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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Sgarbossa NJ, Alarcon-Ruiz CA, Kopitowski KS, Franco JV. Shared decision-making for supporting women's decisions about breast cancer screening. Cochrane Database Syst Rev 2024; 5:CD013822. [PMID: 38726892 PMCID: PMC11082933 DOI: 10.1002/14651858.cd013822.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.
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Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Ruiz Yanzi
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadia J Sgarbossa
- Health Department, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karin S Kopitowski
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Bayne M, Fairey M, Silarova B, Griffin SJ, Sharp SJ, Klein WMP, Sutton S, Usher-Smith JA. Effect of interventions including provision of personalised cancer risk information on accuracy of risk perception and psychological responses: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:83-95. [PMID: 31439435 PMCID: PMC6919334 DOI: 10.1016/j.pec.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To synthesize the literature on the effect of provision of personalised cancer risk information to individuals at population level risk on accuracy of risk perception and psychological responses. METHODS A systematic review and random effects meta-analysis of articles published from 01/01/2000 to 01/07/2017. RESULTS We included 23 studies. Immediately after provision of risk information 87% of individuals were able to recall the absolute risk estimate. Less than half believed that to be their risk, with up to 71% believing their risk to be higher than the estimate. Provision of risk information increased accuracy of perceived absolute risk immediately after risk information compared with no information (pooled RR 4.16 (95%CI 1.28-13.49), 3 studies). There was no significant effect on comparative risk accuracy (pooled RR 1.39 (0.72-2.69), 2 studies) and either no change or a reduction in cancer worry, anxiety and fear. CONCLUSION These findings highlight the complex cognitive processes involved in the conceptualisation of risk. PRACTICE IMPLICATIONS Individuals who appear to understand and are able to recall risk information most likely do not believe it reflects their own risk.
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Affiliation(s)
- Max Bayne
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Madi Fairey
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge UK
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Stephen Sutton
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Calderón-Mora J, Byrd TL, Alomari A, Salaiz R, Dwivedi A, Mallawaarachchi I, Shokar N. Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial. Am J Health Promot 2019; 34:15-24. [DOI: 10.1177/0890117119871004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US–Mexico border. Design: Cluster randomized controlled study. Setting: El Paso and Hudspeth Counties, Texas. Participants: Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy. Intervention: Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing. Measures: Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory. Analysis: Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables. Results: One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits. Conclusion: This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.
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Affiliation(s)
- Jessica Calderón-Mora
- Department of Molecular and Translational Medicine, Center of Emphasis for Cancer, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Theresa L. Byrd
- Graduate School of Biomedical Sciences, Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Adam Alomari
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Rebekah Salaiz
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Alok Dwivedi
- Department of Molecular and Translational Medicine,Biostatistics and Epidemiology Consulting Lab (BECL), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Indika Mallawaarachchi
- Department of Molecular and Translational Medicine,Biostatistics and Epidemiology Consulting Lab (BECL), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
| | - Navkiran Shokar
- Department of Molecular and Translational Medicine, Center of Emphasis for Cancer, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, TX, USA
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Marshall AA, Zaccardelli A, Yu Z, Prado MG, Liu X, Miller Kroouze R, Kalia SS, Green RC, Triedman NA, Lu B, Deane KD, Iversen MD, Karlson EW, Sparks JA. Effect of communicating personalized rheumatoid arthritis risk on concern for developing RA: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2019; 102:976-983. [PMID: 30558852 PMCID: PMC6491232 DOI: 10.1016/j.pec.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the effect of providing comprehensive personalized risk information on concern for chronic disease development. METHODS Unaffected first-degree relatives (FDRs) of rheumatoid arthritis (RA) patients (n = 238) were randomly allocated to: 1) disclosure of RA risk personalized to demographics, genetics, biomarkers, and behaviors using a web-based tool (PRE-RA arm, n = 78); 2) PRE-RA with interpretation by a health educator (PRE-RA Plus arm, n = 80); and 3) standard RA education (Comparison arm, n = 80). Concern for developing RA was assessed at baseline and immediately, 6 weeks, 6 months, and 12 months post-intervention. RESULTS FDRs randomized to PRE-RA arms were less concerned about developing RA than the Comparison arm at all post-intervention assessments (p < 0.05). Among those concerned about RA risk at baseline, the PRE-RA (OR = 4.7, 95%CI 1.5-14.4) and PRE-RA Plus (OR = 5.2, 95%CI 1.6-17.3) arms were more likely to have reassurance 6 months post-intervention than the Comparison arm. CONCLUSION A comprehensive tool provided reassurance to those at risk for developing a chronic disease, with or without interpretation from a health educator, compared to standard education. PRACTICE IMPLICATIONS Individuals may be more likely to be reassured using a personalized chronic disease risk disclosure tool than a standard non-personalized approach.
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Affiliation(s)
- Allison A Marshall
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Tufts University School of Medicine, 145 Harrison Avenue, 02111, Boston, MA, USA.
| | - Alessandra Zaccardelli
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Zhi Yu
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Maria G Prado
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Xinyi Liu
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Rachel Miller Kroouze
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Sarah S Kalia
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 02115, Boston, MA, USA.
| | - Robert C Green
- Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA; Department of Medicine, Division of Genetics, Brigham and Women's Hospital, 77 Avenue Louis Pasteur, NRB Rm. 250, 02115, Boston, MA, USA; Broad Institute, 415 Main Street, 02142, Cambridge, MA, USA.
| | - Nellie A Triedman
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA.
| | - Bing Lu
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado School of Medicine, 1635 Aurora Court, 80045, Aurora, CO, USA.
| | - Maura D Iversen
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA; Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 301 Robinson Hall, 360 Huntington Avenue, 02115, Boston, MA, USA; Department of Women's and Children's Health, Karolinska Institutet, SE-177 77 Stockholm, Sweden.
| | - Elizabeth W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, 02115, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA.
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Liu PL, Yeo TED. Breast health, risk factors, and cancer screening among lesbian, bisexual, and queer/questioning women in China. Health Care Women Int 2019; 42:947-961. [PMID: 30730783 DOI: 10.1080/07399332.2019.1571062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we examine the health disparities of sexual minority women by surveying 310 lesbian, bisexual, and queer/questioning women (LBQW) in China about their breast health and cancer screening practices. We found that Chinese LBQW, particularly those identified with a masculine gender role and practice chest binding, are vulnerable to breast cancer given their high rates of behavioral risk factors (e.g., cigarette smoking) and symptoms (e.g., breast lumps) but low rates of self and clinical breast examinations. Salient barrier (stigma) and facilitators (social support availability, self-efficacy, and breast cancer information exposure) of breast cancer screening were also identified.
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Affiliation(s)
- Piper Liping Liu
- School of Communication, Hong Kong Baptist University, Hong Kong
| | - Tien Ee Dominic Yeo
- Department of Communication Studies, Hong Kong Baptist University, Hong Kong
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Bowen DJ, Hay JL, Harris-Wai JN, Meischke H, Burke W. All in the family? Communication of cancer survivors with their families. Fam Cancer 2018; 16:597-603. [PMID: 28374161 DOI: 10.1007/s10689-017-9987-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Families often bear the burden of communication about cancer risk, as well as support during and after treatment for cancer in family members. These activities are left up to survivors and their families, with little support or knowledge of useful methods. We present data on aspects of family that are most relevant to risk of cancer-related communication and health promotion among family members. Families (a survivor, one first-degree relative and one parent; n = 313 families) were enrolled in the survey-based study. We assessed multiple aspects of family communication about risk for melanoma among family participants. Families communicate less frequently than desired about cancer risk. Most families do identify a "family health provider" who keeps family data and serves a resource for family members. The reasons given for lack of family communication are diverse but many can be addressed as part of a family communication intervention. Families are poised to improve their family communication about cancer risk and so can play a role in increasing the health of their members.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, Seventh Floor, New York, NY, 10022, USA
| | - Julie N Harris-Wai
- Department of Social and Behavioral Sciences, University of California San Francisco, 3333 California Street, San Francisco, CA, 94110, USA
| | - Hendrika Meischke
- Department of Health Services, University of Washington, Seattle, WA, 98105, USA
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, P. O. Box 357120, Seattle, WA, 98195, USA
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Usher-Smith JA, Masson G, Mills K, Sharp SJ, Sutton S, Klein WMP, Griffin SJ. A randomised controlled trial of the effect of providing online risk information and lifestyle advice for the most common preventable cancers: study protocol. BMC Public Health 2018; 18:796. [PMID: 29940914 PMCID: PMC6019532 DOI: 10.1186/s12889-018-5712-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cancer is a leading cause of mortality and morbidity worldwide. Prevention is recognised by many, including the World Health Organization, to offer the most cost-effective long-term strategy for the control of cancer. One approach that focuses on individuals is the provision of personalised risk information. However, whether such information motivates behaviour change and whether the effect is different with varying formats of risk presentation is unclear. We aim to assess the short-term effect of providing information about personalised risk of cancer in three different formats alongside lifestyle advice on health-related behaviours, risk perception and risk conviction. METHODS In a parallel group, randomised controlled trial 1000 participants will be recruited through the online platform Prolific. Participants will be allocated to either a control group receiving cancer-specific lifestyle advice alone or one of three intervention groups receiving the same lifestyle advice alongside their estimated 10-year risk of developing one of the five most common preventable cancers, calculated from self-reported modifiable behavioural risk factors, in one of three different formats (bar chart, pictograph or qualitative scale). The primary outcome is change from baseline in computed risk relative to an individual with a recommended lifestyle at three months. Secondary outcomes include: perceived risk of cancer; anxiety; cancer-related worry; intention to change behaviour; and awareness of cancer risk factors. DISCUSSION This study will provide evidence on the short-term effect of providing online information about personalised risk of cancer alongside lifestyle advice on risk perception and health-related behaviours and inform the development of interventions. TRIAL REGISTRATION ISRCTN17450583. Registered 30 January 2018.
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Affiliation(s)
- Juliet A. Usher-Smith
- The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
| | - Golnessa Masson
- The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
| | - Katie Mills
- The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
| | - Stephen J. Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Stephen Sutton
- Behavioural Science Group, The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
| | | | - Simon J. Griffin
- The Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge, CB2 0SR UK
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Usher-Smith JA, Silarova B, Sharp SJ, Mills K, Griffin SJ. Effect of interventions incorporating personalised cancer risk information on intentions and behaviour: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e017717. [PMID: 29362249 PMCID: PMC5786113 DOI: 10.1136/bmjopen-2017-017717] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide a comprehensive review of the impact on intention to change health-related behaviours and health-related behaviours themselves, including screening uptake, of interventions incorporating information about cancer risk targeted at the general adult population. DESIGN A systematic review and random-effects meta-analysis. DATA SOURCES An electronic search of MEDLINE, EMBASE, CINAHL and PsycINFO from 1 January 2000 to 1 July 2017. INCLUSION CRITERIA Randomised controlled trials of interventions including provision of a personal estimate of future cancer risk based on two or more non-genetic variables to adults recruited from the general population that include at least one behavioural outcome. RESULTS We included 19 studies reporting 12 outcomes. There was significant heterogeneity in interventions and outcomes between studies. There is evidence that interventions incorporating personalised cancer risk information do not affect intention to attend or attendance at screening (relative risk 1.00 (0.97-1.03)). There is limited evidence that they increase smoking abstinence, sun protection, adult skin self-examination and breast examination, and decrease intention to tan. However, they do not increase smoking cessation, parental child skin examination or intention to protect skin. No studies assessed changes in diet, alcohol consumption or physical activity. CONCLUSIONS Interventions incorporating personalised cancer risk information do not affect uptake of screening, but there is limited evidence of effect on some health-related behaviours. Further research, ideally including objective measures of behaviour, is needed before cancer risk information is incorporated into routine practice for health promotion in the general population.
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Affiliation(s)
- Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Barbora Silarova
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Mattingly AE, Kiluk JV, Lee MC. Clinical Considerations of Risk, Incidence, and Outcomes of Breast Cancer in Sexual Minorities. Cancer Control 2017; 23:373-382. [PMID: 27842326 DOI: 10.1177/107327481602300408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer is a leading cause of cancer-related mortality in women. Limited research exists on the impact of sexual orientation on overall risk of and mortality from breast cancer. We sought to summarize the medical literature on breast cancer in sexual minority women and identify possible disparities in this population. METHODS A comprehensive literature search was conducted for English-language studies in peer-reviewed medical journals that referenced breast cancer and sexual minority, lesbian, bisexual, or transgender individuals. Articles published between January 2000 and November 2015 were included. They were reviewed for relevance to breast cancer risk stratification, breast cancer mortality, breast reconstruction, and transgender issues. RESULTS Behavioral risks, reproductive risks, and risks associated with decreased access to health care may all affect outcomes for sexual minorities with breast cancer. Limited studies have mixed results regarding mortality associated with breast cancer in sexual minorities due to an inconsistent reporting of sexual orientation. CONCLUSIONS Overall, the research examining breast cancer in sexual minority women remains limited. This finding is likely due to limitations in the reporting of sexual orientation within large databases, thus making broader-scale research difficult.
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Affiliation(s)
- Anne E Mattingly
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, FL, USA.
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Nathan AG, Marshall IM, Cooper JM, Huang ES. Use of Decision Aids with Minority Patients: a Systematic Review. J Gen Intern Med 2016; 31:663-76. [PMID: 26988981 PMCID: PMC4870418 DOI: 10.1007/s11606-016-3609-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities. METHODS We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05. RESULTS We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs. DISCUSSION DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.
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Affiliation(s)
- Aviva G Nathan
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
| | - Imani M Marshall
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Jennifer M Cooper
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Elbert S Huang
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
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Matthews AK, Hotton A, Li CC, Miller K, Johnson A, Jones KW, Thai J. An Internet-Based Study Examining the Factors Associated with the Physical and Mental Health Quality of Life of LGBT Cancer Survivors. LGBT Health 2015; 3:65-73. [PMID: 26789396 DOI: 10.1089/lgbt.2014.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The purpose of this study was to examine factors associated with the quality of life of lesbian, gay, bisexual, and transgender (LGBT) cancer survivors. METHODS Data were collected via a nationally advertised online short-form health survey. RESULTS Factors associated with lower physical quality of life included younger age at diagnosis, cancer type, medical co-morbidities, being overweight or obese, recurrence, and current cancer treatment. Lower mental quality of life was associated with younger age, smoking, lower perceived quality of care, lower perceived support, and higher cancer-related worry. CONCLUSIONS Findings highlight a need for health promotion interventions specifically for LGBT cancer survivors.
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Affiliation(s)
- Alicia K Matthews
- 1 College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,2 Howard Brown Health Center , Chicago, Illinois
| | - Anna Hotton
- 3 Department of Infectious Diseases, John H. Stroger Hospital , Chicago, Illinois
| | - Chien-Ching Li
- 4 Department of Health Systems Management, College of Health Sciences, Rush University , Chicago, Illinois
| | - Katherine Miller
- 5 Jane Addams College of Social Work, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Amy Johnson
- 6 School of Public Health, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Kyle W Jones
- 2 Howard Brown Health Center , Chicago, Illinois.,7 Department of Psychology, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Jennie Thai
- 2 Howard Brown Health Center , Chicago, Illinois
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12
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Bowen DJ, Burke W, Hay JL, Meischke H, Harris JN. Effects of web-based intervention on risk reduction behaviors in melanoma survivors. J Cancer Surviv 2015; 9:279-86. [PMID: 25425205 PMCID: PMC4442031 DOI: 10.1007/s11764-014-0412-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Melanoma is the most severe form of skin cancer, and survivors of melanoma carry increased risk of additional melanoma diagnosis. Multiple methods exist for primary and secondary prevention of melanoma in survivors. This study tested a web-based family communication intervention to improve these preventive behaviors in melanoma families. METHODS Families (a survivor, at least one first-degree relative and a parent) were randomized either to receive the intervention package or to serve as comparison families. We assessed melanoma prevention behaviors in each cohort member before and after the intervention. The intervention was a web-based multicomponent intervention focused on increasing family communication and exchange of risk information. RESULTS Results indicated that, compared to comparison survivors, intervention survivors improved their skin self-examination and their sun protection behaviors significantly from before to after intervention. CONCLUSION These data support the use of web-based interventions for behavioral changes in survivors and allow for consideration of dissemination of this successful intervention. These data have implications for interventions that can help cancer families deal with issues of risk and illness. IMPLICATIONS FOR CANCER SURVIVORS These data indicate that survivors can benefit from exposure to a website that helps direct their future health behaviors.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, 1107 NE 45th Street # 305, Box 357120, Seattle, WA, 98105, USA,
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13
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Rizer AM, Mauery DR, Haynes SG, Couser B, Gruman C. Challenges in Intervention Research for Lesbian and Bisexual Women. LGBT Health 2015; 2:105-12. [PMID: 26790115 DOI: 10.1089/lgbt.2014.0122] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE More than one-third of U.S. adults are obese, the highest prevalence occurring among women age 60 and older (42.3%), and women ages 40 to 59 (36.0%). This issue is even more pronounced among lesbian and bisexual (LB) women. Studies suggest this population may be twice as likely to be overweight or obese as heterosexual women. Despite this public health issue, little has been done to reduce overweight and obesity in LB women. METHODS During the design of healthy-weight interventions aimed at reducing overweight and obesity in older LB women through increased physical activity and improved nutrition, we conducted a systematic review of health interventions targeting older LB women to identify and describe core characteristics present in such interventions. We identified 878 articles and studies as potentially relevant to our review and evaluated them for inclusion in our analysis. We analyzed five interventions, including two on smoking cessation and one each on physical activity, breast cancer screening, and alcohol abuse. RESULTS Results indicate that, regardless of desired health outcome, typical intervention characteristics included: social support, education, goal setting, peer-based facilitation, and lesbian, gay, bisexual, and transgender (LGBT)-friendly intervention environments. CONCLUSION The lack of health interventions in this population is disconcerting. Coupled with the high and disparate prevalence of overweight and obesity in LB women, the lack of published evidence of efforts targeting this population presents a critical opportunity for policymakers and researchers to respond to this public health concern.
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Affiliation(s)
| | - D Richard Mauery
- 2 Jacobs Institute of Women's Health, The George Washington University School of Public Health and Health Services , Washington, D.C
| | - Suzanne G Haynes
- 3 Office on Women's Health , U.S. Department of Health and Human Services, Washington, D.C
| | - Babette Couser
- 3 Office on Women's Health , U.S. Department of Health and Human Services, Washington, D.C
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Matthews AK, McConnell EA, Li CC, Vargas MC, King A. Design of a comparative effectiveness evaluation of a culturally tailored versus standard community-based smoking cessation treatment program for LGBT smokers. BMC Psychol 2014; 2:12. [PMID: 25566383 PMCID: PMC4269994 DOI: 10.1186/2050-7283-2-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/15/2014] [Indexed: 11/30/2022] Open
Abstract
Background Smoking prevalence rates among the lesbian, gay, bisexual, and transgender (LGBT) population are significantly higher than the general population. However, there is limited research on smoking cessation treatments in this group, particularly on culturally targeted interventions. Moreover, there are few interventions that address culturally specific psychosocial variables (e.g., minority stress) that may influence outcomes. This paper describes the protocol for a comparative effectiveness trial testing an evidence-based smoking cessation program, Courage to Quit, against a culturally tailored version for LGBT smokers, and examines the role of culturally specific psychosocial variables on cessation outcomes. Methods/Design To examine the effectiveness of a culturally targeted versus standard smoking cessation intervention, the study utilizes a 2-arm block, randomized, control trial (RCT) design. Adult LGBT participants (n = 400) are randomized to one of the two programs each consisting of a six-session group program delivered in a community center and an eight week supply of the transdermal nicotine patch. Four individualized telephone counseling sessions occur at weeks 2, 5, 7, and 9, at times of greatest risk for relapse. Study outcome measures are collected at baseline, and 1, 3, 6, and 12 months post quit date. Primary outcomes are expired air carbon monoxide verified 7-day point-prevalence quit rates at each measurement period. Secondary outcomes assess changes in cravings, withdrawal symptoms, smoking cessation self-efficacy, and treatment adherence. Additionally, study staff examines the role of culturally specific psychosocial variables on cessation outcomes using path analysis. Discussion Determining the efficacy of culturally specific versus standard evidence based approaches to smoking cessation is a critical issue facing the field today. This study provides a model for the development and implementation of a culturally tailored smoking cessation intervention for LGBT participants and addresses a gap in the field by examining the role of culturally psychosocial variables associated with cessation outcomes. Trial registration U.S. National Institutes of Health Clinical Trials NCT01633567 Registered 30 May 2012.
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Affiliation(s)
- Alicia K Matthews
- University of Illinois at Chicago (UIC), Chicago, IL USA ; College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL 60612 USA
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15
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Persky S, Kaphingst KA, Allen VC, Senay I. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans. Ann Behav Med 2013; 45:308-17. [PMID: 23389688 DOI: 10.1007/s12160-013-9475-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. PURPOSE A controlled experiment assessed whether perceived physician race influenced African-American patients' (n = 127) risk perception accuracy following the provision of objective lung cancer risk information. METHODS Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. RESULTS Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94) = 4.02, p = .048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. CONCLUSIONS The current study demonstrates that African-American patients' perceptions of a doctor's race are sufficient to independently impact their processing of lung cancer risk information.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Bethesda, MD 20892, USA.
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16
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Edwards AGK, Naik G, Ahmed H, Elwyn GJ, Pickles T, Hood K, Playle R. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database Syst Rev 2013; 2013:CD001865. [PMID: 23450534 PMCID: PMC6464864 DOI: 10.1002/14651858.cd001865.pub3] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a trend towards greater patient involvement in healthcare decisions. Although screening is usually perceived as good for the health of the population, there are risks associated with the tests involved. Achieving both adequate involvement of consumers and informed decision making are now seen as important goals for screening programmes. Personalised risk estimates have been shown to be effective methods of risk communication. OBJECTIVES To assess the effects of personalised risk communication on informed decision making by individuals taking screening tests. We also assess individual components that constitute informed decisions. SEARCH METHODS Two authors searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2012), MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL (EbscoHOST) and PsycINFO (OvidSP) without language restrictions. We searched from 2006 to March 2012. The date ranges for the previous searches were from 1989 to December 2005 for PsycINFO and from 1985 to December 2005 for other databases. For the original version of this review, we also searched CancerLit and Science Citation Index (March 2001). We also reviewed the reference lists and conducted citation searches of included studies and other systematic reviews in the field, to identify any studies missed during the initial search. SELECTION CRITERIA Randomised controlled trials incorporating an intervention with a 'personalised risk communication element' for individuals undergoing screening procedures, and reporting measures of informed decisions and also cognitive, affective, or behavioural outcomes addressing the decision by such individuals, of whether or not to undergo screening. DATA COLLECTION AND ANALYSIS Two authors independently assessed each included trial for risk of bias, and extracted data. We extracted data about the nature and setting of interventions, and relevant outcome data. We used standard statistical methods to combine data using RevMan version 5, including analysis according to different levels of detail of personalised risk communication, different conditions for screening, and studies based only on high-risk participants rather than people at 'average' risk. MAIN RESULTS We included 41 studies involving 28,700 people. Nineteen new studies were identified in this update, adding to the 22 studies included in the previous two iterations of the review. Three studies measured informed decision with regard to the uptake of screening following personalised risk communication as a part of their intervention. All of these three studies were at low risk of bias and there was strong evidence that the interventions enhanced informed decision making, although with heterogeneous results. Overall 45.2% (592/1309) of participants who received personalised risk information made informed choices, compared to 20.2% (229/1135) of participants who received generic risk information. The overall odds ratios (ORs) for informed decision were 4.48 (95% confidence interval (CI) 3.62 to 5.53 for fixed effect) and 3.65 (95% CI 2.13 to 6.23 for random effects). Nine studies measured increase in knowledge, using different scales. All of these studies showed an increase in knowledge with personalised risk communication. In three studies the interventions showed a trend towards more accurate risk perception, but the evidence was of poor quality. Four out of six studies reported non-significant changes in anxiety following personalised risk communication to the participants. Overall there was a small non-significant decrease in the anxiety scores. Most studies (32/41) measured the uptake of screening tests following interventions. Our results (OR 1.15 (95% CI 1.02 to 1.29)) constitute low quality evidence, consistent with a small effect, that personalised risk communication in which a risk score was provided (6 studies) or the participants were given their categorised risk (6 studies), increases uptake of screening tests. AUTHORS' CONCLUSIONS There is strong evidence from three trials that personalised risk estimates incorporated within communication interventions for screening programmes enhance informed choices. However the evidence for increasing the uptake of such screening tests with similar interventions is weak, and it is not clear if this increase is associated with informed choices. Studies included a diverse range of screening programmes. Therefore, data from this review do not allow us to draw conclusions about the best interventions to deliver personalised risk communication for enhancing informed decisions. The results are dominated by findings from the topic area of mammography and colorectal cancer. Caution is therefore required in generalising from these results, and particularly for clinical topics other than mammography and colorectal cancer screening.
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Affiliation(s)
- Adrian G K Edwards
- Cochrane Institute of Primary Care and Public Health, School ofMedicine, Cardiff University, Cardiff, UK.
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17
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Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, Melillo S, Carvalho M, Taplin S, Bastani R, Rimer BK, Vernon SW, Melvin CL, Taylor V, Fernandez M, Glanz K. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med 2012; 43:97-118. [PMID: 22704754 DOI: 10.1016/j.amepre.2012.04.009] [Citation(s) in RCA: 346] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/03/2012] [Accepted: 04/04/2012] [Indexed: 11/28/2022]
Abstract
CONTEXT Screening reduces mortality from breast, cervical, and colorectal cancers. The Guide to Community Preventive Services previously conducted systematic reviews on the effectiveness of 11 interventions to increase screening for these cancers. This article presents results of updated systematic reviews for nine of these interventions. EVIDENCE ACQUISITION Five databases were searched for studies published during January 2004-October 2008. Studies had to (1) be a primary investigation of one or more intervention category; (2) be conducted in a country with a high-income economy; (3) provide information on at least one cancer screening outcome of interest; and (4) include screening use prior to intervention implementation or a concurrent group unexposed to the intervention category of interest. Forty-five studies were included in the reviews. EVIDENCE SYNTHESIS Recommendations were added for one-on-one education to increase screening with fecal occult blood testing (FOBT) and group education to increase mammography screening. Strength of evidence for client reminder interventions to increase FOBT screening was upgraded from sufficient to strong. Previous findings and recommendations for reducing out-of-pocket costs (breast cancer screening); provider assessment and feedback (breast, cervical, and FOBT screening); one-on-one education and client reminders (breast and cervical cancer screening); and reducing structural barriers (breast cancer and FOBT screening) were reaffirmed or unchanged. Evidence remains insufficient to determine effectiveness for the remaining screening tests and intervention categories. CONCLUSIONS Findings indicate new and reaffirmed interventions effective in promoting recommended cancer screening, including colorectal cancer screening. Findings can be used in community and healthcare settings to promote recommended care. Important research gaps also are described.
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Affiliation(s)
- Susan A Sabatino
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia 30341, USA.
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18
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Cochran SD, Mays VM. Risk of breast cancer mortality among women cohabiting with same sex partners: findings from the National Health Interview Survey, 1997-2003. J Womens Health (Larchmt) 2012; 21:528-33. [PMID: 22360695 DOI: 10.1089/jwh.2011.3134] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lesbians and bisexual women are more likely than other women to evidence a unique mix of common breast cancer risk factors. It is not known if this results in greater breast cancer mortality risk. We investigate possible sexual orientation-related differences in risk for fatal breast cancer in a large representative U.S. sample of married and cohabiting women. METHODS Between 1997 and 2003, the National Health Interview Survey (NHIS) interviewed married or cohabiting female participants, aged 18-80 years inclusively, who reported either a male (n=136,174) or female (n=693) coresidential relationship partner. These records are linked to the National Death Index to provide information on mortality status as of December 31, 2006. Employing these data, we estimated the age-adjusted relative risk (RR) and its 95% confidence interval (CI) for mortality attributed to breast cancer using a Cox proportional hazard model. RESULTS Women in same-sex couples, compared to women in different-sex relationships, had greater age-adjusted risk for fatal breast cancer (RR=3.2, CI 1.01-10.21) but did not differ in their overall risk for mortality. CONCLUSIONS Our findings provide tentative support that sexual orientation is differentially linked to risk of fatal breast cancer. These findings underscore the need to investigate further breast cancer morbidity and mortality risk among women with minority sexual orientation.
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Affiliation(s)
- Susan D Cochran
- Department of Epidemiology, University of California, Los Angeles, California 90095-1772, USA.
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19
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Burkhalter JE, Hay JL, Coups E, Warren B, Li Y, Ostroff JS. Perceived risk for cancer in an urban sexual minority. J Behav Med 2011; 34:157-69. [PMID: 20872174 PMCID: PMC3684154 DOI: 10.1007/s10865-010-9296-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
Lesbians, gay men, and bisexuals are a sexual minority experiencing elevated cancer risk factors and health disaparites, e.g., elevated tobacco use, disproportionate rates of infection with human immunodeficiency virus. Little attention has been paid to cancer prevention, education, and control in sexual minorities. This study describes cancer risk perceptions and their correlates so as to generate testable hypotheses and provide a foundation for targeting cancer prevention and risk reduction efforts in this high risk population. A cross-sectional survey of affiliates of a large urban community center serving sexual minority persons yielded a study sample of 247 anonymous persons. The survey assessed demographics, absolute perceived cancer risk, cancer risk behaviors, desired lifestyle changes to reduce cancer risk, and psychosocial variables including stress, depression, and stigma. Univariate and multivariate nonparametric statistics were used for analyses. The sample was primarily white non-Hispanic, middle-aged, and > 80% had at least a high school education. Mean values for absolute perceived cancer risk (range 0-100% risk), were 43.0 (SD = 25.4) for females, and for males, 49.3 (SD = 24.3). For females, although the multivariate regression model for absolute perceived cancer risk was statistically significant (P < .05), no single model variable was significant. For men, the multivariate regression model was significant (P < .001), with endorsement of "don't smoke/quit smoking" to reduce personal cancer risk (P < .001), and greater number of sexual partners (P = .054), positively associated with absolute perceived risk for cancer. This study provides novel data on cancer risk perceptions in sexual minorities, identifying correlates of absolute perceived cancer risk for each gender and several potential foci for cancer prevention interventions with this at-risk group.
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Affiliation(s)
- Jack E. Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Jennifer L. Hay
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Elliot Coups
- The Cancer Institute of New Jersey, UMDNJ-Robert Wood, Johnson Medical School, 195 Little Albany Street, 5th Floor, Room 5567, New Brunswick, NJ 08901, USA
| | - Barbara Warren
- Hunter College Institute for LGBT Social Science & Public Policy, 695 Park Avenue, Rm 1305, New York, NY 10065, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
| | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial, Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022-4503, USA
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Herrick AL, Matthews AK, Garofalo R. Health risk behaviors in an urban sample of young women who have sex with women. JOURNAL OF LESBIAN STUDIES 2010; 14:80-92. [PMID: 20077268 DOI: 10.1080/10894160903060440] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We examined the prevalence of sexual and substance use behaviors among a group of young women who have sex with women (WSW) aged 16 to 24. A convenience sample of 137 young WSW participants completed a confidential survey that included demographics, substance use, and sexual risk behaviors. Descriptive analyses were used to interpret the data. Comparisons were made between rates of risk behaviors in this sample and non-sexual minority youth in a national dataset. The mean age of participants was 19.6 (SD = 2.3) and 59% were from communities of color. Participants reported a history of risky behaviors including anal intercourse with men (26%), monthly binge drinking (22%), pregnancy (20%), and tobacco use (54%). These findings highlight the need for health promotion interventions aimed at reducing risky health behaviors in this highly vulnerable and underserved sub-population of young women.
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Affiliation(s)
- Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Parran Hall, Pittsburgh, PA 15260 USA.
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21
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Hart SL, Bowen DJ. Sexual orientation and intentions to obtain breast cancer screening. J Womens Health (Larchmt) 2009; 18:177-85. [PMID: 19183089 DOI: 10.1089/jwh.2007.0447] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This longitudinal study examined predictors of intentions to obtain breast cancer screening in two samples, one comprising self-identified lesbian/bisexual women (n = 150) and the other comprising heterosexual women (n = 400). We hypothesized that beliefs about mammography, cancer vulnerability, and attitudes toward the medical provider would mediate the relationship between sexual orientation and plans to obtain breast cancer screening. METHODS Women in this study participated in one of two larger clinical trials of breast cancer risk counseling methods. All participants completed questionnaires about breast cancer screening attitudes at baseline and at a 6-month follow-up. RESULTS Logistic regression analyses, controlling for age, education, and race, revealed that baseline negative beliefs about mammography, lower levels of provider trust, and less perceived risk of breast cancer significantly mediated the relationship between sexual orientation and 6-month intentions to obtain a clinical breast examination (CBE) and mammography. CONCLUSIONS These findings suggest that attitudes and beliefs about breast cancer, breast cancer screening, and medical providers impact lesbian/bisexual women's willingness to plan for CBE and mammography.
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Affiliation(s)
- Stacey L Hart
- Department of Psychology, Ryerson University, Toronto, ON M5B 2K3 Canada.
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Senay I, Kaphingst KA. Anchoring-and-adjustment bias in communication of disease risk. Med Decis Making 2009; 29:193-201. [PMID: 19279297 DOI: 10.1177/0272989x08327395] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the next decade, advances in genomics will make it increasingly possible to provide patients with personalized, genetic-based risks of common diseases, allowing them the opportunity to take preventive steps through behavioral changes. However, previous research indicates that people may insufficiently adjust their subjective risk to the objective risk value communicated to them by a healthcare provider, a phenomenon called anchoring-and-adjustment bias. In this narrative review, we analyze existing research on how patients process disease-risk information, and the processing biases that may occur, to show that the bias observed in disease-risk communication is potentially malleable to change. We recommend that, to reduce this bias and change patients' misperceptions of disease risk in clinical settings, future studies investigate the effects of forewarning patients about the bias, tailoring risk information to their numeracy level, emphasizing social roles, increasing motivation to form accurate risk perception, and reducing social stigmatization, disease worry and information overload.
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Affiliation(s)
- Ibrahim Senay
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Lesbians and cancer: an overlooked health disparity. Cancer Causes Control 2008; 19:1009-20. [PMID: 18551371 DOI: 10.1007/s10552-008-9176-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 05/01/2008] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the breast, cervical, ovarian, lung, and colorectal cancer literatures using a novel application of the cancer disparities grid to identify disparities along domains of the cancer continuum focusing on lesbians as a minority population. METHODS Computerized databases were searched for articles published from 1981 to present. Cumulative search results identified 51 articles related to lesbians and disparities, which were classified by domain. RESULTS The majority of articles identified were related to breast and cervical cancer screening. Barriers to adequate screening for both cancers include personal factors, poor patient-provider communication, and health care system factors. Tailored risk counseling has been successful in increasing lesbian's mammography and Pap screening. Ovarian, lung, and colorectal cancer have been virtually unexplored in this population. An "Adjustment to Illness/Quality of Life" domain was added to capture literature on psychosocial aspects of cancer. CONCLUSIONS This review revealed a lack of research for specific cancers and for specific aspects of the cancer continuum. The limited number of studies identified focused on issues related to screening/prevention in cervical and breast cancers, with almost no attention to incidence, etiology, diagnosis, treatment, survival, morbidity, or mortality. We present implications for social and public health policy, research, and prevention.
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