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Zhu X, Squiers L, Madson G, Helmueller L, Southwell BG, Alam S, Finney Rutten LJ. Patient-Provider Communication and Colorectal Cancer Screening Completion Using Multi-target Stool DNA Testing. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02479-w. [PMID: 39031303 DOI: 10.1007/s13187-024-02479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 07/22/2024]
Abstract
Colorectal cancer (CRC) screening continues to be underutilized in the USA despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Understanding how patient-provider communication influences CRC screening can inform interventions to improve screening completion. We developed a behavioral theory-informed survey to identify patient-provider communication factors associated with multi-target stool DNA (mt-sDNA) screening completion. The survey was administered by RTI International between 03/2022 and 06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021 and 9/2021. Respondents completed an electronic or paper survey. Multivariable logistic regression was used to identify patient-provider communication factors associated with mt-sDNA test completion. A total of 2973 participants completed the survey (response rate, 21.7%) and 81.6% of them (n = 2427) reported having had a conversation with provider about mt-sDNA testing before the test was ordered. Having a conversation with the provider about the test, including discussions about costs, the need for follow-up testing and test instructions were associated with higher odds of test completion and being "very likely" to use the test in the future. Lack of discussion about advantages and disadvantages of available CRC screening options and lack of patient involvement in CRC screening decision-making were associated with reduced odds of test completion and likelihood of future use. Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | | | | | | | - Shama Alam
- Exact Sciences Corporation, Madison, WI, USA
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2
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Tsai MH, Moore JX, Odhiambo LA, Andrzejak SE, Tingen MS. Colorectal cancer screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. J Cancer Surviv 2024; 18:541-552. [PMID: 36217067 PMCID: PMC9549837 DOI: 10.1007/s11764-022-01258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To examine whether sociodemographic characteristics, access to care, risk behavior factors, and chronic health conditions were associated with colorectal cancer (CRC) screening utilization among breast, cervical, prostate, skin, and lung cancer survivors. METHODS We analyzed the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data on 9780 eligible cancer survivors. Descriptive statistics and multivariable logistic regression models were applied to assess the association between guideline-concordant CRC screening and the mentioned characteristics. RESULTS Overall, 81.9%, 65%, 88%,78.1%, and 80.1% of breast, cervical, prostate, skin, and lung cancer survivors received CRC screening, respectively (p-value < 0.001). In multivariable analysis, breast, cervical, and skin cancer survivors aged 60 years or older were associated with higher odds of receiving CRC screening. Respondents that had their recency of routine checkup two or more years before had lower odds of having CRC screening among cervical (OR = 0.06; 95% CI, 0.02-0.22), prostate (OR = 0.26; 95% CI, 0.14-0.49), and skin cancer (OR = 0.50; 95% CI, 0.36-0.70) survivors. The presence of chronic diseases was also associated with guideline-concordant CRC screening among breast, prostate, and skin cancer survivors. CONCLUSIONS Our findings provide important evidence on potential factors that are associated with guideline-concordant CRC screening utilization across different cancer survivors, which include older age, recency of routine checkup, and multiple chronic diseases. Moreover, variation in CRC screening utilization across cancer survivors may highlight missed opportunities for secondary cancer prevention. IMPLICATIONS FOR CANCER SURVIVORS Establishing clear CRC screening guidelines and including patient-provider communication on recommendation in cancer survivorship care may increase adherence to CRC screening.
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Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Justin X Moore
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Lorriane A Odhiambo
- Institute of Public and Preventive Health, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Martha S Tingen
- Cancer Prevention, Control, and Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA
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3
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Zhu X, Squiers L, Helmueller L, Madson G, Southwell BG, Alam S, Finney Rutten LJ. Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control. Soc Sci Med 2024; 340:116397. [PMID: 38043438 DOI: 10.1016/j.socscimed.2023.116397] [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: 05/19/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023]
Abstract
Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Shama Alam
- Exact Sciences Corporation, Madison, WI, USA
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4
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Adegboyega A, Adeyimika D, Omoadoni O, Mark D. HPV vaccination and cervical cancer screening promotion among Black individuals: social ecological perspectives from key informants interviews. ETHNICITY & HEALTH 2023; 28:1026-1040. [PMID: 36973897 PMCID: PMC10522792 DOI: 10.1080/13557858.2023.2193360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/10/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. DESIGN Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. RESULTS Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. CONCLUSIONS SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population.
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Affiliation(s)
| | | | | | - Dignan Mark
- College of Medicine, Prevention Research Center, University of Kentucky, Lexington, KY, USA
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5
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Tran BD, Latif K, Reynolds TL, Park J, Elston Lafata J, Tai-Seale M, Zheng K. "Mm-hm," "Uh-uh": are non-lexical conversational sounds deal breakers for the ambient clinical documentation technology? J Am Med Inform Assoc 2023; 30:703-711. [PMID: 36688526 PMCID: PMC10018260 DOI: 10.1093/jamia/ocad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/13/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Ambient clinical documentation technology uses automatic speech recognition (ASR) and natural language processing (NLP) to turn patient-clinician conversations into clinical documentation. It is a promising approach to reducing clinician burden and improving documentation quality. However, the performance of current-generation ASR remains inadequately validated. In this study, we investigated the impact of non-lexical conversational sounds (NLCS) on ASR performance. NLCS, such as Mm-hm and Uh-uh, are commonly used to convey important information in clinical conversations, for example, Mm-hm as a "yes" response from the patient to the clinician question "are you allergic to antibiotics?" MATERIALS AND METHODS In this study, we evaluated 2 contemporary ASR engines, Google Speech-to-Text Clinical Conversation ("Google ASR"), and Amazon Transcribe Medical ("Amazon ASR"), both of which have their language models specifically tailored to clinical conversations. The empirical data used were from 36 primary care encounters. We conducted a series of quantitative and qualitative analyses to examine the word error rate (WER) and the potential impact of misrecognized NLCS on the quality of clinical documentation. RESULTS Out of a total of 135 647 spoken words contained in the evaluation data, 3284 (2.4%) were NLCS. Among these NLCS, 76 (0.06% of total words, 2.3% of all NLCS) were used to convey clinically relevant information. The overall WER, of all spoken words, was 11.8% for Google ASR and 12.8% for Amazon ASR. However, both ASR engines demonstrated poor performance in recognizing NLCS: the WERs across frequently used NLCS were 40.8% (Google) and 57.2% (Amazon), respectively; and among the NLCS that conveyed clinically relevant information, 94.7% and 98.7%, respectively. DISCUSSION AND CONCLUSION Current ASR solutions are not capable of properly recognizing NLCS, particularly those that convey clinically relevant information. Although the volume of NLCS in our evaluation data was very small (2.4% of the total corpus; and for NLCS that conveyed clinically relevant information: 0.06%), incorrect recognition of them could result in inaccuracies in clinical documentation and introduce new patient safety risks.
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Affiliation(s)
- Brian D Tran
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kareem Latif
- School of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Tera L Reynolds
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Jihyun Park
- Department of Computer Science, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
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Elston Lafata J, Shires DA, Shin Y, Flocke S, Resnicow K, Johnson M, Nixon E, Sun X, Hawley S. Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial. Med Decis Making 2022; 42:985-998. [PMID: 35762832 PMCID: PMC9583291 DOI: 10.1177/0272989x221104094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Even after a physician recommendation, many people remain unscreened for
colorectal cancer (CRC). The proliferation of electronic health records
(EHRs) and tethered online portals may afford new opportunities to embed
patient-facing interventions within clinic workflows and engage patients
following a physician recommendation for care. We evaluated the
effectiveness of a patient-facing intervention designed to complement
physician office-based recommendations for CRC screening. Design Using a 2-arm pragmatic, randomized clinical trial, we evaluated the
intervention’s effect on CRC screening use as documented in the EHR (primary
outcome) and the extent to which the intervention reached the target
population. Trial participants were insured, aged 50 to 75 y, with a
physician recommendation for CRC screening. Typical EHR functionalities,
including patient registries, health maintenance flags, best practice
alerts, and secure messaging, were used to support research-related
activities and deliver the intervention to enrolled patients. Results A total of 1,825 adults consented to trial participation, of whom 78%
completed a baseline survey and were exposed to the intervention. Most trial
participants (>80%) indicated an intent to be screened on the baseline
survey, and 65% were screened at follow-up, with no significant differences
by study arm. One-third of eligible patients were sent a secure message.
Among those, more than three-quarters accessed study material. Conclusions By leveraging common EHR functionalities, we integrated a patient-facing
intervention within clinic workflows. Despite practice integration, the
intervention did not improve screening use, likely in part due to
portal-based interventions not reaching those for whom the intervention may
be most effective. Implications Embedding patient-facing interventions within the EHR enabled practice
integration but may minimize program effectiveness by missing important
segments of the patient population. Highlights
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Affiliation(s)
- Jennifer Elston Lafata
- UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for Health Policy and Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Yongyun Shin
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Flocke
- School of Medicine, Oregon Health and Science University
| | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Morgan Johnson
- UNC Eshelman School of Pharmacy, University of North Carolina, at Chapel Hill, Chapel Hill, NC, USA
| | - Ellen Nixon
- Center for Health Policy and Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Xinxin Sun
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Hawley
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
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7
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Creagh NS, Zammit C, Brotherton JM, Saville M, McDermott T, Nightingale C, Kelaher M. The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075905. [PMID: 35147064 PMCID: PMC8841921 DOI: 10.1177/17455065221075905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus–based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. Objective: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. Methods: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. Results: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. Conclusion: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia’s National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus–based cervical screening program, this model may assist in greater engagement of under-screened participants.
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Affiliation(s)
- Nicola S Creagh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claire Zammit
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Julia Ml Brotherton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,VCS Population Health, VCS Foundation, Carlton, VIC, Australia
| | - Marion Saville
- VCS Population Health, VCS Foundation, Carlton, VIC, Australia.,University Department of Obstetrics and Gynecology, The Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Claire Nightingale
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Kelaher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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8
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Saman DM, Walton KM, Harry ML, Asche SE, Truitt AR, Henzler-Buckingham HA, Allen CI, Ekstrom HL, O'Connor PJ, Sperl-Hillen JM, Ziegenfuss JY, Bianco JA, Elliott TE. Understanding primary care providers' perceptions of cancer prevention and screening in a predominantly rural healthcare system in the upper Midwest. BMC Health Serv Res 2019; 19:1019. [PMID: 31888630 PMCID: PMC6937782 DOI: 10.1186/s12913-019-4872-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cancer is the leading cause of death in the United States, with the burden expected to rise in the coming decades, increasing the need for effective cancer prevention and screening options. The United States Preventive Services Task Force has suggested that a shared decision-making process be used when clinicians and patients discuss cancer screening. The electronic medical record (EMR) often provides only reminders or alerts to primary care providers (PCPs) when screenings are due, a strategy with limited efficacy. Methods We administered a cross-sectional electronic survey to PCPs (n = 165, 53% response rate) at 36 Essentia Health primary care clinics participating in a large, National Cancer Institute-funded study on a cancer prevention clinical decision support (CDS) tool. The survey assessed PCP demographics, perceptions of the EMR’s ability to help assess and manage patients’ cancer risk, and experience and comfort level discussing cancer screening and prevention with patients. Results In these predominantly rural clinics, only 49% of PCPs thought the EMR was well integrated to help assess and manage cancer risk. Both advanced care practitioners and physicians agreed that cancer screening and informed discussion of cancer risks are important; however, only 53% reported their patients gave cancer screening a high priority relative to other health issues. Conclusions The impact of EMR-linked CDS delivered to both patients and PCPs may improve cancer screening, but only if it is easy to use and saves PCPs time.
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Affiliation(s)
- Daniel M Saman
- Essentia Institute of Rural Health, 502 E. Second Street, Duluth, MN, 55805, USA.
| | - Kayla M Walton
- Essentia Institute of Rural Health, 502 E. Second Street, Duluth, MN, 55805, USA
| | - Melissa L Harry
- Essentia Institute of Rural Health, 502 E. Second Street, Duluth, MN, 55805, USA
| | - Stephen E Asche
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - Anjali R Truitt
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | | | - Clayton I Allen
- Essentia Institute of Rural Health, 502 E. Second Street, Duluth, MN, 55805, USA
| | - Heidi L Ekstrom
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - Patrick J O'Connor
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - JoAnn M Sperl-Hillen
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | | | - Joseph A Bianco
- Essentia Health - Ely Clinic, 300 W. Conan Street, Ely, MN, 55731, USA
| | - Thomas E Elliott
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
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9
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Shen MJ, Lafata JE, D’Agostino TA, Bylund CL. Lower Adherence: A Description of Colorectal Cancer Screening Barrier Talk. JOURNAL OF HEALTH COMMUNICATION 2019; 25:43-53. [PMID: 31795843 PMCID: PMC6981046 DOI: 10.1080/10810730.2019.1697909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Understanding how patients and physicians discuss screening barriers may illuminate reasons for non-adherence to recommended colorectal cancer (CRC) screening. The goal of the present study was to describe patients' reporting of and physicians' responses to CRC screening barriers and examine their associations with patients' CRC screening behaviors. Audio-recorded primary care consultations (N = 413) with patients due for CRC screening were used to identify CRC screening-related barrier talk and physician responses. Presence of barrier talk was associated with less patient adherence to CRC screening (OR = 0.568, p = 0.007). Neither CRC screening talk (n = 413) nor physician responses (n = 151) were associated with patients' CRC screening. Among the consultations in which barrier talk occurred (n = 151), patients most often reported test-related (28.9%) and psychological (26.1%) barriers. Barriers were most often reported in the context of CRC screening discussions (45.7%) or in direct response to a physician's question about CRC screening (48.6%). Results indicated that patients rarely raised CRC screening barriers unprompted and that presence of barrier talk was predictive of CRC screening behavior. These findings may help improve future clinical practice by highlighting that patients may benefit from physicians initiating and facilitating discussions of CRC screening barriers and directly helping patients overcome known barriers to CRC screening.
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Affiliation(s)
| | - Jennifer Elston Lafata
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Henry Ford Health System, Detroit, MI
| | | | - Carma L. Bylund
- Memorial Sloan Kettering Cancer Center; New York, NY, USA
- University of Florida; Gainesville, FL
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10
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Steenland M, Sinaiko A, Glynn A, Fitzgerald T, Cohen J. The effect of the Affordable Care Act on patient out-of-pocket cost and use of preventive cancer screenings in Massachusetts. Prev Med Rep 2019; 15:100924. [PMID: 31333996 PMCID: PMC6617340 DOI: 10.1016/j.pmedr.2019.100924] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/15/2019] [Accepted: 06/15/2019] [Indexed: 12/11/2022] Open
Abstract
In an effort to increase use of preventive health care, The Patient Protection and Affordable Care Act (ACA) eliminated cost-sharing for preventive cancer screening services for the privately insured. The impact on patient spending and use of these screenings is still poorly understood. We used an interrupted time series analysis with the Massachusetts All-Payer Claims Database (2009-2012) to assess changes in trends in costs and use of breast, cervical and colorectal cancer screenings after the ACA policy. We find that the ACA was associated with a 0.024 (95% CI: -0.031, -0.017, p < 0.001) and 0.424 (95% CI: -0.481, -0.368, p < 0.001) percentage point decrease in the likelihood of a copayment each week for preventive breast and cervical cancer screenings respectively. The likelihood of copayment for colon cancer screening declined throughout the study period, with the rate of decline slowing following the ACA (trend in percent of screenings with copayment -0.130 before vs -0.071 after ACA, p = 0.014). Overall, we find only weak evidence that the ACA policy increased screenings. We find no significant effect on utilization for cervical cancer or colon cancer screening. For breast cancer screening, we find a small immediate increase in the utilization rate in the month after the policy change, with no change in trend after the ACA policy. Policy makers may need to consider other complementary policy options to increase screening rates.
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Affiliation(s)
- Maria Steenland
- Population Studies and Training Center, Brown University, 68 Waterman St, Providence, RI 02912, USA
| | - Anna Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Amy Glynn
- Commonwealth Care Alliance, 30 Winter Street, Boston, MA 02108, USA
| | | | - Jessica Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
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11
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Dyer KE, Shires DA, Flocke SA, Hawley ST, Jones RM, Resnicow K, Shin Y, Lafata JE. Patient-Reported Needs Following a Referral for Colorectal Cancer Screening. Am J Prev Med 2019; 56:271-280. [PMID: 30554975 PMCID: PMC6438715 DOI: 10.1016/j.amepre.2018.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Patient-physician communication about colorectal cancer screening can affect screening use, but discussions often lack information that patients need for informed decision making and seldom address personal preferences or barriers. To address this gap, a series of patient focus groups was conducted to guide the development of an online, interactive decision support program. This article presents findings on patient information needs and barriers to colorectal cancer screening after receiving a screening recommendation from a physician, and their perspectives on using electronic patient portals as platforms for health-related decision support. METHODS Primary care patients with recent colonoscopy or stool testing orders were identified via the centralized data repository of a large Midwestern health system. Seven gender-stratified focus groups (N=45 participants) were convened between April and July 2016. Sessions were audio recorded, transcribed, coded, and analyzed for commonly expressed themes beginning in August 2016. RESULTS Findings reveal a consistent need for simple and clear information on colorectal cancer screening. Participants desired step-by-step explanations of the colonoscopy procedure and information about bowel preparation options/alternatives. The desired level of additional information varied: some patients wanted to know about and act on test options, whereas others preferred following their physician-recommended testing path. Fears and concerns were prevalent, particularly about colonoscopy, and patients reported challenges getting these concerns and their informational needs addressed. Finally, they expressed consistent support for using the patient portal to gather additional information from their physician. CONCLUSIONS Patient portals may offer an opportunity to build sustainable programs for decision support and assistance that are integrated with clinic workflows and processes.
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Affiliation(s)
- Karen E Dyer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Susan A Flocke
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; University of Michigan School of Public Health, Ann Arbor, Michigan; VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania; Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Ken Resnicow
- University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Yongyun Shin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer Elston Lafata
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina; UNC Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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12
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Lafata JE, Shin Y, Flocke SA, Hawley ST, Jones RM, Resnicow K, Schreiber M, Shires DA, Tu SP. Randomised trial to evaluate the effectiveness and impact of offering postvisit decision support and assistance in obtaining physician-recommended colorectal cancer screening: the e-assist: Colon Health study-a protocol study. BMJ Open 2019; 9:e023986. [PMID: 30617102 PMCID: PMC6326296 DOI: 10.1136/bmjopen-2018-023986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/14/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening. METHODS AND ANALYSIS In partnership with healthcare teams, we developed 'e-assist: Colon Health', a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians. ETHICS AND DISSEMINATION All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action. TRIAL REGISTRATION NUMBER NCT02798224; Pre-results.
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Affiliation(s)
- Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | - Yongyun Shin
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Susan A Flocke
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Sarah T Hawley
- Department of Medicine, Center for Health Communications Research, Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Shin-Ping Tu
- Department of Internal Medicine, University of California Davis Health, Sacramento, California, USA
- University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
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Tate CE, Matlock DD, Dalton AF, Schilling LM, Marcus A, Schommer T, Lyon C, Lewis CL. Implementation and Evaluation of a Novel Colorectal Cancer Decision Aid Using a Centralized Delivery Strategy. Jt Comm J Qual Patient Saf 2018; 44:353-360. [PMID: 29793886 DOI: 10.1016/j.jcjq.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/27/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States; however, CRC screening reduces both incidence and mortality rates. Patient decision aids (DAs) are an evidence-based strategy to support patients making health-related decisions. CRC screening DAs can be unsuccessful due to provider preferences for colonoscopy and lack of effective DA implementation strategies within clinical settings. METHODS A hybrid implementation-effectiveness study was conducted testing the feasibility of using an existing centralized preventive health screening outreach infrastructure to implement a novel CRC DA across a health care system. Participants included primary care patients at one of three study clinics. Implementation was assessed by determining whether patients remembered receiving the DA and were aware of CRC screening options. Effectiveness was measured by comparing overall screening rates between the control and intervention groups. RESULTS Using a centralized delivery system was a feasible and efficient method for implementing DAs to a large academic health system. More than 90% of the intervention group remembered receiving the DA, and 80% found it helpful in their decision-making process. The DA was successful in improving CRC screening knowledge; however, overall CRC screening rates significantly decreased between the control and intervention periods (50.8% vs. 39.2%, respectively; p = 0.03). CONCLUSION Centralized delivery is a feasible method for DA implementation. Although DAs increase knowledge, the true effectiveness of CRC DAs in clinical settings is unknown, as a result of the number in screening tests, diversity in DA format, and the variability in dissemination and implementation practices.
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Eberth JM, McDonnell KK, Sercy E, Khan S, Strayer SM, Dievendorf AC, Munden RF, Vernon SW. A national survey of primary care physicians: Perceptions and practices of low-dose CT lung cancer screening. Prev Med Rep 2018; 11:93-99. [PMID: 29984145 PMCID: PMC6030390 DOI: 10.1016/j.pmedr.2018.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022] Open
Abstract
Soon after the National Lung Screening Trial, organizations began to endorse low-dose computed tomography (LCDT) screening for lung cancer in high-risk patients. Concerns about the risks versus benefits of screening, as well as the logistics of identifying and referring eligible patients, remained among physicians. This study aimed to examine primary care physicians' knowledge, attitudes, referral practices, and associated barriers regarding LDCT screening. We administered a national survey of primary care physicians in the United States between September 2016 and April 2017. Physicians received up to 3 mailings, 1 follow-up email, and received varying incentives to complete the survey. Overall, 293 physicians participated, for a response rate of 13%. We used weighted descriptive statistics to characterize participants and their responses. Over half of the respondents correctly reported that the US Preventive Services Task Force recommends LDCT screening for high-risk patients. Screening recommendations for patients not meeting high-risk criteria varied. Although 75% agreed that the benefits of LDCT screening outweigh the risks, fewer agreed that there is substantial evidence that screening reduces mortality (50%). The most commonly reported barriers to ordering screening included prior authorization requirements (57%), lack of insurance coverage (53%), and coverage denials (31%). The most frequently cited barrier to conducting LDCT screening shared decision making was patients' competing health priorities (42%). Given the impact of physician recommendations on cancer screening utilization, further understanding of physicians' LDCT screening attitudes and shared decision-making practices is needed. Clinical practice and policy changes are also needed to engage more patients in screening discussions. Most physicians had five or less lung cancer screening referrals in the past year Recommendation strategies varied, but often aligned with USPSTF or NCCN guidelines Physicians were uncertain about the efficacy and cost-effectiveness of screening Insurance coverage and costs were commonly cited as barriers to screening referral A common barrier to performing SDM was patients' competing health priorities
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Erica Sercy
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samira Khan
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Scott M Strayer
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Amy C Dievendorf
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States
| | - Sally W Vernon
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
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Shin HY, Suh M, Park B, Jun JK, Choi KS. Perceptions of colorectal cancer screening and recommendation behaviors among physicians in Korea. BMC Cancer 2017; 17:860. [PMID: 29246126 PMCID: PMC5732373 DOI: 10.1186/s12885-017-3881-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022] Open
Abstract
Background Physician recommendations for colorectal cancer (CRC) screening have consistently been shown to be a strong predictor of screening. The aim of this study was to investigate perceptions of CRC screening modalities and recommendation behaviors among physicians in Korea. Methods A cross-sectional, nationally representative survey conducted between November 2013 and February 2014. In total, 379 physicians (241 primary care physicians and 138 physicians affiliated with the Korean Association for the Study of Intestinal Diseases responded to this survey (overall response rate of 31.4%). Results About 29% of all respondents “always” recommended and about 67% “sometimes” recommended CRC screening. Colonoscopy was perceived as an effective primary screening tool for CRC, and 80% of the physicians recommended colonoscopy for CRC screening. Only 7% recommended FOBT. In multivariate analysis, recommending FOBT was associated with stronger belief in the screening efficacy of FOBT (aOR 3.70, 95% CI 2.09, 6.57), weaker belief in the screening efficacy of colonoscopy (aOR 0.29, 95% CI 0.12, 0.69), and negative decisional balance for colonoscopy screening (aOR 0.82, 95% CI 0.71, 0.95). Conclusions Although FOBT is provided free-of-charge through a nationwide CRC screening program, colonoscopy was more commonly recommended and preferred by physicians. Electronic supplementary material The online version of this article (10.1186/s12885-017-3881-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Republic of Korea.,College of Nursing, Korea University, 145, Anam-ro, Seongbuk-Gu, Seoul, 137-713, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Republic of Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Centre, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Centre, 323 Ilsan-ro, Ilsandong-gu, Goyang, 410-769, Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Centre, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Republic of Korea.
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Do Primary Care Provider Strategies Improve Patient Participation in Colorectal Cancer Screening? Am J Gastroenterol 2017; 112:622-632. [PMID: 28244494 DOI: 10.1038/ajg.2017.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/06/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Screening rates for colorectal cancer (CRC) remain suboptimal. The impact of provider strategies to enhance screening participation in the population is uncertain. The objective of this study was to determine the effect of provider strategies to increase screening in a single-payer system. METHODS A population-based survey was conducted in primary care providers (PCPs) linked to patients using administrative data in Ontario, Canada. Patients were due for CRC screening from April 2012 to March 2013. Patients were followed up until 31 March 2014. We determined time to become up-to-date with CRC screening. Cox proportional hazards models examined the association between PCP strategies and uptake of screening, adjusted for physician and patient factors. RESULTS A total of 717 PCPs and their 147,834 rostered patients due for CRC screening were included. Most physicians employed strategies to enhance screening participation, including electronic medical record use, reminders, generation of lists, audit and feedback reports, or designating staff responsible for screening. No single strategy was strongly associated with screening. For those >1 year overdue, a systematic approach to generate lists of patients overdue for screening was weakly associated with screening uptake (hazard ratio (HR)=1.14, 95% CI: 1.03-1.26, P=0.04 >5 years overdue vs. <1 year overdue). The use of multiple PCP strategies was associated with screening participation (HR=1.27, 95% CI: 1.16-1.39, P<0.0001 for PCPs using 4-5 vs. 0-1 strategies). Practice-based strategies were self-reported. CONCLUSIONS In practice, while individual PCP strategies have little effect, the use of multiple strategies to enhance screening appears to improve CRC screening uptake in patients.
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Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
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Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
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Van Horn L, Carson JAS, Appel LJ, Burke LE, Economos C, Karmally W, Lancaster K, Lichtenstein AH, Johnson RK, Thomas RJ, Vos M, Wylie-Rosett J, Kris-Etherton P. Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e505-e529. [DOI: 10.1161/cir.0000000000000462] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2013, the American Heart Association and American College of Cardiology published the “Guideline on Lifestyle Management to Reduce Cardiovascular Risk,” which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association’s 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the
2015–2020 Dietary Guidelines for Americans
issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.
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Sanders M, Fiscella K, Veazie P, Dolan JG, Jerant A. Does patient time spent viewing computer-tailored colorectal cancer screening materials predict patient-reported discussion of screening with providers? HEALTH EDUCATION RESEARCH 2016; 31:555-562. [PMID: 27343254 PMCID: PMC4945861 DOI: 10.1093/her/cyw032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The main aim is to examine whether patients' viewing time on information about colorectal cancer (CRC) screening before a primary care physician (PCP) visit is associated with discussion of screening options during the visit. We analyzed data from a multi-center randomized controlled trial of a tailored interactive multimedia computer program (IMCP) to activate patients to undergo CRC screening, deployed in primary care offices immediately before a visit. We employed usage time information stored in the IMCP to examine the association of patient time spent using the program with patient-reported discussion of screening during the visit, adjusting for previous CRC screening recommendation and reading speed.On average, patients spent 33 minutes on the program. In adjusted analyses, 30 minutes spent using the program was associated with a 41% increase in the odds of the patient having a discussion with their PCP (1.04, 1.59, 95% CI). In a separate analysis of the tailoring modules; the modules encouraging adherence to the tailored screening recommendation and discussion with the patient's PCP yielded significant results. Other predictors of screening discussion included better self-reported physical health and increased patient activation. Time spent on the program predicted greater patient-physician discussion of screening during a linked visit.Usage time information gathered automatically by IMCPs offers promise for objectively assessing patient engagement around a topic and predicting likelihood of discussion between patients and their clinician.
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Affiliation(s)
- Mechelle Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - James G Dolan
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Lantz PM, Evans WD, Mead H, Alvarez C, Stewart L. Knowledge of and Attitudes Toward Evidence-Based Guidelines for and Against Clinical Preventive Services: Results from a National Survey. Milbank Q 2016; 94:51-76. [PMID: 26994709 PMCID: PMC4941980 DOI: 10.1111/1468-0009.12181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
POLICY POINTS Both the underuse and overuse of clinical preventive services relative to evidence-based guidelines are a public health concern. Informed consumers are an important foundation of many components of the Affordable Care Act, including coverage mandates for proven clinical preventive services recommended by the US Preventive Services Task Force. Across sociodemographic groups, however, knowledge of and positive attitudes toward evidence-based guidelines for preventive care are extremely low. Given the demonstrated low levels of consumers' knowledge of and trust in guidelines, coupled with their strong preference for involvement in preventive care decisions, better education and decision-making support for evidence-based preventive services are greatly needed. CONTEXT Both the underuse and overuse of clinical preventive services are a serious public health problem. The goal of our study was to produce population-based national data that could assist in the design of communication strategies to increase knowledge of and positive attitudes toward evidence-based guidelines for clinical preventive services (including the US Preventive Services Task Force, USPSTF) and to reduce uncertainty among patients when guidelines change or are controversial. METHODS In late 2013 we implemented an Internet-based survey of a nationally representative sample of 2,529 adults via KnowledgePanel, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and those with less than a high school education were oversampled. We then conducted descriptive statistics and multivariable logistic regression analysis to identify the prevalence of and sociodemographic characteristics associated with key knowledge and attitudinal variables. FINDINGS While 36.4% of adults reported knowing that the Affordable Care Act requires insurance companies to cover proven preventive services without cost sharing, only 7.7% had heard of the USPSTF. Approximately 1 in 3 (32.6%) reported trusting that a government task force would make fair guidelines for preventive services, and 38.2% believed that the government uses guidelines to ration health care. Most of the respondents endorsed the notion that research/scientific evidence and expert medical opinion are important for the creation of guidelines and that clinicians should follow guidelines based on evidence. But when presented with patient vignettes in which a physician made a guideline-based recommendation against a cancer-screening test, less than 10% believed that this recommendation alone, without further dialogue and/or the patient's own research, was sufficient to make such a decision. CONCLUSIONS Given these demonstrated low levels of knowledge and mistrust regarding guidelines, coupled with a strong preference for shared decision making, better consumer education and decision supports for evidence-based guidelines for clinical preventive services are greatly needed.
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Affiliation(s)
- Paula M Lantz
- Gerald R. Ford School of Public Policy, University of Michigan
| | - W Douglas Evans
- Milken Institute School of Public Health, George Washington University
| | - Holly Mead
- Milken Institute School of Public Health, George Washington University
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Lafata JE, Wunderlich T, Flocke SA, Oja-Tebbe N, Dyer KE, Siminoff LA. Physician use of persuasion and colorectal cancer screening. Transl Behav Med 2015; 5:87-93. [PMID: 25729457 DOI: 10.1007/s13142-014-0284-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N = 414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Virginia Commonwealth University, Richmond, VA USA
| | - Tracy Wunderlich
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Oakland University, Detroit, MI USA
| | | | | | - Karen E Dyer
- Virginia Commonwealth University, Richmond, VA USA
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Daly JM, Xu Y, Levy BT. Colon polyp model use for educating about colorectal cancer screening in the Iowa Research Network. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:401-406. [PMID: 24668406 PMCID: PMC4249697 DOI: 10.1007/s13187-014-0637-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Providing a model of a colon segment with an adenomatous polyp and cancer can help to educate patients about the adenoma to carcinoma sequence and how this sequence can be interrupted with appropriate testing. The purpose of this study was to assess the use of a three-dimensional colon model with polyps and cancer provided to family physicians or nurses in some Iowa Research Network family physician offices. Colon models were provided to 117 family medicine healthcare providers interested in colorectal cancer screening. Using a mailed survey and follow-up telephone calls to non-responders, 81 (69%) questionnaires were returned. Thirty-six (44%) of the respondents reported they had used the model, 33 (41%) reported they used the model for a mean 16% of their patients in a month's time, 31 (38%) reported using the model to teach patients about the colon and polyps prior to a colonoscopy. Other model use described by respondents included educating staff to promote patient willingness for colonoscopies, demonstrating the need for colon cancer screening, and teaching patients about annual fecal occult blood tests. Respondents agreed that anatomical models are helpful for patient education, the design of the colon model was good, and that it facilitated demonstration of colon polyps. Possible recommendations for an office-wide adoption of an anatomical model would be an in-service for all employees and a standard location for finding the model.
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Affiliation(s)
- Jeanette M Daly
- Department of Family Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 01290-F PFP, Iowa City, IA, 52242, USA,
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Public health and cooperative group partnership: a colorectal cancer intervention. Semin Oncol Nurs 2013; 30:61-73. [PMID: 24559782 DOI: 10.1016/j.soncn.2013.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe the development of a multi-component colorectal cancer educational tool for female breast cancer survivors through a cooperative group and public health partnership. DATA SOURCES PubMed, World Wide Web, guidelines from professional organizations, surveys and focus groups with breast cancer survivors. CONCLUSION Collaboration is at the core of cooperative group and public health research. This partnership led to the development of a colorectal cancer educational tool for breast cancer survivors. Focus groups revealed that female breast cancer survivors were receptive to education on colorectal cancer screening. IMPLICATIONS FOR NURSING PRACTICE Nurses are instrumental in research collaborations between cooperative groups and public health. The colorectal educational intervention for breast cancer survivors serves as an exemplar of partnerships leading to innovative research planning and implementation outcomes.
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