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Ellen JG, Matos J, Viola M, Gallifant J, Quion J, Anthony Celi L, Abu Hussein NS. Participant flow diagrams for health equity in AI. J Biomed Inform 2024; 152:104631. [PMID: 38548006 DOI: 10.1016/j.jbi.2024.104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/29/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
Selection bias can arise through many aspects of a study, including recruitment, inclusion/exclusion criteria, input-level exclusion and outcome-level exclusion, and often reflects the underrepresentation of populations historically disadvantaged in medical research. The effects of selection bias can be further amplified when non-representative samples are used in artificial intelligence (AI) and machine learning (ML) applications to construct clinical algorithms. Building on the "Data Cards" initiative for transparency in AI research, we advocate for the addition of a participant flow diagram for AI studies detailing relevant sociodemographic and/or clinical characteristics of excluded participants across study phases, with the goal of identifying potential algorithmic biases before their clinical implementation. We include both a model for this flow diagram as well as a brief case study explaining how it could be implemented in practice. Through standardized reporting of participant flow diagrams, we aim to better identify potential inequities embedded in AI applications, facilitating more reliable and equitable clinical algorithms.
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Affiliation(s)
| | - João Matos
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Faculty of Engineering, University of Porto, Porto, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESCTEC), Porto, Portugal
| | | | - Jack Gallifant
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Critical Care, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Justin Quion
- University of the East Ramon Magsaysay Memorial Medical School, Quezon City, Philippines
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Smith JS, Vaz OM, Gaber CE, Des Marais AC, Chirumamilla B, Hendrickson L, Barclay L, Richman AR, Brooks X, Pfaff A, Brewer NT. Recruitment strategies and HPV self-collection return rates for under-screened women for cervical cancer prevention. PLoS One 2023; 18:e0280638. [PMID: 36952486 PMCID: PMC10035812 DOI: 10.1371/journal.pone.0280638] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/04/2023] [Indexed: 03/25/2023] Open
Abstract
In the United States, medically underserved women carry a heavier burden of cancer incidence and mortality, yet are largely underrepresented in cancer prevention studies. My Body, My Test is a n observational cohort, multi-phase cervical cancer prevention study in North Carolina that recruited low-income women, aged 30-65 years and who had not undergone Pap testing in ≥ 4 years. Participants were offered home-based self-collection of cervico-vaginal samples for primary HPV testing. Here, we aimed to describe the recruitment strategies utilized by study staff, and the resulting recruitment and self-collection kit return rates for each specific recruitment strategy. Participants were recruited through different approaches: either direct (active, staff-effort intensive) or indirect (passive on the part of study staff). Of a total of 1,475 individuals screened for eligibility, 695 were eligible (47.1%) and 487 (70% of eligible) participants returned their self-collection kit. Small media recruitment resulted in the highest number of individuals found to be study eligible, with a relatively high self-collection kit return of 70%. In-clinic in-reach resulted in a lower number of study-eligible women, yet had the highest kit return rate (90%) among those sent kits. In contrast, 211 recruitment which resulted in the lowest kit return of 54%. Small media, word of mouth, and face-to-face outreach resulted in self-collection kit return rates ranging from 72 to 79%. The recruitment strategies undertaken by study staff support the continued study of reaching under-screened populations into cervical cancer prevention studies.
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Affiliation(s)
- Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
| | - Olivia M Vaz
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Charley E Gaber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Andrea C Des Marais
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Bhavika Chirumamilla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Lori Hendrickson
- Hospital Epidemiology, University of North Carolina Medical Center, Chapel Hill, NC, United States of America
| | - Lynn Barclay
- American Sexual Health Association, Research Triangle Park, NC, United States of America
| | - Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States of America
| | - Xian Brooks
- School of Nursing, University of Louisville, Louisville, KY, United States of America
| | - Anna Pfaff
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States of America
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
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Characteristics of Asian-American Breast Cancer Survivors Retained in a 3-Month Technology-Based Intervention. Cancer Nurs 2022; 45:E766-E774. [PMID: 34661563 PMCID: PMC9001739 DOI: 10.1097/ncc.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Technology-based intervention programs are known to be effective in approaching socially excluded groups or racial/ethnic minorities, including this specific population. However, the retention of participants in technology-based intervention studies is far more complicated and challenging compared with conventional studies targeting racial/ethnic minorities. OBJECTIVE This study aimed to identify the complex characteristics of the groups within Asian American breast cancer survivors who were successfully retained in a 3-month technology-based intervention study. METHODS This secondary analysis of the data from a larger ongoing intervention study included 155 Asian American breast cancer survivors. Major variables were measured using multiple instruments including the questions on characteristics of the participants, the Personal Resource Questionnaire, perceived isolation, Memorial Symptom Assessment Scale-Short Form, Cancer Behavior Inventory, 34-item Supportive Care Needs Survey Short Form, and Functional Assessment of Cancer Therapy Scale-Breast Cancer. Data analyses were done through χ2 tests, t tests, and decision tree analyses. RESULTS The retention rates differed by subethnicity (P = .025), immigration age (P < .001), and stage of breast cancer (P = .003). The decision tree indicated four groups with the highest probability of retention: (a) those who were diagnosed with stage II, III, or IV breast cancer, (b) those who immigrated to the United States after turning 31 years old, and (c) those who had high perceived barriers. CONCLUSION This study provides directions for future retention strategies for technology-based interventions among Asian American breast cancer survivors. IMPLICATIONS FOR PRACTICE Participants' characteristics need to be considered in developing retain strategies for technology-based interventions among Asian American breast cancer survivors.
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Tarnasky AM, Tran GN, Nicolla J, Friedman FAP, Wolf S, Troy JD, Sung AD, Shah K, Oury J, Thompson JC, Gagosian B, Pollak KI, Manners I, Zafar SY. Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial. JCO Oncol Pract 2021; 17:e1440-e1449. [PMID: 33797952 PMCID: PMC8791821 DOI: 10.1200/op.20.00757] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Insured patients with cancer face high treatment-related, out-of-pocket (OOP) costs and often cannot access financial assistance. We conducted a randomized, controlled trial of Bridge, a patient-facing app designed to identify eligible financial resources for patients. We hypothesized that patients using Bridge would experience greater OOP cost reduction than controls. METHODS We enrolled patients with cancer who had OOP expenses from January 2018 to March 2019. We randomly assigned patients 1:1 to intervention (Bridge) versus control (financial assistance educational websites). Primary and secondary outcomes were self-reported OOP costs and subjective financial distress 3 months postenrollment. In post hoc analyses, we analyzed application for and receipt of financial assistance at 3 months postenrollment. We used chi-square, Mann-Whitney tests, and logistic regression to compare study arms. RESULTS We enrolled 200 patients. The median age was 57 years (IQR, 47.0-63.0). Most patients had private insurance (71%), and the median household income was $62,000 in US dollars (USD) (IQR, $36,000-$100,000 [USD]). Substantial missing data precluded assessment of primary and secondary outcomes. In post hoc analyses, patients in the Bridge arm were more likely than controls to both apply for and receive financial assistance. CONCLUSION We were unable to test our primary outcome because of excessive missing follow-up survey data. In exploratory post hoc analyses, patients who received a financial assistance app were more likely to apply for and receive financial assistance. Ultimately, our study highlights challenges faced in identifying measurable outcomes and retaining participants in a randomized, controlled trial of a mobile app to alleviate financial toxicity.
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Affiliation(s)
| | | | | | | | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Jesse D Troy
- Department of Pediatrics, Duke University, Durham, NC
| | - Anthony D Sung
- Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Durham, NC
| | - Kanan Shah
- NYU Grossman School of Medicine, New York, NY
| | | | | | | | - Kathryn I Pollak
- Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Durham, NC
| | | | - S Yousuf Zafar
- Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Durham, NC
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Howards PP, Mink PJ, Kim KH, Woodard JJ, Mertens AC. Comparison of Young Adult Female Cancer Survivors Recruited from a Population-Based Cancer Registry to Eligible Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:727-735. [PMID: 33531434 DOI: 10.1158/1055-9965.epi-20-1409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population-based cancer registries provide a resource to recruit young adult cancer survivors who may not be easily identified otherwise. METHODS We compared demographic and cancer-related characteristics of participants in a cohort of female young adult cancer survivors to those of eligible survivors in the Georgia Cancer Registry, a population-based registry in the United States. We examined associations between survivor characteristics and nonparticipation using logistic regression and associations between survivor characteristics and different types of nonparticipation (refusal, unable to contact, or unresolved vs. interviewed) using polytomous regression. RESULTS The Georgia Cancer Registry was able to contact 60% of eligible women (3,061/5,137). Of those, 78% agreed to study contact (n = 2,378), and of those, 56% were interviewed (n = 1,342). Participation was similar across age at contact and at diagnosis but varied across cancer type from 17% for cervical cancer to 32% for breast cancer. White women were slightly more likely to be interviewed (28%) than African American women (23%), which was mostly attributable to greater difficulty in contacting African American women (odds ratio 1.7, 95% confidence interval: 1.5-2.1). CONCLUSIONS The greatest challenge to recruiting women was contacting them, which differed across some but not all demographic and cancer-related characteristics. When successfully contacted, most survivors agreed to participate. IMPACT Population-based cancer registries can serve as an invaluable resource to recruit representative samples of young adult cancer survivors, who are otherwise difficult to identify.
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Affiliation(s)
- Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Pamela J Mink
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Health Economics Program, Minnesota Department of Health, Saint Paul, Minnesota
| | - Konny H Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jill J Woodard
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Emory University, School of Medicine, Department of Pediatrics, Atlanta, Georgia
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Mayadev J, Klapheke A, Yashar C, Hsu IC, Kamrava M, Mundt AJ, Mell LK, Einck J, Benedict S, Valicenti R, Cress R. Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. Gynecol Oncol 2018; 150:73-78. [PMID: 29709291 DOI: 10.1016/j.ygyno.2018.04.563] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE The treatment for locally advanced cervical cancer is external beam radiation (EBRT), concurrent chemotherapy, and brachytherapy (BT). We investigated demographic and socioeconomic factors that influence trends in BT utilization and disparities in survival. METHODS Using the California Cancer Registry, cervical cancer patients FIGO IB2-IVA from 2004 to 2014 were identified. We collected tumor, demographic and socioeconomic (SES) factors. We used multivariable logistic regression analysis to determine predictors of use of BT. Using Cox proportional hazards, we examined the impact of BT vs EBRT boost on cause specific (CSS) and overall survival (OS). RESULTS We identified 4783 patients with FIGO stage 11% IB2; 32% II, 54% III, 3% IVA. Nearly half (45%) of patients were treated with BT, 18% were treated with a EBRT boost, and 37% had no boost. Stage II and III were more likely to be treated with BT (p = 0.002 and p = 0.0168) vs Stage IB2. As patients aged, the use of BT decreased. Using multivariate analysis, BT impacted CCS (HR 1.16, p = 0.0330) and OS (HR 1.14, p = 0.0333). Worse CSS was observed for black patients (p = 0.0002), low SES (p = 0.0263), stage III and IVA (p < 0.0001. Black patients, low and middle SES had worse OS, (p = 0.0003). CONCLUSIONS The utilization of BT in locally advanced cervical cancer was low at 45%, with a decrease in CSS and OS. Black patients and those in low SES had worse CSS. As we strive for outcome improvement in cervical cancer, we need to target increasing access and disparities for quality and value.
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Affiliation(s)
| | - Amy Klapheke
- California Cancer Registry, Sacramento, CA, United States
| | | | - I-Chow Hsu
- UCSF Medical Center, San Francisco, CA, United States
| | | | | | | | - John Einck
- UC San Diego, San Diego, CA, United States
| | | | | | - Rosemary Cress
- California Cancer Registry, Sacramento, CA, United States
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Flores G, Portillo A, Lin H, Walker C, Fierro M, Henry M, Massey K. A successful approach to minimizing attrition in racial/ethnic minority, low-income populations. Contemp Clin Trials Commun 2017; 5:168-174. [PMID: 28378019 PMCID: PMC5376068 DOI: 10.1016/j.conctc.2017.01.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Recruiting and retaining minority participants in clinical trials continue to be major challenges. Although multiple studies document lower minority trial enrollment, much less is known about effective minority retention strategies. Our objectives were to evaluate an innovative approach to high RCT retention of minority children, and identify child/caregiver characteristics predicting attrition. METHODS The Kids' HELP trial examined the effects of Parent Mentors on insuring uninsured minority children. We tested a retention strategic framework consisting of: 1) optimizing cultural/linguistic competency; 2) staff training on participant relationships and trust; 3) comprehensive participant contact information; 4) an electronic tracking database; 5) reminders for upcoming outcomes-assessment appointments; 6) frequent, sustained contact attempts for non-respondents; 7) financial incentives; 8) individualized rapid-cycle quality-improvement approaches to non-respondents; 9) reinforcing study importance; and 10) home assessment visits. We compared attrition in Kids' HELP vs. two previous RCTs in similar populations, and conducted bivariate and multivariable analyses of factors associated with Kids' HELP attrition. RESULTS Attrition in Kids' HELP was lower than in two similar RCTs, at 10.9% vs. 37% and 40% (P <0.001). After multivariable adjustment, missing the first outcomes follow-up assessment was the only factor significantly associated with attrition (relative risk=1.5; 95% confidence interval, 1.1-2.0). CONCLUSIONS A retention strategic framework was successful in minimizing attrition in minority, low-income children. Participants missing first assessment appointments were at highest risk of subsequent attrition. These findings suggest that deploying this framework may help RCT retention of low-income minority children, particularly those at the highest risk of subsequent attrition.
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Affiliation(s)
- Glenn Flores
- Medica Research Institute, Minneapolis, MN, United States; Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States; and Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States; address: Medica Research Institute, MR-CW105, P.O. Box 9310, Minneapolis, MN 55440, United States
| | - Alberto Portillo
- Department of Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, NA2.110, Dallas, TX, 75390, United States
| | - Hua Lin
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Candy Walker
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, United States
| | - Marco Fierro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Monica Henry
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Kenneth Massey
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
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Ni Y, Beck AF, Taylor R, Dyas J, Solti I, Grupp-Phelan J, Dexheimer JW. Will they participate? Predicting patients' response to clinical trial invitations in a pediatric emergency department. J Am Med Inform Assoc 2016; 23:671-80. [PMID: 27121609 PMCID: PMC4926740 DOI: 10.1093/jamia/ocv216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/30/2015] [Indexed: 12/27/2022] Open
Abstract
Objective (1) To develop an automated algorithm to predict a patient’s response (ie, if the patient agrees or declines) before he/she is approached for a clinical trial invitation; (2) to assess the algorithm performance and the predictors on real-world patient recruitment data for a diverse set of clinical trials in a pediatric emergency department; and (3) to identify directions for future studies in predicting patients’ participation response. Materials and Methods We collected 3345 patients’ response to trial invitations on 18 clinical trials at one center that were actively enrolling patients between January 1, 2010 and December 31, 2012. In parallel, we retrospectively extracted demographic, socioeconomic, and clinical predictors from multiple sources to represent the patients’ profiles. Leveraging machine learning methodology, the automated algorithms predicted participation response for individual patients and identified influential features associated with their decision-making. The performance was validated on the collection of actual patient response, where precision, recall, F-measure, and area under the ROC curve were assessed. Results Compared to the random response predictor that simulated the current practice, the machine learning algorithms achieved significantly better performance (Precision/Recall/F-measure/area under the ROC curve: 70.82%/92.02%/80.04%/72.78% on 10-fold cross validation and 71.52%/92.68%/80.74%/75.74% on the test set). By analyzing the significant features output by the algorithms, the study confirmed several literature findings and identified challenges that could be mitigated to optimize recruitment. Conclusion By exploiting predictive variables from multiple sources, we demonstrated that machine learning algorithms have great potential in improving the effectiveness of the recruitment process by automatically predicting patients’ participation response to trial invitations.
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Affiliation(s)
- Yizhao Ni
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Andrew F Beck
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Regina Taylor
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Jenna Dyas
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Imre Solti
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Jacqueline Grupp-Phelan
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | - Judith W Dexheimer
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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duPont NC, Mahoney MC, Kahn LS, Vest BM, Widman CA, Clark-Hargrave NS, Erwin DO. Developing a Smoking Cessation Intervention for Low Income and Minority Women. JOURNAL OF WOMEN'S HEALTH CARE 2016; 5:309. [PMID: 28824830 PMCID: PMC5558895 DOI: 10.4172/2167-0420.1000309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this qualitative pilot study was to elicit patient and provider feedback on how to develop a smoking cessation program for low income women with cervical dysplasia in an urban Women's Health Center. METHODS A community-based participatory research project incorporating a focus group and structured interviews was utilized to elicit feedback on how to develop a culturally appropriate smoking cessation program appealing to low-income and minority women smokers. RESULTS Qualitative data from 13 patients, 4 nurses, and 6 staff members collected between January 2012-August 2012 described the challenges of finding effective mechanisms for cessation interventions that met the schedules and needs of low income and minority patients. Input from office staff indicated insufficient educational resources to offer patients, limited skills to assist patients and the importance of perceived patient readiness to quit as barriers to creating an effective smoking cessation program. CONCLUSION Smoking cessation services targeting low-income and minority female smokers can be enhanced by providing clinic staff with patient education materials and smoking cessation training.
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Affiliation(s)
- Nefertiti C duPont
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Martin C Mahoney
- Departments of Medicine and Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Linda S Kahn
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Christy A Widman
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Nikia S Clark-Hargrave
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
| | - Deborah O Erwin
- Division of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York, USA
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Harter G, Darden J, McMenemy N, McElvy T, Hendrich A. Consent and enrollment process: achieving high enrollment rates for obstetric research. Appl Nurs Res 2015; 29:101-6. [PMID: 26856497 DOI: 10.1016/j.apnr.2015.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
AIM The aim was to study the development, design, and implementation of a patient consent and enrollment initiative to identify strategies that enhanced participation. BACKGROUND Consent and enrollment of patients, especially pregnant women, remains a challenge in healthcare research. Although many barriers have been identified, strategies to consistently improve consent and enrollment are less defined. METHODS A case study was conducted on a consent and enrollment approach aimed at optimizing participation of mothers who delivered their infants from July 1, 2010 through June 30, 2013. Data were gathered through practitioner interviews, focus groups, and documentation review for each year of the study. RESULTS A total of 19,236 mothers enrolled, representing an 85% enrollment rate at the five study sites. Enrollment rates improved over time with increased nursing engagement in patient recruitment, site specific adaptations and patient education strategies. CONCLUSIONS Nursing's active role in implementation and rapid feedback loop of a multifaceted consent and enrollment program showed promise.
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Affiliation(s)
| | | | - Nancy McMenemy
- St. John Hospital and Medical Center, Detroit, MI 48236, USA
| | - Tiffany McElvy
- Sacred Heart Hospital of Pensacola, Pensacola, FL 32504, USA
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Wenzel L, Osann K, Hsieh S, Tucker JA, Monk BJ, Nelson EL. Psychosocial telephone counseling for survivors of cervical cancer: results of a randomized biobehavioral trial. J Clin Oncol 2015; 33:1171-9. [PMID: 25713429 DOI: 10.1200/jco.2014.57.4079] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Survivors of cervical cancer experience quality-of-life (QOL) disruptions that persist years after treatment. This study examines the effect of a psychosocial telephone counseling (PTC) intervention on QOL domains and associations with biomarkers. PATIENTS AND METHODS We conducted a randomized clinical trial in survivors of cervical cancer, who were ≥ 9 and less than 30 months from diagnosis (n = 204), to compare PTC to usual care (UC). PTC included five weekly sessions and a 1-month booster. Patient-reported outcomes (PROs) and biospecimens were collected at baseline and 4 and 9 months after enrollment. Changes in PROs over time and associations with longitudinal change in cytokines as categorical variables were analyzed using multivariable analysis of variance for repeated measures. RESULTS Participant mean age was 43 years; 40% of women were Hispanic, and 51% were non-Hispanic white. Adjusting for age and baseline scores, participants receiving PTC had significantly improved depression and improved gynecologic and cancer-specific concerns at 4 months compared with UC participants (all P < .05); significant differences in gynecologic and cancer-specific concerns (P < .05) were sustained at 9 months. Longitudinal change in overall QOL and anxiety did not reach statistical significance. Participants with decreasing interleukin (IL) -4, IL-5, IL-10, and IL-13 had significantly greater improvement in QOL than those with increasing cytokine levels. CONCLUSION This trial confirms that PTC benefits mood and QOL cancer-specific and gynecologic concerns for a multiethnic underserved population of survivors of cancer. The improvement in PROs with decreases in T-helper type 2 and counter-regulatory cytokines supports a potential biobehavioral pathway relevant to cancer survivorship.
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Affiliation(s)
- Lari Wenzel
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Kathryn Osann
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Susie Hsieh
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jo A Tucker
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Bradley J Monk
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Edward L Nelson
- Lari Wenzel, Kathryn Osann, Susie Hsieh, Jo A. Tucker, and Edward L. Nelson, University of California Irvine, Irvine, CA; and Bradley J. Monk, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ
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Effectiveness of a 12-month randomized clinical trial to increase physical activity in multiethnic postpartum women: results from Hawaii's Nā Mikimiki Project. Prev Med 2014; 69:214-23. [PMID: 25285751 PMCID: PMC4312232 DOI: 10.1016/j.ypmed.2014.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/16/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Few postpartum ethnic minority women perform leisure-time moderate-to-vigorous physical activity (MVPA). The study tested the effectiveness of a 12-month tailored intervention to increase MVPA in women with infants 2-12months old. METHODS From 2008 to 2011, women (n=311) with infants (average age=5.7months) from Honolulu, Hawaii were randomly assigned to receive tailored telephone calls and access to a mom-centric website (n=154) or access to a standard PA website (n=157). MVPA was measured at baseline, 6, and 12months using self-report and acclerometers. RESULTS Controlling for covariates, the tailored condition significantly increased self-reported MVPA from an average of 44 to 246min/week compared with 46 to 156min/week for the standard condition (p=0.027). Mothers with≥2 children had significantly greater increases in MVPA in response to the tailored intervention than those with one child (p=0.016). Accelerometer-measured MVPA significantly increased over time (p=0.0001), with no condition differences. There was evidence of reactivity to initially wearing accelerometers; the tailored intervention significantly increased MVPA among women with low baseline accelerometer MVPA minutes, but not among those with high minutes (pinteraction=0.053). CONCLUSION A tailored intervention effectively increased MVPA over 12months in multiethnic women with infants, particularly those with more than one child.
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Iwelunmor J, Newsome V, Airhihenbuwa CO. Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. ETHNICITY & HEALTH 2014; 19:20-46. [PMID: 24266638 PMCID: PMC4589260 DOI: 10.1080/13557858.2013.857768] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This paper reviews available studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. METHODS We search electronic databases and conducted a thematic analysis of empirical studies that applied the PEN-3 cultural model to address the impact of culture on health behaviors. Studies were mapped to describe their methods, target population and the health behaviors or health outcomes studied. Forty-five studies met the inclusion criteria. RESULTS The studies reviewed used the PEN-3 model as a theoretical framework to centralize culture in the study of health behaviors and to integrate culturally relevant factors in the development of interventions. The model was also used as an analysis tool, to sift through text and data in order to separate, define and delineate emerging themes. PEN-3 model was also significant with exploring not only how cultural context shapes health beliefs and practices, but also how family systems play a critical role in enabling or nurturing positive health behaviors and health outcomes. Finally, the studies reviewed highlighted the utility of the model with examining cultural practices that are critical to positive health behaviors, unique practices that have a neutral impact on health and the negative factors that are likely to have an adverse influence on health. DISCUSSION The limitations of model and the role for future studies are discussed relative to the importance of using PEN-3 cultural model to explore the influence of culture in promoting positive health behaviors, eliminating health disparities and designing and implementing sustainable public health interventions.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Valerie Newsome
- Behavioral Science Training, National Development and Research Institutes, New York, NY, USA
| | - Collins O. Airhihenbuwa
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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Schapira MM, Mackenzie ER, Lam R, Casarett D, Seluzicki CM, Barg FK, Mao JJ. Breast cancer survivors willingness to participate in an acupuncture clinical trial: a qualitative study. Support Care Cancer 2013; 22:1207-15. [PMID: 24362843 DOI: 10.1007/s00520-013-2073-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Acupuncture is a complementary and alternative medicine (CAM) modality that shows promise as a component of supportive breast cancer care. Lack of robust recruitment for clinical trial entry has limited the evidence base for acupuncture as a treatment modality among breast cancer survivors. The objective of this study is to identify key decision-making factors among breast cancer survivors considering entry into an acupuncture clinical trial for treatment of symptoms. METHODS Semistructured interviews were conducted among African-American (n=12) and Caucasian (n=13) breast cancer survivors. Verbatim transcripts were made and analyzed by two or more independent coders using NVivo software. Major recurring themes were identified and a theoretical framework developed. RESULTS Six themes emerged reflecting key attributes of the decision to enter a clinical trial: (1) symptom appraisal, (2) practical barriers (e.g., distance and travel), (3) beliefs about the interventions (e.g., fear of needles and dislike of medications), (4) comfort with elements of clinical trial design (e.g., randomization, the nature of the control intervention, and blinding), (5) trust, and (6) altruism. African-American and Caucasian women weighed similar attributes but differed in the information sources sought regarding clinical trial entry and in concerns regarding the use of a placebo in a clinical trial. CONCLUSIONS Our findings contribute to the development of a theoretical model of decision making for breast cancer survivors considering participation in a CAM clinical trial. Insights regarding the decision making process can inform interventions to support informed decision making and robust recruitment to CAM trials among cancer survivors.
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Affiliation(s)
- Marilyn M Schapira
- The Philadelphia VA Center for Health Equity Research and Promotion, University of Pennsylvania, Philadelphia, PA, USA,
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Nagler RH, Ramanadhan S, Minsky S, Viswanath K. Recruitment and Retention for Community-Based eHealth Interventions with Populations of Low Socioeconomic Position: Strategies and Challenges. THE JOURNAL OF COMMUNICATION 2013; 63:201-220. [PMID: 23439871 PMCID: PMC3579669 DOI: 10.1111/jcom.12008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given persistent communication inequalities, it is important to develop interventions to improve Internet and health literacy among underserved populations. These goals drove the Click to Connect (C2C) project, a community-based eHealth intervention that provided novice computer users of low socioeconomic position (SEP) with broadband Internet access, training classes, a Web portal, and technical support. In this paper, we describe the strategies used to recruit and retain this population, the budgetary implications of such strategies, and the challenges and successes we encountered. Results suggest that personal contact between study staff and participants and provision of in-depth technical support were central to successful recruitment and retention. Such investments are essential to realize the promise of eHealth with underserved populations.
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Affiliation(s)
- Rebekah H Nagler
- Department of Society, Human Development, and Health, Harvard School of Public Health and Center for Community-Based Research, Dana-Farber Cancer Institute
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Hui D, Glitza I, Chisholm G, Yennu S, Bruera E. Attrition rates, reasons, and predictive factors in supportive care and palliative oncology clinical trials. Cancer 2012; 119:1098-105. [PMID: 23132290 DOI: 10.1002/cncr.27854] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/15/2012] [Accepted: 08/30/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Attrition is common among supportive care/palliative oncology clinical trials. However, to the authors' knowledge, few studies to date have documented the reasons and predictors for dropout. In the current study, the authors' objective was to determine the rate, reasons, and factors associated with attrition both before reaching the primary endpoint and at the end of the study. METHODS A review of all prospective interventional supportive care/palliative oncology trials conducted in the Department of Palliative Care and Rehabilitation Medicine at The University of Texas MD Anderson Cancer Center in Houston between 1999 and 2011 was performed. Patient and study characteristics and attrition data were extracted. RESULTS A total of 1214 patients were included in 18 clinical trials. The median age of the patients was 60 years. Approximately 41% had an Eastern Cooperative Oncology Group performance status of ≥ 3, a median Edmonton Symptom Assessment Scale (ESAS) for fatigue of 7 of 10, and a median ESAS for dyspnea of 2 of 10. The attrition rate was 26% (95% confidence interval [95% CI], 23%-28%) for the primary endpoint and 44% (95% CI, 41%-47%) for the end of the study. Common reasons for primary endpoint dropout were symptom burden (21%), patient preference (15%), hospitalization (10%), and death (6%). Primary endpoint attrition was associated with a higher baseline intensity of fatigue (odds ratio [OR], 1.10 per point; P = .01) and a longer study duration (P = .04). End-of-study attrition was associated with higher baseline levels of dyspnea (OR, 1.06; P = .01), fatigue (OR, 1.08; P = .01), Hispanic race (OR, 1.87; P = .002), higher level of education (P = .02), longer study duration (P = .01), and outpatient studies (P = 0.05). CONCLUSIONS The attrition rate was high in supportive care/palliative oncology clinical trials, and was associated with various patient characteristics and a high baseline symptom burden. These findings have implications for future clinical trial design including eligibility criteria and sample size calculation.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Vuchinich S, Flay BR, Aber L, Bickman L. Person mobility in the design and analysis of cluster-randomized cohort prevention trials. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:300-13. [PMID: 22249907 DOI: 10.1007/s11121-011-0265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Person mobility is an inescapable fact of life for most cluster-randomized (e.g., schools, hospitals, clinic, cities, state) cohort prevention trials. Mobility rates are an important substantive consideration in estimating the effects of an intervention. In cluster-randomized trials, mobility rates are often correlated with ethnicity, poverty and other variables associated with disparity. This raises the possibility that estimated intervention effects may generalize to only the least mobile segments of a population and, thus, create a threat to external validity. Such mobility can also create threats to the internal validity of conclusions from randomized trials. Researchers must decide how to deal with persons who leave study clusters during a trial (dropouts), persons and clusters that do not comply with an assigned intervention, and persons who enter clusters during a trial (late entrants), in addition to the persons who remain for the duration of a trial (stayers). Statistical techniques alone cannot solve the key issues of internal and external validity raised by the phenomenon of person mobility. This commentary presents a systematic, Campbellian-type analysis of person mobility in cluster-randomized cohort prevention trials. It describes four approaches for dealing with dropouts, late entrants and stayers with respect to data collection, analysis and generalizability. The questions at issue are: 1) From whom should data be collected at each wave of data collection? 2) Which cases should be included in the analyses of an intervention effect? and 3) To what populations can trial results be generalized? The conclusions lead to recommendations for the design and analysis of future cluster-randomized cohort prevention trials.
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Affiliation(s)
- Sam Vuchinich
- School of Social and Behavioral Health Sciences, Oregon State University, 314 Milam Hall, Corvallis, OR 97331, USA.
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Lee JY, Lensing SY, Schwebke JR. Retention of clinical trial participants in a study of nongonococcal urethritis (NGU), a sexually transmitted infection in men. Contemp Clin Trials 2012; 33:606-10. [PMID: 22261236 PMCID: PMC3346855 DOI: 10.1016/j.cct.2011.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/22/2011] [Accepted: 12/21/2011] [Indexed: 11/24/2022]
Abstract
Nongonococcal urethritis (NGU), an inflammation of the urethra not caused by gonorrhea, is the most common urethritis syndrome seen in men in the United States. It is a sexually transmitted infection commonly caused by Chlamydia trachomatis, a pathogen which occurs more frequently in African-American men compared to white men. The purpose of this study was to investigate factors related to retention of study participants in a randomized, double-blinded clinical trial that evaluated four treatment regimens for the treatment of NGU. After the one-week treatment period, follow-up visits were scheduled during days 15-19 and days 35-45. Participants were phoned prior to scheduled appointments to encourage attendance, and contacted after missed appointments to reschedule their clinic visits. Of the 305 male study participants, 298 (98%) were African-American, 164 (54%) were 25 years of age or younger, and 80 (31%) had a post-secondary school education. The overall retention rate was 75%. Factors associated with study completion were educational level attained and clinical center. Participants with higher levels of education were more likely to complete the study. Clinical centers with the highest retention rates also provided the highest monetary incentives for participation. The retention rate for this study suggests that strategies are needed for improving the proportion of study participants that complete a clinical trial among young men with a sexually transmitted disease. These strategies may include increasing contacts with study participants to remind them of scheduled study visits using text messaging or social media and the use of financial incentives.
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Affiliation(s)
- Jeannette Y. Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, #781, Little Rock, Arkansas 72205,
| | - Shelly Y. Lensing
- University of Arkansas for Medical Sciences, 4301 West Markham, #781, Little Rock, Arkansas 72205,
| | - Jane R. Schwebke
- University of Alabama at Birmingham, ZRB 239, 1530 3RD Avenue South, Birmingham, Alabama 35294-0007,
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