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McPhee NJ, Nightingale CE, Harris SJ, Segelov E, Ristevski E. Barriers and enablers to cancer clinical trial participation and initiatives to improve opportunities for rural cancer patients: A scoping review. Clin Trials 2022; 19:464-476. [PMID: 35586873 DOI: 10.1177/17407745221090733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Claire E Nightingale
- Monash Rural Health, Monash University, Bendigo, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel J Harris
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - Eva Segelov
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, VIC, Australia.,Department of Oncology, Monash Health, Clayton, VIC, Australia
| | - Eli Ristevski
- Monash Rural Health, Monash University, Warragul, VIC, Australia
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Perry J, VanDenKerkhof EG, Wilson R, Tripp DA. Guided Internet-based Psycho-educational Intervention Using Cognitive Behavioral Therapy and Self-management for Individuals with Chronic Pain: A Feasibility Study. Pain Manag Nurs 2017; 18:179-189. [PMID: 28433488 DOI: 10.1016/j.pmn.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/06/2016] [Accepted: 12/23/2016] [Indexed: 01/22/2023]
Abstract
When considering barriers to chronic pain treatment, there is a need to deliver nonpharmacological therapies in a way that is accessible to all individuals who may benefit. To conduct feasibility testing using a guided, Internet-based intervention for individuals with chronic pain, a novel, Internet-based, chronic pain intervention (ICPI) was developed, using concepts proven effective in face-to-face interventions. This study was designed to assess usability of the ICPI and feasibility of conducting larger-scale research, and to collect preliminary data on effectiveness of the intervention. Data were collected at baseline, after each of the six intervention modules, and 12 weeks after intervention completion. Forty-one participants completed baseline questionnaires, and 15 completed the 12-week postintervention questionnaires. At baseline, all participants reported satisfaction with the structure of the intervention and ease of use. Internet-based platforms such as Facebook aided in accrual of participants, making further large-scale study of the ICPI feasible. There is preliminary evidence suggesting that the ICPI improves emotional function but not physical function, with a small but significant decrease in pain intensity and pain interference. Most participants felt they benefited at least minimally as a result of using the ICPI. The ICPI was well received by participants and demonstrated positive outcomes in this preliminary study. Further research with more participants is feasible and necessary to fully assess the effect of this intervention.
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Affiliation(s)
- Jennifer Perry
- School of Nursing, Queen's University, Kingston, Ontario, Canada; School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada.
| | - Elizabeth G VanDenKerkhof
- Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Rosemary Wilson
- Department of Anesthesiology and Perioperative Medicine, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Dean A Tripp
- Departments of Psychology, Anesthesiology, and Urology, Queen's University, Kingston, Ontario, Canada
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3
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Chang GJ, Kopetz S. Coordination of care in colon cancer. Cancer 2015; 121:3201-2. [PMID: 26043269 DOI: 10.1002/cncr.29473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/30/2015] [Indexed: 11/09/2022]
Affiliation(s)
- George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Elderly breast and colorectal cancer patients' clinical course: patient and contextual influences. Med Care 2014; 52:809-17. [PMID: 25119954 DOI: 10.1097/mlr.0000000000000180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The social and medical environments that surround people are each independently associated with their cancer course. The extent to which these characteristics may together mediate patients' cancer care and outcomes is not known. METHODS Using multilevel methods and data, we studied elderly breast and colorectal cancer patients (level I) within urban social (level II: ZIP code tabulation area) and health care (level III: hospital service area) contexts. We sought to determine (1) which, if any, observable social and medical contextual attributes were associated with patient cancer outcomes after controlling for observable patient attributes, and (2) the magnitude of residual variation in patient cancer outcomes at each level. RESULTS Numerous patient attributes and social area attributes, including poverty, were associated with unfavorable patient cancer outcomes across the full clinical cancer continuum for both cancers. Health care area attributes were not associated with patient cancer outcomes. After controlling for observable covariates at all 3 levels, there was substantial residual variation in patient cancer outcomes at all levels. CONCLUSIONS After controlling for patient attributes known to confer risk of poor cancer outcomes, we find that neighborhood socioeconomic disadvantage exerts an independent and deleterious effect on residents' cancer outcomes, but the area supply of the specific types of health care studied do not. Multilevel interventions targeted at cancer patients and their social areas may be useful. We also show substantial residual variation in patient outcomes across social and health care areas, a finding potentially relevant to traditional small area variation research methods.
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Gruca TS, Nam I, Tracy R. Trends in medical oncology outreach clinics in rural areas. J Oncol Pract 2014; 10:e313-20. [PMID: 25052498 DOI: 10.1200/jop.2013.001350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the long-term trends in medical oncology outreach in Iowa, a state with a high proportion of rural residents, and to assess the involvement of the 2011 Iowa oncology workforce in visiting consultant clinics using a unique data source. METHODS Outreach locations and clinic frequencies are tracked annually in the Visiting Medical Consultant Database (Carver College of Medicine) along with the physicians' primary practice locations. Growth in the number of cities served and number of clinic days from 1989 to 2011 was analyzed using joinpoint analysis. Data from 2011 were used to estimate the trip length for participating oncologists. RESULTS The number of rural cities served by medical oncology outreach increased significantly between 1989 and 1996. Clinic days grew significantly in two periods: 1989 to 1998 and 2003 to 2005. In 2011, more than 2,100 clinic days were provided in 66 sites (95% of clinic days in rural areas). Almost half of all Iowa-based oncologists regularly participate in outreach. Oncologists staffing visiting consultant clinics in Iowa drive an estimated 21,000 miles per month. CONCLUSIONS For more than 20 years, visiting medical oncologists have brought cancer care to rural patients in Iowa. Access to cancer care in rural Iowa (ie, clinic days) increased significantly in the post-Medicare Modernization Act period (after 2005). High participation rates and travel burdens may influence oncologist training and retention strategies. Because the Affordable Care Act seeks to expand access for vulnerable populations (eg, rural elderly), it is critical to better understand the existing system of rural cancer care delivery.
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Affiliation(s)
- Thomas S Gruca
- Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea
| | - Inwoo Nam
- Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea
| | - Roger Tracy
- Tippie College of Business, University of Iowa, Iowa City, IA; and Chung-Ang University, Seoul, South Korea
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Kirchhoff AC, Hart G, Campbell EG. Rural and urban primary care physician professional beliefs and quality improvement behaviors. J Rural Health 2014; 30:235-43. [PMID: 24528129 DOI: 10.1111/jrh.12067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated whether primary care physicians (PCPs) from urban and rural practices differ on attitudes and behaviors related to quality improvement (QI) activities, patient relationships, and professionalism/self-regulation. METHODS Data from a national survey that assessed physician attitudes and behaviors based on the Physician Charter on Medical Professionalism were used. Of the 1,891 survey respondents, N = 840 were PCPs (n = 274 family medicine (response rate = 67.5%); n = 257 general internal medicine (60.8%); and n = 309 pediatricians (72.7%)). Using Rural-Urban Commuting Area (RUCA) codes, PCPs were classified as urban and rural according to their practice ZIP code. FINDINGS A total of n = 691 physicians were urban and n = 127 rural. Attitudes regarding participating in QI did not differ by practice location; however, rural PCPs were more likely to have reviewed an other physician's records for QI than urban PCPs (65.6% vs 48.0%, P < .001). Rural physicians were more likely to agree that physicians should talk with their patients about the cost of care than urban PCPs (40.5% vs 29.2%, P = .02). While all PCPs endorsed attitudes regarding the importance of professional behaviors (eg, reporting impaired/incompetent colleagues, disclosing medical errors) at generally similar levels, their behaviors differed. More rural physicians had a personal knowledge of an impaired/incompetent physician than urban physicians (20.7% vs 12.7%, P = .02). CONCLUSIONS PCPs from rural and urban areas share similar attitudes regarding the importance of participating in QI and fulfilling professional responsibilities. However, certain behaviors (eg, knowledge of impaired colleagues) do differ. These results should be confirmed in larger studies of rural PCPs.
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Affiliation(s)
- Anne C Kirchhoff
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
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Hines R, Markossian T, Johnson A, Dong F, Bayakly R. Geographic residency status and census tract socioeconomic status as determinants of colorectal cancer outcomes. Am J Public Health 2014; 104:e63-71. [PMID: 24432920 DOI: 10.2105/ajph.2013.301572] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of geographic residency status and census tract (CT)-level socioeconomic status (SES) on colorectal cancer (CRC) outcomes. METHODS This was a retrospective cohort study of patients diagnosed with CRC in Georgia for the years 2000 through 2007. Study outcomes were late-stage disease at diagnosis, receipt of treatment, and survival. RESULTS For colon cancer, residents of lower-middle-SES and low-SES census tracts had decreased odds of receiving surgery. Rural, lower-middle-SES, and low-SES residents had decreased odds of receiving chemotherapy. For patients with rectal cancer, suburban residents had increased odds of receiving radiotherapy, but low SES resulted in decreased odds of surgery. For survival, rural residents experienced a partially adjusted 14% (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.07, 1.22) increased risk of death following diagnosis of CRC that was somewhat explained by treatment differences and completely explained by CT-level SES. Lower-middle- and low-SES participants had an adjusted increased risk of death following diagnosis for CRC (lower-middle: HR = 1.16; 95% CI = 1.10, 1.22; low: HR = 1.24; 95% CI = 1.16, 1.32). CONCLUSIONS Future efforts should focus on developing interventions and policies that target rural residents and lower SES areas to eliminate disparities in CRC-related outcomes.
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Affiliation(s)
- Robert Hines
- Robert Hines and Frank Dong are with the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita. At the time of the study, Talar Markossian was with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Asal Johnson is with the Center for International Studies, Georgia Southern University. Rana Bayakly is with the Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, Health Protection Division, Georgia Department of Public Health, Atlanta
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Uhlman MA, Gruca TS, Tracy R, Bing MT, Erickson BA. Improving Access to Urologic Care for Rural Populations Through Outreach Clinics. Urology 2013; 82:1272-6. [DOI: 10.1016/j.urology.2013.08.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 08/03/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
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Tracy R, Nam I, Gruca TS. The influence of visiting consultant clinics on measures of access to cancer care: evidence from the state of Iowa. Health Serv Res 2013; 48:1719-29. [PMID: 23480819 PMCID: PMC3796110 DOI: 10.1111/1475-6773.12050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the effect of visiting consultant clinics on measures of access to cancer care for rural patients. DATA SOURCES 2010 Visiting Medical Consultant Database for the state of Iowa (Carver College of Medicine) and the Iowa Physicians Information System (Carver College of Medicine). STUDY DESIGN We compared shortest driving times to the nearest medical oncologist for all Iowa census tracts under two scenarios: including only primary practice locations and adding monthly visiting consultant clinic locations. PRINCIPAL FINDINGS For rural Iowans, the median driving time to the closest site for medical oncology care falls from 51.6 to 19.2 minutes when monthly visiting consultant clinics are considered. CONCLUSIONS Including visiting consultant clinics has a significant impact on measures of geographic access to cancer care.
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Affiliation(s)
- Roger Tracy
- Office of Statewide Clinical Education Programs, Carver College of Medicine, University of Iowa, Iowa City, IA
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Lamont EB, He Y, Subramanian SV, Zaslavsky AM. Do socially deprived urban areas have lesser supplies of cancer care services? J Clin Oncol 2012; 30:3250-7. [PMID: 22869877 DOI: 10.1200/jco.2011.40.4228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Area social deprivation is associated with unfavorable health outcomes of residents across the full clinical course of cancer from the stage at diagnosis through survival. We sought to determine whether area social factors are associated with the area health care supply. PATIENTS AND METHODS We studied the area supply of health services required for the provision of guideline-recommended care for patients with breast cancer and colorectal cancer (CRC) in each of the following three distinct clinical domains: screening, treatment, and post-treatment surveillance. We characterized area social factors in 3,096 urban zip code tabulation areas by using Census Bureau data and the health care supply in the corresponding 465 hospital service areas by using American Hospital Association, American Medical Association, and US Food and Drug Administration data. In two-level hierarchical models, we assessed associations between social factors and the supply of health services across areas. RESULTS We found no clear associations between area social factors and the supply of health services essential to the provision of guideline recommended breast cancer and CRC care in urban areas. The measures of health service included the supply of physicians who facilitate screening, treatment, and post-treatment care and the supply of facilities required for the same services. CONCLUSION Because we found that the supply of types of health care required for the provision of guideline-recommended cancer care for patients with breast cancer and CRC did not vary with markers of area socioeconomic disadvantage, it is possible that previously reported unfavorable breast cancer and CRC outcomes among individuals living in impoverished areas may have occurred despite an apparent adequate area health care supply.
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Brems C, Johnson ME, Warner TD, Roberts LW. Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care 2009; 20:105-18. [PMID: 16608714 DOI: 10.1080/13561820600622208] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The research literature is replete with reports of barriers to care perceived by rural patients seeking healthcare. Less often reported are barriers perceived by the rural healthcare providers themselves. The current study is an extensive survey of over 1,500 healthcare providers randomly selected from two US states with large rural populations, Alaska and New Mexico. Barriers consistently identified across rural and urban regions by all healthcare professionals were Patient Complexity, Resource Limitations, Service Access, Training Constraints, and Patient Avoidance of Care. Findings confirmed that rural areas, however, struggle more with healthcare barriers than urban and small urban areas, especially as related to Resource Limitations, Confidentiality Limitations, Overlapping Roles, Provider Travel, Service Access, and Training Constraints. Almost consistently, the smaller a provider's practice community, the greater the reports of barriers, with the most severe barriers reported in small rural communities.
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Mc Daid C, Hodges Z, Fayter D, Stirk L, Eastwood A. Increasing participation of cancer patients in randomised controlled trials: a systematic review. Trials 2006; 7:16. [PMID: 16707011 PMCID: PMC1489947 DOI: 10.1186/1745-6215-7-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 05/17/2006] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are many barriers to patient participation in randomised controlled trials of cancer treatments. To increase participation in trials, strategies need to be identified to overcome these barriers. Our aim was to assess the effectiveness of interventions to overcome barriers to patient participation in randomised controlled trials (RCTs) of cancer treatments. METHODS A systematic review was conducted. Published and unpublished studies in any language were searched for in fifteen electronic databases, including MEDLINE, EMBASE, CINAHL and PsycINFO, from inception to the end of 2004. Studies of any interventions to improve cancer patient participation in RCTs, which reported the change in recruitment rates, were eligible for inclusion. RCTs and non-randomised controlled trials as well as before and after studies reporting baseline rates specific to the population being investigated were included. Data were extracted by one reviewer into structured summary tables and checked for accuracy by a second reviewer. Each included study was assessed against a checklist for methodological quality by one reviewer and checked by a second reviewer. A narrative synthesis was conducted. RESULTS Eight studies were identified that met the inclusion criteria: three RCTs, two non-randomised controlled trials and three observational studies. Six of the studies had an intervention that had some relevance to the UK. There was no robust evidence that any of the interventions investigated led to an increase in cancer patient participation in RCTs, though one good quality RCT found that urologists and nurses were equally effective at recruiting participants to a treatment trial for prostate cancer. Although there was no evidence of an effect in any of the studies, the evidence was not of sufficient quality to be able to conclude that these interventions therefore do not work. CONCLUSION There is not a strong evidence-base for interventions that increase cancer patient participation in randomised trials. Further research is required to evaluate the effectiveness of strategies to increase participation in cancer treatment trials.
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Affiliation(s)
- Catriona Mc Daid
- Centre for Reviews and Dissemination, University of York, York, YO10, 5DD, UK
| | - Zoé Hodges
- London School of Hygiene and Tropical Medicine, 9 Bedford Square, London, WC1B 3RE, UK
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, YO10, 5DD, UK
| | - Lisa Stirk
- Centre for Reviews and Dissemination, University of York, York, YO10, 5DD, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, YO10, 5DD, UK
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Nelson W, Lushkov G, Pomerantz A, Weeks WB. Rural health care ethics: is there a literature? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2006; 6:44-50. [PMID: 16500852 DOI: 10.1080/15265160500506746] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues.
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