC Res Notes 2016; 9:319. [PMID: 27328767 PMCID: PMC4915185 DOI: 10.1186/s13104-016-2124-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands. Methods We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis. Results The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies. Conclusions The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.
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Affiliation(s)
- Adee J Bodewes
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Leak C, Goggins K, Schildcrout JS, Theobald C, Donato KM, Bell SP, Schnelle J, Kripalani S. Effect of Health Literacy on Research Follow-Up. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:83-91. [PMID: 26513035 PMCID: PMC4706551 DOI: 10.1080/10810730.2015.1058442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous research has not examined the effect of health literacy on research subjects' completion of scheduled research follow-up. This article evaluates patient factors associated with incomplete research follow-up at three time points after enrollment in a large, hospital-based prospective cohort study. Predictor variables included health literacy, age, race, gender, education, employment status, difficulty paying bills, hospital diagnosis, length of stay, self-reported global health status, depression, perceived health competence, medication adherence, and health care system distrust. In a sample of 2,042 patients, multivariable models demonstrated that lower health literacy and younger age were significantly associated with a lower likelihood of completing research follow-up interviews at 2-3 days, 30 days, and 90 days after hospital discharge. In addition, patients who had less education, were currently employed, and had moderate financial stress were less likely to complete 90-day follow-up. This study is the first to demonstrate that lower health literacy is a significant predictor of incomplete research follow-up.
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Affiliation(s)
- Cardella Leak
- Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
| | - Jonathan S. Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center
- Department of Anesthesiology, Vanderbilt University Medical Center
| | - Cecelia Theobald
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | | | - Susan P. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
| | - John Schnelle
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center
- Center for Effective Health Communication, Vanderbilt University Medical Center
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center
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Ulrich A, Thompson B, Livaudais JC, Espinoza N, Cordova A, Coronado GD. Issues in biomedical research: what do Hispanics think? Am J Health Behav 2013; 37:80-5. [PMID: 22943104 DOI: 10.5993/ajhb.37.1.9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine barriers and facilitators of biomedical research participation among Hispanics in a rural community in Washington State. METHODS Questionnaires addressed socio-demographics, health care access, and barriers and facilitators of participation in biomedical studies. This is a descriptive analysis of the findings. RESULTS Barriers include the need to care for family members (82%), fear of having to pay for research treatments (74%), cultural beliefs (65%), lack of time (75%) and trust (71%), and the degree of hassle (73%). Facilitators include having a friend/relative with the disease being researched (80%) and monetary compensation (73%). CONCLUSION Researchers should be mindful of these facilitators and barriers when recruiting for biomedical research studies.
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Affiliation(s)
- Angela Ulrich
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Riden HE, Grooms KN, Clark CR, Cohen LR, Gagne J, Tovar DA, Ommerborn MJ, Orton PS, Johnson PA. Lessons learned obtaining informed consent in research with vulnerable populations in community health center settings. BMC Res Notes 2012; 5:624. [PMID: 23134938 PMCID: PMC3532200 DOI: 10.1186/1756-0500-5-624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve equity in access to medical research, successful strategies are needed to recruit diverse populations. Here, we examine experiences of community health center (CHC) staff who guided an informed consent process to overcome recruitment barriers in a medical record review study. METHODS We conducted ten semi-structured interviews with CHC staff members. Interviews were audiotaped, transcribed, and structurally and thematically coded. We used NVivo, an ethnographic data management software program, to analyze themes related to recruitment challenges. RESULTS CHC interviewees reported that a key challenge to recruitment included the difficult balance between institutional review board (IRB) requirements for informed consent, and conveying an appropriate level of risk to patients. CHC staff perceived that the requirements of IRB certification itself posed a barrier to allowing diverse staff to participate in recruitment efforts. A key barrier to recruitment also included the lack of updated contact information on CHC patients. CHC interviewees reported that the successes they experienced reflected an alignment between study aims and CHC goals, and trusted relationships between CHCs and staff and the patients they recruited. CONCLUSIONS Making IRB training more accessible to CHC-based staff, improving consent form clarity for participants, and developing processes for routinely updating patient information would greatly lower recruitment barriers for diverse populations in health services research.
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Affiliation(s)
- Heather E Riden
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
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Barnett J, Aguilar S, Brittner M, Bonuck K. Recruiting and retaining low-income, multi-ethnic women into randomized controlled trials: successful strategies and staffing. Contemp Clin Trials 2012; 33:925-32. [PMID: 22732312 DOI: 10.1016/j.cct.2012.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/16/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
Developing effective recruitment and retention strategies in populations with traditionally high attrition rates is critical to the success of Randomized Controlled Trials (RCTs). Data on successful participation of women from low-income, minority populations in RCTs of behavioral interventions are limited. This is problematic given the multiplicity of Healthy People 2020 goals that target health disparities in these populations. This paper reports successful recruitment and retention methods from two separately funded NIH clinical trials of primary care-based prenatal interventions to increase breastfeeding among ethnically diverse, low-income women in urban medical centers in the Bronx, NY. It also presents the required staff effort necessary to conduct such a successful RCT, in terms of full-time equivalents (FTEs). Results include timely recruitment of 941 participants over 29 months, with 98.1% completing >¯¯1 follow-up interview. A recruitment and retention plan that maximized study staff access and availability to the participant, as well as strong study staff rapport with participants, addressed previously reported barriers in this population, optimizing follow-up rates. A qualitative assessment of the participants' study experience suggesting that high retention was due to strong rapport with participants, short interviews requiring little time commitment, and participants' perception of the study as informative, provides further evidence of our approach's effectiveness. Logistical protocol procedures and staff management strategies relating to successful recruitment/retention are provided to propose a practical, cost-effective and translational recruitment-retention plan for other researchers to adopt.
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Affiliation(s)
- Josephine Barnett
- Albert Einstein College of Medicine, Department of Family and Social Medicine, Bronx, NY, USA.
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9
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Fair AM, Wujcik D, Lin JMS, Grau A, Wilson V, Champion V, Zheng W, Egan KM. Obesity, gynecological factors, and abnormal mammography follow-up in minority and medically underserved women. J Womens Health (Larchmt) 2012; 18:1033-9. [PMID: 19558307 DOI: 10.1089/jwh.2008.0791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The relationship between obesity and screening mammography adherence has been examined previously, yet few studies have investigated obesity as a potential mediator of timely follow-up of abnormal (Breast Imaging Reporting and Data System [BIRADS-0]) mammography results in minority and medically underserved patients. METHODS We conducted a retrospective cohort study of 35 women who did not return for follow-up >6 months from index abnormal mammography and 41 who returned for follow-up < or =6 months in Nashville, Tennessee. Patients with a BIRADS-0 mammography event in 2003-2004 were identified by chart review. Breast cancer risk factors were collected by telephone interview. Multivariate logistic regression was performed on selected factors with return for diagnostic follow-up. RESULTS Obesity and gynecological history were significant predictors of abnormal mammography resolution. A significantly higher frequency of obese women delayed return for mammography resolution compared with nonobese women (64.7% vs. 35.3%). A greater number of hysterectomized women returned for diagnostic follow-up compared with their counterparts without a hysterectomy (77.8% vs. 22.2%). Obese patients were more likely to delay follow-up >6 months (adjusted OR 4.09, p = 0.02). Conversely, hysterectomized women were significantly more likely to return for timely mammography follow-up < or =6 months (adjusted OR 7.95, p = 0.007). CONCLUSIONS Study results suggest that weight status and gynecological history influence patients' decisions to participate in mammography follow-up studies. Strategies are necessary to reduce weight-related barriers to mammography follow-up in the healthcare system including provider training related to mammography screening of obese women.
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Affiliation(s)
- Alecia Malin Fair
- Department of Surgery, Meharry Medical College, Nashville, Tennessee 37208, USA.
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10
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Applebaum AJ, Lichtenthal WG, Pessin HA, Radomski JN, Simay Gökbayrak N, Katz AM, Rosenfeld B, Breitbart W. Factors associated with attrition from a randomized controlled trial of meaning-centered group psychotherapy for patients with advanced cancer. Psychooncology 2011; 21:1195-204. [PMID: 21751295 DOI: 10.1002/pon.2013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The generalizability of palliative care intervention research is often limited by high rates of study attrition. This study examined factors associated with attrition from a randomized controlled trial comparing meaning-centered group psychotherapy (MCGP), an intervention designed to help advanced cancer patients sustain or enhance their sense of meaning to the supportive group psychotherapy (SGP), a standardized support group. METHODS Patients with advanced solid tumor cancers (n = 153) were randomized to eight sessions of either the MCGP or SGP. They completed assessments of psychosocial, spiritual, and physical well-being pretreatment, midtreatment, and 2 months post-treatment. Attrition was assessed in terms of the percent of participants who failed to complete these assessments, and demographic, psychiatric, medical, and study-related correlates of attrition were examined for the participants in each of these categories. RESULTS The rates of attrition at these time points were 28.1%, 17.7%, and 11.1%, respectively; 43.1% of the participants (66 of 153) completed the entire study. The most common reason for dropout was patients feeling too ill. Attrition rates did not vary significantly between study arms. The participants who dropped out pretreatment reported less financial concerns than post-treatment dropouts, and the participants who dropped out of the study midtreatment had poorer physical health than treatment completers. There were no other significant associations between attrition and any demographic, medical, psychiatric, or study-related variables. CONCLUSIONS These findings highlight the challenge of maintaining advanced cancer patients in longitudinal research and suggest the need to consider alternative approaches (e.g., telemedicine) for patients who might benefit from group interventions but are too ill to travel.
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Sikorskii A, Wyatt GK, Siddiqi AEA, Tamkus D. Recruitment and early retention of women with advanced breast cancer in a complementary and alternative medicine trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:734517. [PMID: 19620179 PMCID: PMC3137428 DOI: 10.1093/ecam/nep051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 05/07/2009] [Indexed: 12/25/2022]
Abstract
More than 80% of women with breast cancer are now reported to be using complementary and alternative medicine (CAM) therapies during conventional treatment. A randomized clinical trial (RCT) of reflexology with late stage breast cancer patients serves as the data source for this article. The purposes were to investigate: (i) reasons for refusal to participate in a RCT of reflexology; (ii) the differences between those who completed the baseline interview and those who dropped out before baseline; and (iii) the utility of the Palliative Prognostic Score (PPS) as a prognostic screening tool in minimizing early attrition (before baseline) from the trial. Eligible women (N = 400) approached at 12 cancer centers in the Midwest had advanced breast cancer, were on chemotherapy or hormonal therapy, and had a PPS of 11 or less. Comparisons of those who dropped out early (N = 33) to those who stayed in the trial (N = 240) were carried out using Wilcoxon rank, t-, chi-squared and Fisher's exact tests. The reasons of being "too sick" or "overwhelmed" were given by less than 12% of the women who refused to participate. There was a higher early dropout rate among black women compared to other (primarily white) women (P = .01). Cancer recurrence and metastasis, age, and the PPS were not predictive of early retention of women. Specialized techniques may be needed to ensure black women remain in the trial once consented. Women with advanced disease were likely to enter and remain in the trial despite deterioration in health.
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Affiliation(s)
- Alla Sikorskii
- Department of Statistics and Probability, College of Natural Science, Michigan State University, East Lansing, MI 48824, USA
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Pal T, Rocchio E, Garcia A, Rivers D, Vadaparampil S. Recruitment of Black Women for a Study of Inherited Breast Cancer Using a Cancer Registry–Based Approach. Genet Test Mol Biomarkers 2011; 15:69-77. [DOI: 10.1089/gtmb.2010.0098] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Tuya Pal
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Epidemiology and Cancer Genetics, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida
| | - Erin Rocchio
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Ana Garcia
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
| | - Desiree Rivers
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Susan Vadaparampil
- Division of Population Sciences, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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Fair AM, Wujcik D, Lin JMS, Zheng W, Egan KM, Grau AM, Champion VL, Wallston KA. Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women. J Health Care Poor Underserved 2010; 21:71-94. [PMID: 20173286 DOI: 10.1353/hpu.0.0264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.
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Affiliation(s)
- Alecia Malin Fair
- Department of Surgery, Meharry Medical College, Nashville, TN 37208, USA.
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Wujcik D, Wolff SN. Recruitment of African Americans to National Oncology Clinical Trials through a clinical trial shared resource. J Health Care Poor Underserved 2010; 21:38-50. [PMID: 20173284 DOI: 10.1353/hpu.0.0251] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 2000, using National Institutes of Health/National Cancer Institute (NIH/NCI) U54 funds, a clinical trials shared resource was established at Nashville General Hospital at Meharry to attract more African Americans to national cancer clinical trials. This Report from the Field describes the model used to achieve this end.
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Affiliation(s)
- Debra Wujcik
- Meharry Medical College, Nashville, TN 37208, USA
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Hamilton AS, Hofer TP, Hawley ST, Morrell D, Leventhal M, Deapen D, Salem B, Katz SJ. Latinas and breast cancer outcomes: population-based sampling, ethnic identity, and acculturation assessment. Cancer Epidemiol Biomarkers Prev 2009; 18:2022-9. [PMID: 19549806 DOI: 10.1158/1055-9965.epi-09-0238] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Latinas and African-Americans with breast cancer, especially those of lower socioeconomic status and acculturation, have been underrepresented in studies assessing treatment satisfaction, decision-making, and quality of life. A study was designed to recruit a large and representative sample of these subgroups. MATERIALS AND METHODS Incident cases were selected by rapid case ascertainment (RCA) in the Los Angeles Surveillance, Epidemiology, and End Results Registry from 2005 to 2006, with oversampling of Latinas and African-Americans. Patients were mailed a questionnaire and $10 incentive 5 to 6 months after diagnosis; nonrespondents were contacted by telephone. Multivariate analysis was used to assess possible response bias. The RCA definition of Hispanic origin was validated by self-reports. The Short Acculturation Scale for Hispanics index for Latina respondents was used. RESULTS One thousand six hundred and ninety-eight eligible breast cancer cases were selected and 1,223 participated, for a response rate of 72.0%, which varied little by race/ethnicity. Age, race/ethnicity, and clinical factors were not associated with response; however, respondents were slightly more likely to be married and from higher socioeconomic status census tracts than nonrespondents. The RCA definition of Hispanic identity was highly sensitive (94.6%) and specific (90.0%). Lower acculturation was associated with lower education and literacy among Latinas. DISCUSSION High response rates among all subgroups were achieved due to the use of RCA, an incentive, extensive telephone follow-up, a native Spanish-speaking interviewer, and a focused questionnaire. The low acculturation index category identified a highly vulnerable subgroup. This large sample representing subgroups with greater problems will provide a basis for developing better interventions to assist these women.
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Affiliation(s)
- Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90089-9175, USA.
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