1
|
Resnick D, Schapira MM, Smith JM, Bautista A, Xu C, Jones L, Aysola J. Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App. JMIR Form Res 2021; 5:e22510. [PMID: 34259162 PMCID: PMC8319782 DOI: 10.2196/22510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/12/2020] [Accepted: 05/07/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. OBJECTIVE This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. METHODS In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app's acceptability by qualitatively analyzing open-ended responses regarding participants' overall experience with the app. We assessed participants' engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. RESULTS The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app's ease of use and health behavior-promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. CONCLUSIONS The implementation of a mobile cancer prevention goal-setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients.
Collapse
Affiliation(s)
- Daniel Resnick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Marilyn M Schapira
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- The Center for Health Equity Research and Promotion, Michael J Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Jazmine M Smith
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA, United States
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Allison Bautista
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA, United States
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Chang Xu
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA, United States
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Liz Jones
- Transmogrify, Conshohocken, PA, United States
| | - Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
2
|
Anderson EE, Tejeda S, Childers K, Stolley MR, Warnecke RB, Hoskins KF. Breast Cancer Risk Assessment Among Low-Income Women of Color in Primary Care: A Pilot Study. J Oncol Pract 2015; 11:e460-7. [PMID: 26036266 PMCID: PMC4507393 DOI: 10.1200/jop.2014.003558] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The US Preventive Services Task Force recommends identifying candidates for breast cancer (BC) chemoprevention and referring them for genetic counseling as part of routine care. Little is known about the feasibility of implementing these recommendations or how low-income women of color might respond to individualized risk assessment (IRA) performed by primary care providers (PCPs). METHODS Women recruited from a federally qualified health center were given the option to discuss BC risk status with their PCP. Comprehensive IRA was performed using a software tool designed for the primary care environment combining three assessment instruments and providing risk-adapted recommendations for screening, prevention, and genetic referral. Logistic regression models assessed factors associated with wanting to learn and discuss BC risk with PCP. RESULTS Of 237 participants, only 12.7% (n = 30) did not want to discuss IRA results with their PCP. Factors associated with lower odds of wanting to learn results included having private insurance and reporting ever having had a mammogram. Factors associated with higher odds of wanting to learn results included older age (50 to 69 years) and increased BC worry. For all women wishing to learn results, IRA was successfully completed and delivered to the PCP immediately before the encounter for incorporation into the well-visit evaluation. CONCLUSION Incorporation of US Preventive Services Task Force recommendations as part of routine primary care is feasible. Interest in IRA seems high among underserved women. This approach warrants further investigation as a strategy for addressing disparities in BC mortality.
Collapse
Affiliation(s)
- Emily E Anderson
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Silvia Tejeda
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Kimberly Childers
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Melinda R Stolley
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Richard B Warnecke
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| | - Kent F Hoskins
- Neiswanger Institute for Bioethics, Loyola University Chicago Stritch School of Medicine, Maywood; College of Medicine, University of Illinois at Chicago; Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL; Medical College of Wisconsin, Milwaukee, WI; and Disney Family Center at Providence St Joseph Medical Center, Burbank, CA
| |
Collapse
|
3
|
Price-Haywood EG, Harden-Barrios J, Cooper LA. Comparative effectiveness of audit-feedback versus additional physician communication training to improve cancer screening for patients with limited health literacy. J Gen Intern Med 2014; 29:1113-21. [PMID: 24590734 PMCID: PMC4099465 DOI: 10.1007/s11606-014-2782-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/05/2013] [Accepted: 12/27/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND We designed a continuing medical education (CME) program to teach primary care physicians (PCP) how to engage in cancer risk communication and shared decision making with patients who have limited health literacy (HL). OBJECTIVE We evaluated whether training PCPs, in addition to audit-feedback, improves their communication behaviors and increases cancer screening among patients with limited HL to a greater extent than only providing clinical performance feedback. DESIGN Four-year cluster randomized controlled trial. PARTICIPANTS Eighteen PCPs and 168 patients with limited HL who were overdue for colorectal/breast/cervical cancer screening. INTERVENTIONS Communication intervention PCPs received skills training that included standardized patient (SP) feedback on counseling behaviors. All PCPs underwent chart audits of patients' screening status semiannually up to 24 months and received two annual performance feedback reports. MAIN MEASURES PCPs experienced three unannounced SP encounters during which SPs rated PCP communication behaviors. We examined between-group differences in changes in SP ratings and patient knowledge of cancer screening guidelines over 12 months; and changes in patient cancer screening rates over 24 months. KEY RESULTS There were no group differences in SP ratings of physician communication at baseline. At follow-up, communication intervention PCPs were rated higher in general communication about cancer risks and shared decision making related to colorectal cancer screening compared to PCPs who only received performance feedback. Screening rates increased among patients of PCPs in both groups; however, there were no between-group differences in screening rates except for mammography. The communication intervention did not improve patient cancer screening knowledge. CONCLUSION Compared to audit and feedback alone, including PCP communication training increases PCP patient-centered counseling behaviors, but not cancer screening among patients with limited HL. Larger studies must be conducted to determine whether lack of changes in cancer screening were due to clinic/patient sample size versus ineffectiveness of communication training to change outcomes.
Collapse
Affiliation(s)
- Eboni G Price-Haywood
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, SL-16, New Orleans, LA, 70112, USA,
| | | | | |
Collapse
|
4
|
Thompson T, Seo J, Griffith J, Baxter M, James A, Kaphingst KA. "You don't have to keep everything on paper": African American women's use of family health history tools. J Community Genet 2013; 4:251-61. [PMID: 23397492 PMCID: PMC3666835 DOI: 10.1007/s12687-013-0138-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/27/2013] [Indexed: 01/30/2023] Open
Abstract
Little is known about African American women's collection of family health history (FHH) information and use of FHH tools. Most FHH research has investigated tools that use a biomedical paradigm, but other kinds of tools, such as those that include information about family social context, have been developed for use in diverse populations. Using mixed methods, we interviewed 32 African American women about behavioral steps to collecting FHH, family communication about health, and reactions to a biomedical FHH tool. Participants chose one of two FHH tools to take home. A follow-up call three weeks later assessed tool use. Many participants expressed support for writing down FHH information, but at baseline few had done so; most participants who had collected FHH information had done so verbally. Participants reacted positively to the biomedical FHH tool used during the interview, with many saying it allowed them to see patterns in their FHH. At follow-up, 67 % reported using their FHH tool, primarily to promote discussion among family members; only 32 % used the tool to write down FHH information. Although participants thought collecting FHH information was important and had positive reactions to both tools, the majority did not use the tools to write down information and instead collected FHH informally. These findings underline the importance of separating the components of FHH collection behaviors to analyze the steps used in FHH creation. Practitioners should consider additional methods of encouraging patients to create written FHHs in order to share the information with health care providers.
Collapse
Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Washington University in St. Louis, 700 Rosedale Avenue, St. Louis, MO, 63112, USA,
| | | | | | | | | | | |
Collapse
|
5
|
Anderson EE, Hoskins K. Individual breast cancer risk assessment in underserved populations: integrating empirical bioethics and health disparities research. J Health Care Poor Underserved 2013; 23:34-46. [PMID: 23124498 DOI: 10.1353/hpu.2012.0178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model.
Collapse
Affiliation(s)
- Emily E Anderson
- Neiswanger Institute for Bioethics at Loyola University Chicago, Stritch School of Medicine, Chicago, IL, USA.
| | | |
Collapse
|
6
|
Sussner KM, Jandorf L, Valdimarsdottir HB. Educational needs about cancer family history and genetic counseling for cancer risk among frontline healthcare clinicians in New York City. Genet Med 2011; 13:785-93. [PMID: 21555944 PMCID: PMC4403244 DOI: 10.1097/gim.0b013e31821afc8e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study investigated the educational needs of frontline healthcare clinicians about cancer family history and genetic counseling for cancer risk. METHODS We conducted a voluntary, anonymous survey among (1) general medicine clinicians, (2) obstetrics/gynecology clinicians, and (3) nurse practitioners at Mount Sinai School of Medicine in New York City. RESULTS A total of 143 clinicians completed the survey (response rate 81%). The majority of clinicians (77.5%) reported regularly completing family histories on cancer risk for their patients, but only 1.7% considered themselves "experts" in interpreting risk to make prevention, screening, and treatment recommendations. Numerous barriers to cancer family history collection were noted. More than half (55.8%) reported referring patients to genetic counseling, although only 14.3% reported confidence in their ability to make appropriate referrals. The majority reported that they would apply genetic counseling for cancer risk in their practice if they had the skills (84.9%). There was some variability found regarding specialty. CONCLUSION Despite widespread use of family histories for cancer risk, barriers remain to appropriate cancer risk management among frontline healthcare clinicians. Development of educational training programs to assist clinicians with collection of cancer family history information, interpretation, and appropriate referral along with teaching direct application of a modified form of genetic counseling for low-medium risk patients and referral of patients at genetic risk is warranted.
Collapse
Affiliation(s)
- Katarina M Sussner
- Department of Oncological Sciences, Cancer Prevention and Control, Mount Sinai School of Medicine, New York City, New York 10029, USA.
| | | | | |
Collapse
|
7
|
Edwards QT, Seibert D. Pre- and posttest evaluation of a breast cancer risk assessment program for nurse practitioners. ACTA ACUST UNITED AC 2011; 22:376-81. [PMID: 20590960 DOI: 10.1111/j.1745-7599.2010.00523.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Numerous studies have shown that healthcare providers, including nurse practitioners (NPs) fail to provide breast cancer risk assessment (BrCRA) in primary care settings. A potential barrier to the use of BrCRA is insufficient knowledge or training of risk assessment. The purpose of this study was to analyze the outcome of a BrCRA program developed to enhance NPs' knowledge of risk assessment and use of empiric risk assessment models. DATA SOURCES Thirty-five NPs participated in a before-after (pretest-posttest design) study evaluating the effectiveness of a BrCRA education program conducted at a national NP conference. Demographics, pre/post knowledge, and course satisfaction measures were all examined as a part of this pilot study. CONCLUSION Continuing education through the implementation of a BrCRA program significantly increased NPs knowledge in assessing breast cancer risk and the use of empiric risk assessment models. IMPLICATIONS FOR PRACTICE Many healthcare providers, including NPs, are inadequately prepared to assess a woman's risk for breast cancer. Understanding breast cancer risk assessment is essential if NPs are to provide appropriate counseling, management, and referral strategies needed to reduce a woman's risk for developing the disease. Continuing education provides one means to enhance NP's knowledge of BrCRA.
Collapse
Affiliation(s)
- Quannetta T Edwards
- Western University of Health Sciences, College of Graduate Nursing, Pomona, California 91766-1854, USA.
| | | |
Collapse
|
8
|
Vig HS, Armstrong J, Egleston BL, Mazar C, Toscano M, Bradbury AR, Daly MB, Meropol NJ. Cancer genetic risk assessment and referral patterns in primary care. Genet Test Mol Biomarkers 2010; 13:735-41. [PMID: 20001580 DOI: 10.1089/gtmb.2009.0037] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study was undertaken to describe cancer risk assessment practices among primary care providers (PCPs). METHODS An electronic survey was sent to PCPs affiliated with a single insurance carrier. Demographic and practice characteristics associated with cancer genetic risk assessment and testing activities were described. Latent class analysis supported by likelihood ratio tests was used to define PCP profiles with respect to the level of engagement in genetic risk assessment and referral activity based on demographic and practice characteristics. RESULTS 860 physicians responded to the survey (39% family practice, 29% internal medicine, 22% obstetrics/gynecology (OB/GYN), 10% other). Most respondents (83%) reported that they routinely assess hereditary cancer risk; however, only 33% reported that they take a full, three-generation pedigree for risk assessment. OB/GYN specialty, female gender, and physician access to a genetic counselor were independent predictors of referral to cancer genetics specialists. Three profiles of PCPs, based upon referral practice and extent of involvement in genetics evaluation, were defined. CONCLUSION Profiles of physician characteristics associated with varying levels of engagement with cancer genetic risk assessment and testing can be identified. These profiles may ultimately be useful in targeting decision support tools and services.
Collapse
Affiliation(s)
- Hetal S Vig
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Breast cancer risk communication: assessment of primary care physicians by standardized patients. Genet Med 2009; 11:735-41. [PMID: 19661809 DOI: 10.1097/gim.0b013e3181b2e5eb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess primary care providers' communication about breast cancer risk. METHODS We evaluated 86 primary care providers' communication of risk using unannounced standardized (simulated) patients. Physicians were randomly assigned to receive one of three cases: (1) moderate risk case (n = 25), presenting with a breast lump and mother with postmenopausal breast cancer; (2) high-risk (maternal side) case (n = 28), presenting with concern about breast cancer risk; and (3) high-risk (paternal side) case (n = 33), presenting with an unrelated problem. After the appointment, three qualitative parameters were assessed by standardized patients on a 3-point scale (3 = highest satisfaction, 1 = lowest): whether the physician took adequate time; acknowledged her concerns; and offered reassurance. RESULTS Mean satisfaction with physician communication was higher for the moderate risk case (2.92) than for the high-risk paternal case (2.25) or high-risk maternal case (2.42) (P < 0.0001). The score was not influenced by session length, medical specialty, or physician gender. CONCLUSION Physicians more consistently provided a moderate risk standardized patients with reassurance and support compared with the high-risk cases. Primary care physicians may be more unprepared or uneasy addressing the issues raised by more complex scenarios and may benefit from training in the assessment and communication of breast cancer risk.
Collapse
|
10
|
Boulware LE, Carson KA, Troll MU, Powe NR, Cooper LA. Perceived susceptibility to chronic kidney disease among high-risk patients seen in primary care practices. J Gen Intern Med 2009; 24:1123-9. [PMID: 19711135 PMCID: PMC2762510 DOI: 10.1007/s11606-009-1086-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 03/04/2009] [Accepted: 08/04/2009] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized. OBJECTIVE To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management. DESIGN AND PARTICIPANTS Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices. MEASUREMENTS We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses. MAIN RESULTS In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores. CONCLUSIONS Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.
Collapse
Affiliation(s)
- L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
11
|
Wahls TL, Peleg I. Patient- and system-related barriers for the earlier diagnosis of colorectal cancer. BMC FAMILY PRACTICE 2009; 10:65. [PMID: 19754964 PMCID: PMC2758830 DOI: 10.1186/1471-2296-10-65] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 09/15/2009] [Indexed: 11/17/2022]
Abstract
Background A cohort of colorectal cancer (CRC) patients represents an opportunity to study missed opportunities for earlier diagnosis. Primary objective: To study the epidemiology of diagnostic delays and failures to offer/complete CRC screening. Secondary objective: To identify system- and patient-related factors that may contribute to diagnostic delays or failures to offer/complete CRC screening. Methods Setting: Rural Veterans Administration (VA) Healthcare system. Participants: CRC cases diagnosed within the VA between 1/1/2000 and 3/1/2007. Data sources: progress notes, orders, and pathology, laboratory, and imaging results obtained between 1/1/1995 and 12/31/2007. Completed CRC screening was defined as a fecal occult blood test or flexible sigmoidoscopy (both within five years), or colonoscopy (within 10 years); delayed diagnosis was defined as a gap of more than six months between an abnormal test result and evidence of clinician response. A summary abstract of the antecedent clinical care for each patient was created by a certified gastroenterologist (GI), who jointly reviewed and coded the abstracts with a general internist (TW). Results The study population consisted of 150 CRC cases that met the inclusion criteria. The mean age was 69.04 (range 35-91); 99 (66%) were diagnosed due to symptoms; 61 cases (46%) had delays associated with system factors; of them, 57 (38% of the total) had delayed responses to abnormal findings. Fifteen of the cases (10%) had prompt symptom evaluations but received no CRC screening; no patient factors were identified as potentially contributing to the failure to screen/offer to screen. In total, 97 (65%) of the cases had missed opportunities for early diagnosis and 57 (38%) had patient factors that likely contributed to the diagnostic delay or apparent failure to screen/offer to screen. Conclusion Missed opportunities for earlier CRC diagnosis were frequent. Additional studies of clinical data management, focusing on following up abnormal findings, and offering/completing CRC screening, are needed.
Collapse
Affiliation(s)
- Terry L Wahls
- VA Iowa City Health Care System, Iowa City, Iowa, USA.
| | | |
Collapse
|
12
|
Integrating genetic risk assessment for multi-factorial conditions into primary care. Prim Health Care Res Dev 2009. [DOI: 10.1017/s1463423609001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
13
|
Kelly KM, Ferketich AK, Sturm AC, Porter K, Sweet K, Kemp K, Schwirian P, Westman JA. Cancer risk and risk communication in urban, lower-income neighborhoods. Prev Med 2009; 48:392-6. [PMID: 19463493 DOI: 10.1016/j.ypmed.2009.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 01/16/2009] [Accepted: 01/16/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Family history of cancer is an important risk factor for the disease, and communicating with family and physicians about family history is critical to cancer risk assessment. This study examined cancer risk communication with family and physicians. METHODS A telephone interview was administered to randomly selected participants (n=217) from 5 urban, lower-income communities in 2006 and 2007. A large proportion of the population were minorities and of lower socio-economic status (47% African American, 43% incomes <$25,000). Most (76%) believed family history was important, and approximately half talked to their family (50%) or their physician (49%) about their cancer risk. RESULTS Respondents were equally likely as family members to initiate discussions about cancer risk, but respondents were more likely to initiate discussions with physicians. Logistic regression models were fit to talk to family, talk to physician, and perceived risk. In multivariable analysis, higher income and greater worry were associated with talking to family about risk, and higher income was associated with talking to physician about risk. Gender, family history and worry were associated with greater perceived risk. CONCLUSION Efforts to decrease income barriers to cancer risk communication are needed.
Collapse
Affiliation(s)
- Kimberly M Kelly
- Human Cancer Genetics, The Ohio State University, Columbus, OH 43210, USA.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Bennett P, Wilkinson C, Turner J, Griffith G, France B, Brain K, Gray J. The impact of breast cancer genetic risk assessment on intentions to perform cancer surveillance behaviors. J Genet Couns 2007; 16:617-23. [PMID: 17549613 DOI: 10.1007/s10897-007-9100-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
One hundred and fifty-four women undergoing breast/ovarian cancer genetic risk assessment completed questionnaires at entry into the Cancer Genetic Service for Wales (CGSW) assessment program and following risk provision, mapping the strength of intentions to engage in a number of preventive/surveillance behaviors, including seeing specialists, breast self-examination, and involvement in screening programs, including mammography. A number of potential predictors of intentions were also assessed, including participants' mood and emotional response to receiving risk information, the perceived benefits (in terms of reassurance and early disease detection) of engaging in each preventive behavior, and the perceived desires of their family and General Practitioner. Intentions to self-examine did not change following risk provision, although strength of intentions to engage in some other preventive behaviors did lessen. Family and General Practitioners appeared to be strong social influences on behavioral intentions, as were the perceived benefits of gaining reassurance and/or early detection of disease.
Collapse
Affiliation(s)
- Paul Bennett
- Centre for Nursing, Health and Social Research, University of Cardiff, Cardiff CF24 0AB, UK.
| | | | | | | | | | | | | |
Collapse
|
15
|
Evans W. Bibliography. HEALTH COMMUNICATION 2005; 18:195-9. [PMID: 16083411 DOI: 10.1207/s15327027hc1802_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- William Evans
- Institute for Communication and Information Research, University of Alabama, Tuscaloosa, AL 35487-0172, USA.
| |
Collapse
|