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Racial disparities in pancreatic cancer clinical trials: Defining the problem and identifying solutions. Adv Cancer Res 2023. [DOI: 10.1016/bs.acr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Huang YJ, Acquati C, Cheung M. Family communication and coping among racial-ethnic minority cancer patients: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e605-e620. [PMID: 34716631 DOI: 10.1111/hsc.13623] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
The ability to actively cope with cancer has been extensively associated with better patient-reported outcomes (PROs). This systematic review aims to synthesise the available literature assessing the experience of cancer patients from racial-ethnic minoritised groups. Given the role of sociocontextual factors, greater emphasis was placed on the relationship between family communication and cancer patients' coping within the three largest racial-ethnic minority groups in the United States. Five databases (CINAHL, MEDLINE, PsycINFO, PubMed, Web of Science) were used to search for peer-reviewed empirical studies published between 2008 and 2021, investigating family communication patterns, coping, and well-being among Black/African American, Asian, and Hispanic/Latinx cancer survivors. Short reports, chapters, abstracts/summaries, systematic reviews, and conference proceedings were excluded. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The Criteria for Critically Appraising Systematic Reviews and Meta-Analyses were used to assess the quality and risk of bias in the included studies. The synthesis process focused on study aims, methods, measures of interests, sample characteristics, data analysis, and study findings. A total of 117 articles were identified, of which 9 met the inclusion criteria. The selected articles were cross-sectional, implementing both quantitative and qualitative designs. Studies included breast, prostate, and mixed cancer types. Sample sizes of quantitative studies ranged from 64 to 338 respondents, while qualitative studies' samples ranged between 9 and 43 participants. Family communication and coping styles varied across minoritised groups, with open family communication contributing to effective individual and family coping. However, empirical evidence about the nature and contribution of family communication to the coping process is sparse. Future research is needed to increase knowledge and psychosocial assessment techniques and interventions targeting family communication and coping among minority communities.
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Affiliation(s)
- Yu-Ju Huang
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
- Department of Health Disparities Research, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Monit Cheung
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
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Hamel LM, Moulder R, Ramseyer FT, Penner LA, Albrecht TL, Boker S, Eggly S. Nonverbal Synchrony: An Indicator of Clinical Communication Quality in Racially-Concordant and Racially-Discordant Oncology Interactions. Cancer Control 2022; 29:10732748221113905. [PMID: 35801386 PMCID: PMC9272474 DOI: 10.1177/10732748221113905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this cross-sectional study was to apply a novel software to
measure and compare levels of nonverbal synchrony, as a potential indicator
of communication quality, in video recordings of racially-concordant and
racially-discordant oncology interactions. Predictions include that the
levels of nonverbal synchrony will be greater during racially-concordant
interactions than racially-discordant interactions, and that levels of
nonverbal synchrony will be associated with traditional measures of
communication quality in both racially-concordant and racially-discordant
interactions. Design This is a secondary observational analysis of video-recorded oncology
treatment discussions collected from 2 previous studies. Setting Two National Cancer Institute-designated Comprehensive Cancer Centers and
another large urban cancer center. Participants Participants from Study 1 include 161 White patients with cancer and 11 White
medical oncologists. Participants from Study 2 include 66
Black/African-American patients with cancer and 17 non-Black medical
oncologists. In both studies inclusion criteria for patients was a recent
cancer diagnosis; in Study 2 inclusion criteria was identifying as
Black/African American. Main outcome measures Nonverbal synchrony and communication quality. Results Greater levels of nonverbal synchrony were observed in racially-discordant
interactions than in racially-concordant interactions. Levels of nonverbal
synchrony were associated with indicators of communication quality, and
these associations were more consistently found in racially-discordant
interactions. Conclusion This study advances clinical communication and disparities research by
successfully applying a novel approach capturing the unconscious nature of
communication, and revealing differences in communication in
racially-discordant and racially-concordant oncology interactions. This
study highlights the need for further exploration of nonverbal aspects
relevant to patient-physician interactions.
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Affiliation(s)
- Lauren M Hamel
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | | | - Louis A Penner
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | | | - Steven Boker
- 2358University of Virginia, Charlottesville, VA, USA
| | - Susan Eggly
- 12267Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Hamel LM, Moulder R, Harper FWK, Penner LA, Albrecht TL, Eggly S. Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists. Cancer 2020; 127:1080-1090. [PMID: 33290592 DOI: 10.1002/cncr.33352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although communication quality is associated with patient outcomes, racial disparities in communication exist, disproportionately burdening Black patients. However, most communication research focuses on verbal behaviors in predominantly White patient populations. We used a newly developed and theory-guided network analysis that examines the dynamic interplay and behavioral convergence and divergence between Black patients with cancer and their oncologists during cancer treatment discussions. METHODS We applied a nonverbal behavioral coding system to thin slices of video recordings of Black patients and their oncologists discussing treatment. We then estimated 3 networks: 1) a temporal network to determine whether a nonverbal behavior predicts another nonverbal behavior at the next time point in an interaction, and how much each nonverbal behavior influences other nonverbal behaviors and is influenced by other nonverbal behaviors; 2) a contemporaneous network to determine whether a nonverbal behavior co-occurs with other nonverbal behaviors at the same time point in an interaction; and 3) a between-dyads network to examine the covariation between nonverbal behaviors across all dyads. RESULTS Black patients (n = 74) and their non-Black physicians (n = 15) showed a mix of convergence and divergence in their nonverbal behaviors at the same points in time, from one time point to the next, and across dyads. Across analyses, convergence was most likely to occur when physicians matched their behaviors to their patients; especially with smiling, gaze, leaning, and laughter behaviors. CONCLUSION Our findings reveal patterns of modifiable behaviors that can potentially inform interventions to reduce disparities in clinical communication and, in turn, treatment and mortality disparities.
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Affiliation(s)
- Lauren M Hamel
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Felicity W K Harper
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Louis A Penner
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Terrance L Albrecht
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
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Kynoch K, Ramis MA, Crowe L, Cabilan CJ, McArdle A. Information needs and information seeking behaviors of patients and families in acute healthcare settings: a scoping review. ACTA ACUST UNITED AC 2020; 17:1130-1153. [PMID: 31192898 DOI: 10.11124/jbisrir-2017-003914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this scoping review was to explore the information needs and information seeking behaviors of patients and families from healthcare providers in acute healthcare settings in existing literature. INTRODUCTION A well-informed family can be crucial to a patient's capacity to cope with their diagnosis and hospital care during acute or chronic illness. Information is therefore critical to both the patient's and family's understanding of the illness and healthcare process. Providing appropriate and timely information can empower patients and families with knowledge and alleviate the anxiety and stress associated with a hospital admission. However, acutely ill patients and families in different acute care settings have considerable and differing information needs. INCLUSION CRITERIA This scoping review included studies undertaken in acute healthcare facilities where patients were over 18 years of age and family members were of any sex, culture and ethnicity. Family was defined as anyone connected to the patient by blood, marriage or other significant relationship. Healthcare provider perspectives of family and patient information needs were excluded. Concepts related to type of information, timing of information, preferences for who delivers the information and method of information delivery. Qualitative and quantitative study designs published from 2010 to 2017 in English were included. METHODS Multiple databases were searched to find published and unpublished studies. A three-step search strategy was utilized. A charting table was developed for the data extraction process to record data relating to the review objectives. Specific data extracted included details on research design, geographical location, year of publication, characteristics of study population, research aims and outcomes as well as key findings related to patient and family information needs. RESULTS The scoping review included 109 studies from across 34 countries. Of these studies, 68 used quantitative research designs, 29 were qualitative in nature and 12 included studies reported using mixed methods. One study used an action research methodology. Nine studies were specific to family information needs. A majority of studies were conducted in the cancer care context, with other acute settings comprising intensive care units, surgical settings and individual medical or surgical units/wards within and across the hospital. While most of the included studies addressed the type of content patients and/or families prefer, a few studies explored the timing of information provision. CONCLUSIONS The international literature on information needs of patient and families comprises multiple published studies on differing aspects of the topic and situated within various acute care contexts. Despite the broad nature of the research, studies suggest that preferences regarding information content, timing of information delivery and choices regarding who delivers information vary across contexts and according to the patient/family member. The complexity behind this variation and strategies to address tailoring information delivery requires further in-depth research.
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Affiliation(s)
- Kate Kynoch
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Mary-Anne Ramis
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | - Linda Crowe
- Evidence in Practice Unit, Mater Misericordiae Limited, South Brisbane, Australia.,The Queensland Centre for Evidence Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence
| | | | - Annie McArdle
- Parent Education and Support Services, Mater Mothers' Hospital, South Brisbane, Australia
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Mpody C, Humphrey L, Kim S, Tobias JD, Nafiu OO. Racial Differences in Do-Not-Resuscitate Orders among Pediatric Surgical Patients in the United States. J Palliat Med 2020; 24:71-76. [PMID: 32543271 DOI: 10.1089/jpm.2020.0053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few studies have investigated the racial differences in do-not-resuscitate (DNR) orders in children, and these studies are limited to oncological cases. We aim to characterize the racial difference in DNR orders among U.S. pediatric surgical patients. Methods: We retrospectively evaluated the mortality of all children who underwent an inpatient surgery between 2012 and 2017 from the National Surgical Quality Improvement Program. We used log-binomial models to estimate the relative risk (RR) and 95% confidence interval (CI) of DNR use comparing white with African American (AA) children. To estimate the risk-adjusted difference in DNR orders, we controlled the analyses for age, prematurity status, emergent case status, American Society of Anesthesiologists class, year of operation, surgical specialty, and surgical complexity. Results: Between 2012 and 2017, a total of 276,917 children underwent inpatient surgery, of whom 0.8% (n = 1601) died within 30 days of operation. Of the 1601 mortality cases, we retained 1212 children who were of either AA (26.0%, n = 350) or white (63.9%, n = 862) race. Most children were neonates, had an American Society of Anesthesiologists class ≥4 (70.0%, n = 811), and developed one or more postoperative complications (68.7%, n = 833). Overall, AA children were more likely to be neonates at the time of surgery (42.0% vs. 40.3%, p < 0.001), to be premature (66.3% vs. 49.0%, p < 0.001), and develop one or more postoperative complications (73.7% vs. 66.7%, p = 0.017). White children were three times more likely to have a DNR order than their AA peers (adjusted RR: 3.01, 95% CI: 1.09-8.56, p = 0.044). Conclusion: Among pediatric surgical patients in the United States, children of white race were three times more likely to have a DNR order in place than their AA peers despite the latter being "sicker" and more likely to develop postoperative complications. The mechanisms underlying this racial difference deserve further elucidation to improve shared decision making and goal-concordant care.
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Affiliation(s)
- Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Humphrey
- Division of Palliative Care, Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Stephani Kim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
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Isaac EI, Meisman AR, Drucker K, Violante S, Behrhorst KL, Floyd A, Rohan JM. The Relationship between Health Disparities, Psychosocial Functioning and Health Outcomes in Pediatric Hematology-Oncology and Stem Cell Transplant Populations: Recommendations for Clinical Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2218. [PMID: 32224963 PMCID: PMC7178256 DOI: 10.3390/ijerph17072218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
Not only do racial and ethnic minority children and adolescents with chronic illness experience disparities in health status and health outcomes, they also experience significant healthcare disparities, including differences in healthcare coverage, access to care, and quality of care. It is well known that the interaction between psychosocial functioning, health behaviors and ethnic and racial disparities, ultimately leads to worse health and psychosocial outcomes in pediatric and AYA chronic illness patient populations, including increased rates of morbidity and mortality. Investigating the impact of racial and ethnic factors on health outcomes, and strategies for reducing these disparities, is of the utmost importance, specifically in life-threatening conditions like cancer and sickle cell disease. This commentary underscores the relative importance of identifying factors that could reduce disparities between minority and non-minority populations. This present paper will focus on the dynamic relationships between health disparities, psychosocial factors and health outcomes within pediatric cancer, sickle cell disease and bone marrow transplant populations, and will offer recommendations for healthcare professionals working with these vulnerable patient populations. The primary goal of this commentary is to provide recommendations for enhancing cultural competency and humility for those working with highly vulnerable patient populations.
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Affiliation(s)
- Evrosina I. Isaac
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
| | - Andrea R. Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Kirstin Drucker
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
| | - Stephanie Violante
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kathryn L. Behrhorst
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Alfonso Floyd
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA; (S.V.); (K.L.B.); (A.F.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer M. Rohan
- Virginia Commonwealth University School of Medicine, 1201 E. Marshall St #4-100, Richmond, VA 23298, USA; (K.D.); (J.M.R.)
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
- Massey Cancer Center Virginia Commonwealth University, Richmond, VA 23298, USA
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Sisk BA, Kang TI, Mack JW. Racial and Ethnic Differences in Parental Decision-Making Roles in Pediatric Oncology. J Palliat Med 2019; 23:192-197. [PMID: 31408409 DOI: 10.1089/jpm.2019.0178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prior work in adult oncology suggests minority patients are less involved in decision making than preferred. However, few studies have explored decision-making experiences of minority parents in pediatric oncology. Objective: To determine whether parental decision-making preferences and experiences vary by race/ethnicity. Design: Questionnaire-based cohort study. Setting/Subjects: Three hundred sixty five parents of children with cancer and their oncologists at two academic centers. Measurements: Parents reported on preferred and actual decision-making roles. Associations between race/ethnicity and decision-making outcomes determined by chi-squared test. Results: Most parents preferred shared decision making (235/368, 64%), whereas 23% (84/368) preferred parent-led decision making and 13% (49/368) preferred oncologist-led decision making. Parental decision-making preferences did not differ by race/ethnicity (p = 0.38, chi-squared test). However, the actual role parents played in decision making differed by parental race/ethnicity, with 25% (71/290) of white parents reporting parent-led decision making, versus 37% (9/24) of black parents, 48% (13/27) of Hispanic parents, and 56% (15/27) of Asian/other parents (p = 0.005, chi-squared test). Oncologists accurately predicted parental preferences for decision making 49% of the time (n = 165/338), but accuracy also differed by race and ethnicity. Oncologists accurately predicted parental preferences for 53% of white parents (140/266), 23% of black parents (5/22), 37% of Hispanic parents (10/27), and 43% of Asian/other race parents (10/23) (p = 0.026, chi-squared test). Conclusions: Minority parents held more active roles than white parents, and oncologists had more difficulty predicting decisional preferences for minority parents relative to white parents. These findings suggest that minority parents are at risk of inferior decision-making experiences.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Tammy I Kang
- Section of Pediatric Palliative Care, Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jennifer W Mack
- Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Hamel LM, Moulder R, Albrecht TL, Boker S, Eggly S, Penner LA. Nonverbal synchrony as a behavioural marker of patient and physician race-related attitudes and a predictor of outcomes in oncology interactions: protocol for a secondary analysis of video-recorded cancer treatment discussions. BMJ Open 2018; 8:e023648. [PMID: 30518586 PMCID: PMC6286484 DOI: 10.1136/bmjopen-2018-023648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Racial disparities in cancer treatment contribute to racial disparities in mortality rates. The quality of patient-physician communication during clinical interactions with black patients and non-black physicians (racially discordant) is poorer than communication quality with white patients (racially concordant). Patient and physician race-related attitudes affect the quality of this communication. These attitudes are likely expressed through subtle non-verbal behaviours, but prior research has not examined these behaviours. Nonverbal synchrony, the coordination of physical movement, reflects the preinteraction attitudes of participants in interactions and predicts their postinteraction perceptions of and affect towards one another. In this study, peer reviewed and funded by the National Institute of Minority Health and Health Disparities (R21MD011766), we will investigate non-verbal synchrony in racially concordant and discordant interactions to better understand racial disparities in clinical communication. METHODS AND ANALYSIS This secondary analysis includes racially concordant (n=163) and racially discordant (n=68) video-recorded oncology interactions, patient and oncologist self-reported race-related attitudes, perceptions of the interaction and observer ratings of physician patient-centred communication and patient and physician affect and rapport. In aim 1, we will assess and compare non-verbal synchrony between physicians and patients in racially concordant and discordant interactions. In aim 2, we will determine the influence of non-verbal synchrony on patient and physician affect and communication. In aim 3, we will examine possible causes (ie, race-related attitudes) and consequences (ie, negative perceptions) of non-verbal synchrony in racially discordant interactions. In aim 4, we will develop and test a mediational model linking physician and patient race-related attitudes to non-verbal synchrony and, in turn, interaction outcomes. ETHICS AND DISSEMINATION The parent and current studies were approved by the Wayne State University Institutional Review Board. Since only archival data will be used, ethical or safety risks are low. We will disseminate our findings to relevant conferences and journals.
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Affiliation(s)
- Lauren M Hamel
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Terrance L Albrecht
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Louis A Penner
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
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10
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Asare M, Peppone LJ, Roscoe JA, Kleckner IR, Mustian KM, Heckler CE, Guido JJ, Sborov M, Bushunow P, Onitilo A, Kamen C. Racial Differences in Information Needs During and After Cancer Treatment: a Nationwide, Longitudinal Survey by the University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:95-101. [PMID: 27097806 PMCID: PMC5074918 DOI: 10.1007/s13187-016-1038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Before treatment, cancer patients need information about side effects and prognosis, while after treatment they need information to transition to survivorship. Research documenting these needs is limited, especially among racial and ethnic minorities. This study evaluated cancer patients' needs according to race both before and after treatment. We compared white (n = 904) to black (n = 52) patients receiving treatment at 17 National Cancer Institute Community Oncology Research Program (NCORP) sites on their cancer-related concerns and need for information before and after cancer treatment. Two-sample t test and chi-squared analyses were used to assess group differences. Compared to white patients, black patients reported significantly higher concerns about diet (44.3 vs. 25.4 %,) and exercise (40.4 vs. 19.7 %,) during the course of treatment. Compared to whites, blacks also had significantly higher concern about treatment-related issues (white vs. black mean, 25.52 vs. 31.78), self-image issues (7.03 vs. 8.60), family-related issues (10.44 vs. 12.84), and financial concerns (6.42 vs. 8.90, all p < 0.05). Blacks, compared to whites, also had significantly greater post-treatment information needs regarding follow-up tests (8.17 vs. 9.44), stress management (4.12 vs. 4.89), and handling stigma after cancer treatment (4.21 vs. 4.89) [all p < 0.05]. Pre-treatment concerns and post-treatment information needs differed by race, with black patients reporting greater information needs and concerns. In clinical practice, tailored approaches may work particularly well in addressing the needs and concerns of black patients.
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Affiliation(s)
- Matthew Asare
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA.
| | - Luke J Peppone
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Joseph A Roscoe
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Ian R Kleckner
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Karen M Mustian
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Charles E Heckler
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Joseph J Guido
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
| | - Mark Sborov
- Metro Minnesota Community Oncology Research Consortium, Saint Louis Park, USA
| | | | | | - Charles Kamen
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY, 14642, USA
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11
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Hamel LM, Penner LA, Albrecht TL, Heath E, Gwede CK, Eggly S. Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer. Cancer Control 2016; 23:327-337. [PMID: 27842322 PMCID: PMC5131730 DOI: 10.1177/107327481602300404] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. METHODS Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. RESULTS Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. CONCLUSION To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
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Affiliation(s)
- Lauren M Hamel
- Wayne State University, Karmanos Cancer Institute, Department of Oncology, Population Studies Disparities Research Program, Detroit, MI, USA.
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Ko NY, Snyder FR, Raich PC, Paskett ED, Dudley D, Lee JH, Levine PH, Freund KM. Racial and ethnic differences in patient navigation: Results from the Patient Navigation Research Program. Cancer 2016; 122:2715-22. [PMID: 27227342 PMCID: PMC4992408 DOI: 10.1002/cncr.30109] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patient navigation was developed to address barriers to timely care and reduce cancer disparities. The current study explored navigation and racial and ethnic differences in time to the diagnostic resolution of a cancer screening abnormality. METHODS The authors conducted an analysis of the multisite Patient Navigation Research Program. Participants with an abnormal cancer screening test were allocated to either navigation or control. The unadjusted median time to resolution was calculated for each racial and ethnic group by navigation and control. Multivariable Cox proportional hazards models were fit, adjusting for sex, age, cancer abnormality type, and health insurance and stratifying by center of care. RESULTS Among a sample of 7514 participants, 29% were non-Hispanic white, 43% were Hispanic, and 28% were black. In the control group, black individuals were found to have a longer median time to diagnostic resolution (108 days) compared with non-Hispanic white individuals (65 days) or Hispanic individuals (68 days) (P<.0001). In the navigated groups, black individuals had a reduction in the median time to diagnostic resolution (97 days) (P<.0001). In the multivariable models, among controls, black race was found to be associated with an increased delay to diagnostic resolution (hazard ratio, 0.77; 95% confidence interval, 0.69-0.84) compared with non-Hispanic white individuals, which was reduced in the navigated arm (hazard ratio, 0.85; 95% confidence interval, 0.77-0.94). CONCLUSIONS Patient navigation appears to have the greatest impact among black patients, who had the greatest delays in care. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2715-2722. © 2016 American Cancer Society.
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Affiliation(s)
- Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA 02118, (617) 638-8036 phone, (617) 638-8096 fax
| | - Frederick R Snyder
- NOVA Research Company, 801 Roeder Road, Suite 700, Silver Spring, MD 20910
| | - Peter C Raich
- Denver Health, Denver, Colorado; and University of Colorado Denver, Aurora, Colorado, 94 High Meadow Dr., Dillon, CO 80435, (970)468-4763
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, 1590 North High Street, Columbus, OH 43201, (614) 293-3917 phone, (614) 293-5611 fax
| | - Donald Dudley
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22908, (434) 243-6790
| | - Ji-Hyun Lee
- University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico 87131-0001, Phone: 505-272-3718
| | - Paul H. Levine
- The George Washington University School of Public Health; and Health Services; and The George Washington Cancer Institute, 950 New Hampshire Ave. NW 5th Floor, Washington, DC 20052, (202) 994-5330
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, 35 Kneeland Street, Boston, Massachusetts 02111
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Family presence during management of acute deterioration: Clinician attitudes, beliefs and perceptions of current practices. ACTA ACUST UNITED AC 2016; 19:159-65. [DOI: 10.1016/j.aenj.2016.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/15/2022]
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Reinard K, Nerenz DR, Basheer A, Tahir R, Jelsema T, Schultz L, Malik G, Air EL, Schwalb JM. Racial disparities in the diagnosis and management of trigeminal neuralgia. J Neurosurg 2016; 126:368-374. [PMID: 26967783 DOI: 10.3171/2015.11.jns151177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. The authors sought to identify racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN), as well as the potential underlying reasons for those disparities, which could serve as areas of focus for future quality improvement initiatives. METHODS The medical records of patients with an ICD-9 code of 350.1, signifying a diagnosis of TN, at the Henry Ford Medical Group (HFMG) in the period from 2006 to 2012 were searched, and clinical and socioeconomic data were retrospectively reviewed. Analyses were conducted to assess potential racial differences in subspecialty referral patterns and the specific type of treatment modality undertaken for patients with TN. RESULTS The authors identified 652 patients eligible for analysis. Compared with white patients, black patients were less likely to undergo percutaneous ablative procedures, stereotactic radiosurgery, or microvascular decompression (p < 0.001). However, there was no difference in the likelihood of blacks and whites undergoing a procedure once they had seen a neurosurgeon (67% vs 70%, respectively; p = 0.712). Blacks and whites were equally likely to be seen by a neurologist or neurosurgeon if they were initially seen in either the emergency room (38% vs 37%, p = 0.879) or internal medicine (48% vs 50%, p = 0.806). Among patients diagnosed (268 patients) after the 2008 publication of the European Federation of Neurological Societies and the American Academy of Neurology guidelines for medical therapy for TN, fewer than 50% were on medications sanctioned by the guidelines, and there were no statistically significant racial disparities between white and black patients (p = 0.060). CONCLUSIONS According to data from a large database from one of the nation's largest comprehensive health care systems, there were significant racial disparities in the likelihood of a patient undergoing a procedure for TN. This appeared to stem from outside HFMG from a difference in referral patterns to the neurologists and neurosurgeons.
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Affiliation(s)
- Kevin Reinard
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Rizwan Tahir
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Timothy Jelsema
- Wayne State University School of Medicine, Detroit, Michigan
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Ghaus Malik
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Ellen L Air
- Department of Neurosurgery, Henry Ford Medical Group, and
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, and.,Wayne State University School of Medicine, Detroit, Michigan
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Eggly S, Barton E, Winckles A, Penner LA, Albrecht TL. A disparity of words: racial differences in oncologist-patient communication about clinical trials. Health Expect 2015; 18:1316-26. [PMID: 23910630 PMCID: PMC3859820 DOI: 10.1111/hex.12108] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients. OBJECTIVE To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African American and White patients. METHODS From an archive of video-recorded oncology visits, we selected all visits with African American patients that included a trial offer (n = 11) and a matched sample of visits with demographically/medically comparable White patients (n = 11). Using mixed qualitative-quantitative methods, we assessed differences by patient race in (i) word count of entire visits and (ii) frequency of mentions and word count of discussions of clinical trials and key elements of consent. RESULTS Visits with African American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation. DISCUSSION AND CONCLUSIONS African American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients. Possible explanations include a less active communication style of African Americans in medical visits, oncologists' concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African American patients, particularly purpose and risks.
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Affiliation(s)
- Susan Eggly
- Department of OncologyWayne State UniversityDetroitMIUSA
| | - Ellen Barton
- Department of EnglishWayne State UniversityDetroitMIUSA
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Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJJA, Scheele F. Factors influencing intercultural doctor-patient communication: a realist review. PATIENT EDUCATION AND COUNSELING 2015; 98:420-45. [PMID: 25535014 DOI: 10.1016/j.pec.2014.11.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/23/2014] [Accepted: 11/17/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works. METHODS A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication. RESULTS In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training. CONCLUSION The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication. PRACTICE IMPLICATIONS Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.
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Affiliation(s)
- Emma Paternotte
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway.
| | - Nadine van der Lee
- Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands.
| | - Albert J J A Scherpbier
- Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Fedde Scheele
- Medical School of Sciences, Vu University Medical Center, Amsterdam, The Netherlands.
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Rousseau SJ, Humiston SG, Yosha A, Winters PC, Loader S, Luong V, Schwartzbauer B, Fiscella K. Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis. Support Care Cancer 2014; 22:3143-51. [PMID: 24890503 PMCID: PMC4221546 DOI: 10.1007/s00520-014-2295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.
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Graves S, Young L, Cousin C. Current Knowledge and Perceptions of Cancer Held by African American Seniors in the District of Columbia. AMERICAN JOURNAL OF HEALTH EDUCATION 2014. [DOI: 10.1080/19325037.2014.901111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Molisani A, Dumenci L, Matsuyama RK. Influences of patient sociodemographics on cancer information received through the first 9 months of treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:158-166. [PMID: 24113903 DOI: 10.1007/s13187-013-0564-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study evaluates the amount and change of information cancer patients report receiving related to disease, diagnostic tests, treatments, physical care, and psychosocial resources over 9 months of treatment. Information received by newly diagnosed, stages II-IV cancer patients receiving treatment (N = 139) at baseline, 4, and 9 months is examined through a two-stage latent growth model. Each information-received category was modeled with latent variables of intercept and slope. Random intercept and slope factors are then regressed on multiple sociodemographic covariates. The mean amount of information received does not change over time, but significant inter-individual variability was observed. Age (younger) and marital status (married) are significantly associated with a higher total amount of information received while education (less) and race (African-American) are significantly associated with slower declines of information received over time. While the mean amount of information cancer patients receive is relatively constant over the course of treatment for the first 9 months, the level and rate of information received is somewhat varied based on patient characteristics. Healthcare professionals need to be aware of the varying amounts of information received by patients and ensure that the amount is consistent with the patient's individual needs.
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Affiliation(s)
- Anthony Molisani
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University (VCU), PO Box 980149, Richmond, VA, 23298-0149, USA,
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Larkin C, Searight HR. A Systematic Review of Cultural Preferences for Receiving Medical “Bad News” in the United States. Health (London) 2014. [DOI: 10.4236/health.2014.616251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Eggly S, Tkatch R, Penner LA, Mabunda L, Hudson J, Chapman R, Griggs JJ, Brown R, Albrecht T. Development of a question prompt list as a communication intervention to reduce racial disparities in cancer treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:282-9. [PMID: 23440665 PMCID: PMC3665702 DOI: 10.1007/s13187-013-0456-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Racial disparities have been found in the use of chemotherapy as cancer treatment. These disparities may be, in part, due to well-documented differences in the quality of communication during clinical interactions with oncologists and Black versus White patients. In this study using a community-based participatory research approach, academic researchers, community members, and oncologists formed a partnership to develop a communication intervention to address racial disparities in cancer care. Partners developed a question prompt list (QPL), a simple tool that can be used to improve communication, and thus treatment, during clinical interactions in which oncologists and Black patients discuss chemotherapy. Partners endorsed the use of a QPL, provided specific suggestions for content and format, conducted and analyzed qualitative interviews with Black patients receiving chemotherapy, and approved the final version. The feasibility and effectiveness of the QPL that resulted from this research process are currently under evaluation in a separate study.
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, MM03CB, Detroit, 48201, MI, USA.
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Sheppard VB, Isaacs C, Luta G, Willey SC, Boisvert M, Harper FWK, Smith K, Horton S, Liu MC, Jennings Y, Hirpa F, Snead F, Mandelblatt JS. Narrowing racial gaps in breast cancer chemotherapy initiation: the role of the patient-provider relationship. Breast Cancer Res Treat 2013; 139:207-16. [PMID: 23588954 PMCID: PMC3662254 DOI: 10.1007/s10549-013-2520-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/01/2013] [Indexed: 10/27/2022]
Abstract
Chemotherapy improves breast cancer survival but is underused more often in black than in white women. We examined associations between patient-physician relationships and chemotherapy initiation and timeliness of initiation among black and white patients. Women with primary invasive, non-metastatic breast cancer were recruited via hospitals (in Washington, DC and Detroit) and community outreach between July 2006 and April 2011. Data were collected via telephone interviews and medical records. Logistic regression models evaluated associations between chemotherapy initiation and independent variables. Since there were race interactions, analyses were race-stratified. Factors associated with time from surgery to chemotherapy initiation and delay of ≥90 days were evaluated with linear and logistic regressions, respectively. Among eligible women, 82.8 % were interviewed and 359 (90.9 %) of those had complete data. The odds of initiating chemotherapy were 3.26 times (95 % CI: 1.51, 7.06) higher among black women reporting greater communication with physicians (vs. lesser), after considering covariates. In contrast, the odds of starting chemotherapy were lower for white women reporting greater communication (vs. lesser) (adjusted OR 0.22, 95 % CI: 0.07, 0.73). The opposing direction of associations was also seen among the sub-set of black and white women with definitive clinical indications for chemotherapy. Among those initiating treatment, black women had longer mean time to the start of chemotherapy than whites (71.8 vs. 55.0 days, p = 0.005), but race was not significant after considering trust in oncologists, where initiation time decreased as trust increased, controlling for covariates. Black women were also more likely to delay ≥90 days than whites (27 vs. 8.3 %; p = 0.024), but this was not significant after considering religiosity. The patient-physician dyad and sociocultural factors may represent leverage points to improve chemotherapy patterns in black women.
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Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program, Lombardi Comprehensive Cancer Center and Department of Oncology, Georgetown University, 3300 Whitehaven St. NW, Suite 4100, Washington, DC 20007, USA.
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Matsuyama RK, Kuhn LA, Molisani A, Wilson-Genderson MC. Cancer patients' information needs the first nine months after diagnosis. PATIENT EDUCATION AND COUNSELING 2013; 90:96-102. [PMID: 23058682 DOI: 10.1016/j.pec.2012.09.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/22/2012] [Accepted: 09/22/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Cancer patients' information needs about disease, diagnostic tests, treatments, physical care, and psychosocial resources during treatment are examined. METHODS Information needs of newly diagnosed, Stages II-IV cancer patients receiving treatment (N=138) were studied over nine months. Information needs were assessed using The Toronto Informational Needs Questionnaire (TINQ). There are five subscales for the TINQ: disease, diagnostic tests, treatment, physical and psychosocial. Health literacy and amount of information wanted were also measured. A repeated measures, univariate two-level model for longitudinal data was analyzed. Separate models for each subscale were constructed and covariates were examined simultaneously for associations with information needs. Models were estimated using FIML. RESULTS Although significant reduction of needs was observed over time, total information needs remained high throughout. Gender (women), age (younger), race (African American), education (lesser), and marital status (married) were significantly associated with higher information needs over time. Cancer type and stage were not significantly associated. CONCLUSION Cancer patients' information needs decrease yet remain high over time. Patients' information needs are highest near diagnosis and change throughout the course of their treatment. PRACTICE IMPLICATIONS As patients obtain and understand information, they will continue to need information in new areas relevant to their care.
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Affiliation(s)
- Robin K Matsuyama
- Department of Social and Behavioral Health, Virginia Commonwealth University & Massey Cancer Center, Richmond, VA 23298-0149, USA.
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Lustria MLA, Noar SM, Cortese J, Van Stee SK, Glueckauf RL, Lee J. A meta-analysis of web-delivered tailored health behavior change interventions. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1039-69. [PMID: 23750972 DOI: 10.1080/10810730.2013.768727] [Citation(s) in RCA: 370] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.
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Affiliation(s)
- Mia Liza A Lustria
- College of Communication and Information, Florida State University, Tallahassee, FL, USA.
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Eggly S, Penner LA, Hagiwara N, Gonzalez R, Harper FWK, Heath EI, Albrecht TL. Patient, companion, and oncologist agreement regarding information discussed during triadic oncology clinical interactions. Psychooncology 2012; 22:637-45. [PMID: 22337320 DOI: 10.1002/pon.3045] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/05/2012] [Accepted: 01/17/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although people with cancer want and need information from their oncologists, patients and oncologists often disagree about what information was discussed during clinical interactions. Most patients have companions present during oncology visits; we investigated whether companions process information more accurately than patients. Specifically, we examined whether patients and companions differed in agreement with oncologists about what was discussed. We also investigated the effect of topic on agreement and patient/companion self-reported understanding of discussions. METHODS Patients with companions were invited to participate on first visits to a cancer center in Detroit, MI. Patients, companions, and oncologists independently completed questionnaires immediately following visits. Participants were asked whether five topics were discussed (diagnosis, prognosis, metastasis, treatment/treatment goals, and side effects) and, if discussed, what oncologists said. Participants were also asked to estimate their own and each other's understanding of discussions. RESULTS A total of 66 patient-companion-oncologist triads participated. Agreement was higher regarding whether topics were discussed than what oncologists said. Agreement did not differ by dyad type. Patients, companions, and oncologists were equally likely to be the source of triadic disagreements. Agreement was high about diagnosis (>90%) but much lower about other topics, particularly side effects. Patients and companions reported greater understanding of discussions than oncologists estimated and more accurately estimated each other's understanding than did oncologists. CONCLUSIONS Companions and patients showed similar levels of agreement with oncologists about what they discussed during visits. Interventions are needed to improve communication of information to both patients and companions, especially about particular topics.
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI 48201, USA.
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Kim Y, Evangelista LS, Phillips LR, Pavlish C, Kopple JD. Racial/ethnic differences in illness, perceptions in minority patients undergoing maintenance hemodialysis. Nephrol Nurs J 2012; 39:39-49. [PMID: 22480051 PMCID: PMC3390251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study examined whether racial/ethnic differences in illness perceptions exist among patients on maintenance hemodialysis. One hundred sixty-one patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis (20% African Americans, 44% Hispanics, 9% Filipinos, and 27% Koreans) completed the Revised Illness Perception Questionnaire. Korean participants had higher emotional disturbance than their counterparts, whereas African-American participants had higher negative perceptions of personal intervention or medical treatment controlling their disease. This study indicates that patients from different racial/ethnic backgrounds undergoing maintenance hemodialysis may perceive their disease differently. This phenomenon could affect clinical outcomes and may require different therapeutic approaches.
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Affiliation(s)
- Youngmee Kim
- Chung-Ang University, Red Cross College of Nursing, Seoul, Korea.
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Matsuyama RK, Wilson-Genderson M, Kuhn L, Moghanaki D, Vachhani H, Paasche-Orlow M. Education level, not health literacy, associated with information needs for patients with cancer. PATIENT EDUCATION AND COUNSELING 2011; 85:e229-e236. [PMID: 21543182 DOI: 10.1016/j.pec.2011.03.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients receiving adjuvant therapy encounter increasingly complex situations and decisions with each new procedure and therapy. To make informed decisions about care, they need to be able to access, process, and understand information. Individuals with limited health literacy may not be able to obtain or understand important information about their cancer and treatment. The rate of low health literacy has been shown to be higher among African Americans than among non-Hispanic Whites. This study examined the associations between race, health literacy, and self-reported needs for information about disease, diagnostic tests, treatments, physical care, and psychosocial resources. METHODS Measures assessing information needs were administered to 138 newly diagnosed cancer patients. Demographics were assessed by survey and health literacy was assessed with two commonly used measures: the Rapid Estimate Adult Literacy in Medicine (REALM) and the Short Test of Health Literacy in Adults (STOFHLA). RESULTS Study findings indicate that educational attainment, rather than health literacy, is a significant predictor of information needs. CONCLUSION Overcoming barriers to information needs may be less dependent on literacy considerations and more dependent on issues that divide across levels of educational attainment. PRACTICE IMPLICATIONS Oncologists and hospital staff should be attentive to the fact that many patients require additional assistance to meet their information needs.
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Affiliation(s)
- Robin K Matsuyama
- Department of Social & Behavioral Health, Virginia Commonwealth University, Richmond, VA, USA.
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Lam WWT, Au AHY, Wong JHF, Lehmann C, Koch U, Fielding R, Mehnert A. Unmet supportive care needs: a cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer. Breast Cancer Res Treat 2011; 130:531-41. [DOI: 10.1007/s10549-011-1592-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 05/13/2011] [Indexed: 01/29/2023]
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