The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups

Collaborative Care and Healthcare Usage in Families with Pediatric Patients During COVID-19: A Secondary Analysis of National Survey of Children's Health (NSCH) Data

One of the most detrimental side effects of the COVID-19 pandemic is the needed but not received care. Forgone health care affects the general public, but particularly children with special care needs. Previous research focused on non-modifiable factors, such as demographic background and insurance coverage. Based on Politi and Street's model of collaborative decision-making, we explored how two modifiable communication factors contributed to the prevention of forgone pediatric care during the COVID-19 pandemic. Using a nationally representative sample (n = 10845) from the 2020 National Survey of Children's Health (NSCH) survey, we found that health-care providers' family-centered communication and shared decision-making may reduce the possibility of forgone care through improved satisfaction with providers' communication. For children with mental health needs, providers' family-centered communication may also stimulate family's capacity to openly communicate, leading to better involvement in care and timely health care seeking. This helps to address COVID-related uncertainty, prevent higher health-care expenditures, and reduce negative health outcomes.

The Relationship Between a Healthy People 2030 Health Literacy-Related Objective (HC/HIT02) and Cancer Prevention and Screening Behaviors

Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Testing proximal, intermediate, and health outcomes of patient centered communication among non-pregnant women of childbearing age with diabetes mellitus: Findings from the Medical Expenditure Panel Survey 2012-2018

Objective

To determine associations between patient-centered communication (PCC) and overall healthcare ratings, self-efficacy, and management adherence among reproductive-age women with diabetes within the framework of Epstein and Street's conceptual model.

Methods

We analyzed longitudinal data from the 2012-2018 Medical Expenditure Panel Survey. The sample included 493 non-pregnant women of childbearing age (18-45 years) with diabetes. Independent variables were domains of PCC (listening, explaining, respecting, spending time, giving instructions, among others). Dependent variables were overall healthcare ratings, self-efficacy, and management adherence. Crude and adjusted associations were evaluated.

Results

Non-pregnant women of childbearing age who reported that their provider always listened to them, explained things, showed respect, and spent enough time with them had greater odds of reporting high overall healthcare ratings. Those who reported their provider always listened to them and spent enough time with them had greater odds of reporting better diabetes care adherence than those whose health care providers did not.

Conclusion

Findings demonstrate that non-pregnant women of childbearing age who report having optimal PCC are more likely to adhere to their diabetes care regimen.

Innovation

This is the first known study using a nationally representative sample of non-pregnant women of childbearing age to examine multiple layers of PCC.

Cervical Cancer Screening Knowledge, Perceptions, and Behaviors in a Multiracial Cohort of Low-Income, Underscreened Women in North Carolina

Background: Underscreened, low-income, and uninsured or publicly insured women in the United States bear a greater burden of cervical cancer morbidity and mortality and may face unique barriers that preclude screening adherence. Methods: Participants were 710 My Body My Test-3 clinical trial participants who were publicly insured or uninsured with incomes ≤250% of the U.S. Federal Poverty Level, aged 25-64 years, and not up to date on cervical cancer screening as per national guidelines. Using Health Belief Model constructs, we assessed screening-related knowledge, perceptions, and behaviors-overall and stratified by race and ethnicity-and estimated associations with past-year attempted screening using multivariable regression models. Results: Overall, knowledge was low about the human papillomavirus, purpose of a Pap test, and recommended screening interval. Perceived severity of cervical cancer was high (3.63 on a 4-point scale). Black and Latina/Hispanic women were more likely to perceive screening as lowering their risk of cervical cancer than White women. Black women reported lower perceived risk of cervical cancer compared with White women (p = 0.03), but Black women were more likely to have sought screening in the past year (p = 0.01). Having at least three doctor visits in the past year was associated with a screening attempt. Greater perceived risk of cervical cancer, more positive perceptions of screening, and feeling more nervousness about screening were also associated with a screening attempt (all p < 0.05). Conclusions: Addressing knowledge gaps and misconceptions about cervical cancer screening and leveraging positive perceptions of screening may improve screening uptake and adherence among diverse underscreened U.S. women. Clinical Trial Registration Number: NCT02651883.

Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use

PURPOSE

We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older.

METHODS

Health Information National Trends Survey 2017-2020 data were analyzed.

RESULTS

AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs.

CONCLUSION

Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.

Understanding the role of access in Hispanic cancer screening disparities

BACKGROUND

Hispanic populations in the United States experience numerous barriers to care access. It is unclear how cancer screening disparities between Hispanic and non-Hispanic White individuals are explained by access to care, including having a usual source of care and health insurance coverage.

METHODS

A secondary analysis of the 2019 National Health Interview Survey was conducted and included respondents who were sex- and age-eligible for cervical (n = 8316), breast (n = 6025), or colorectal cancer screening (n = 11,313). The proportion of ever screened and up to date for each screening type was compared.  Regression models evaluated whether controlling for reporting a usual source of care and type of health insurance (public, private, none) attenuated disparities between Hispanics and non-Hispanic White individuals.

RESULTS

Hispanic individuals were less likely than non-Hispanic White individuals to be up to date with cervical cancer screening (71.6% vs. 74.6%) and colorectal cancer screening (52.9% vs. 70.3%), but up-to-date screening was similar for breast cancer (78.8% vs. 76.3%). Hispanic individuals (vs. non-Hispanic White) were less likely to have a usual source of care (77.9% vs. 86.0%) and more likely to be uninsured (23.6% vs. 7.1%). In regressions, insurance fully attenuated cervical cancer disparities. Controlling for both usual source of care and insurance type explained approximately half of the colorectal cancer screening disparities (adjusted risk difference: -8.3 [-11.2 to -4.8]).

CONCLUSION

Addressing the high rate of uninsurance among Hispanic individuals could mitigate cancer screening disparities. Future research should build on the relative successes of breast cancer screening and investigate additional barriers for colorectal cancer screening.

PLAIN LANGUAGE SUMMARY

This study uses data from a national survey to compare cancer screening use those who identify as Hispanic with those who identify as non-Hispanic White. Those who identify as Hispanic are much less likely to be up to date with colorectal cancer screening than those who identify as non-Hispanic White, slightly less likely to be up to date on cervical cancer screening, and similarly likely to receive breast cancer screening. Improving insurance coverage is important for health equity, as is further exploring what drives higher use of breast cancer screening and lower use of colorectal cancer screening.

Patient Experience with Their Health Care Provider Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus by Race and Ethnicity in the United States

Objectives

The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity.

Design

This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 763; weighted n = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction.

Results

After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women.

Conclusion

There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes.

Factors related to moderate exercise during COVID-19 for overweight and obese individuals: A secondary analysis of HINTS data

Objective

COVID-19 has exacerbated pre-existing rates of overweight and obesity in the United States. mHealth technologies are gaining in popularity for its potential to reduce obesity, if facilitated by patient-centered communication. This study explores predictors of overweight and obese individuals' exercise levels during COVID-19.

Methods

2191 respondents who visited a doctor in the past year and self-reported being overweight were selected from the 2020 Health Information National Trends Survey (HINTS). Respondents reported their physical activity, beliefs about obesity, health tracking behaviors, and communication with providers during the pandemic. Structural equation modeling was used to explore connections among the variables.

Results

Patient-provider (e-)communication was significantly associated with changes in people's obesity-related beliefs and mHealth tracking usage, predicting moderate exercise during the pandemic.

Conclusion

The findings illustrate the need for patient-centered communication encounters to include discussions on mHealth technologies and accessible methods of engaging in physical activity.Innovation: This study examined secondary data provided by overweight and obese individuals from the early days of the COVID-19 pandemic; this population may benefit from targeted health interventions using mHealth technologies. Our findings suggest that healthcare providers should engage patients through mHealth technology and seek to improve digital health literacy to progress physical activity nationwide.

The Impact of IT-Based Healthcare Communication on Mammography Screening Utilization among Women in the United States: National Health Interview Survey (2011-2018)

Effective patient-provider communication improves mammography utilization. Using information technology (IT) promotes health outcomes. However, there are disparities in access to IT that could contribute to disparities in mammography utilization. This study aims to assess the association between IT-based health care communication and mammography utilization and to evaluate if this effect is modified by race/ethnicity and age. To this end, this study was conducted using the National Health Interview Survey from 2011 to 2018. A total of 94,290 women aged 40 years and older were included. Multiple logistic regression models were used, and odds ratios were reported. The study found that all IT-based healthcare communication strategies were significantly associated with mammography utilization in all years from 2011 to 2018. In 2018, women who looked up health information on the internet, scheduled a medical appointment on the internet, and communicated with providers by email had a significantly higher chance to use mammography (p ≤ 0.005 for all strategies across all years). White women and women aged 50 years and older benefited the most from IT-based healthcare communication. In conclusion, facilitating access to IT may help increase mammography utilization, which may contribute to eliminating disparities in breast cancer mortality.

Evaluating and Improving Cancer Screening Process Quality in a Multilevel Context: The PROSPR II Consortium Design and Research Agenda

BACKGROUND

Cancer screening is a complex process involving multiple steps and levels of influence (e.g., patient, provider, facility, health care system, community, or neighborhood). We describe the design, methods, and research agenda of the Population-based Research to Optimize the Screening Process (PROSPR II) consortium. PROSPR II Research Centers (PRC), and the Coordinating Center aim to identify opportunities to improve screening processes and reduce disparities through investigation of factors affecting cervical, colorectal, and lung cancer screening in U.S. community health care settings.

METHODS

We collected multilevel, longitudinal cervical, colorectal, and lung cancer screening process data from clinical and administrative sources on &gt;9 million racially and ethnically diverse individuals across 10 heterogeneous health care systems with cohorts beginning January 1, 2010. To facilitate comparisons across organ types and highlight data breadth, we calculated frequencies of multilevel characteristics and volumes of screening and diagnostic tests/procedures and abnormalities.

RESULTS

Variations in patient, provider, and facility characteristics reflected the PROSPR II health care systems and differing target populations. PRCs identified incident diagnoses of invasive cancers, in situ cancers, and precancers (invasive: 372 cervical, 24,131 colorectal, 11,205 lung; in situ: 911 colorectal, 32 lung; precancers: 13,838 cervical, 554,499 colorectal).

CONCLUSIONS

PROSPR II's research agenda aims to advance: (i) conceptualization and measurement of the cancer screening process, its multilevel factors, and quality; (ii) knowledge of cancer disparities; and (iii) evaluation of the COVID-19 pandemic's initial impacts on cancer screening. We invite researchers to collaborate with PROSPR II investigators.

IMPACT

PROSPR II is a valuable data resource for cancer screening researchers.

Influence of Pediatric Patients' Developmental or Chronic Health Condition Status as a Predictor of Parents' Perceptions of Patient- and Family-Centered Care

Our study aimed to estimate how a pediatric patient's health condition status influences parents' perceptions of patient- and family-centered care (PFCC). We analyzed five years (2013-2017) of Medical Expenditure Panel Survey data in efforts to expand understanding of the family influence in pediatric health encounters, using family systems theory as our theoretical lens. The sample included 36,675 parents of children with developmental or chronic health conditions who reported visiting a health-care provider within the past 12 months. The independent variable was a combined measure of any developmental or chronic health conditions previously diagnosed in the child being assessed. Dependent variables included parent reports of communication variables related to how often providers: listened; showed respect; spent enough time; and explained things well. Multivariable logistic regression was used to evaluate the odds of receiving PFCC using a dichotomous measure of PFCC quality and separate domains. Results found that 1) the dichotomous variable of PFCC showed that parents of children with health conditions were less likely to report their provider always performed all elements of PFCC compared to parents whose children did not have any health conditions; 2) parents of children with developmental or chronic health conditions were less likely to report their provider always explained things well compared to parents whose children did not have any health conditions. Efforts to improve PFCC should focus on training providers to demonstrate high-quality practices to improve health outcomes for pediatric patients with developmental or chronic conditions.

Disparities in Patient- and Family-Centered Care Among Children With Health Conditions

The objective of this study was to estimate and compare the prevalence of patient- and family-centered cae (PFCC) received by children in the United States (US) with chronic and developmental health conditions and determine associations between the presence of the conditions and parents’ perceptions of PFCC after controlling for covariates. Linked data from the 2012–2016 National Health Interview Survey (NHIS) and 2013–2017 Medical Expenditure Panel Survey (MEPS) (n = 7,835) were tested using crude and adjusted logistic regression procedures. Parents of children with developmental delays had 32% lower odds (95% CI = 0.51–0.90) of reporting their healthcare provider always exhibited all PFCC qualities. Parents of children with allergies and developmental delays had 26% (95% CI = 0.58–0.95) and 42% (95% CI = 0.42–0.80) lower odds of reporting their provider always listened carefully compared to parents whose children did not. Findings demonstrate the importance of continuous training for providers to tailor communication for families who have children with health conditions.

Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study

Background

The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services.

Objective

The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months.

Methods

Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted.

Results

Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC.

Conclusions

Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.

Bias Issues in Colorectal Cancer Management: A Review

Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.