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Banerjee SC, Asuzu C, Mapayi B, Olunloyo B, Odiaka E, Daramola OB, Gilliland J, Owoade IA, Kingham P, Alatise OI, Fitzgerald G, Kahn R, Olcese C, Ostroff JS. Feasibility, acceptability, and initial efficacy of empathic communication skills training to reduce lung cancer stigma in Nigeria: a pilot study. J Natl Cancer Inst Monogr 2024; 2024:30-37. [PMID: 38836528 DOI: 10.1093/jncimonographs/lgae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 06/06/2024] Open
Abstract
Effective communication about cancer diagnosis and prognosis in sub-Saharan African oncology settings is often challenged by the cancer-related shame and stigma patients and families experience. Enhancing empathic communication between health care providers, including physicians and nurses, and oncology patients and their families can not only reduce cancer stigma but also improve patient engagement, treatment satisfaction, and quality of life. To reduce lung cancer stigma, we adapted an evidence-based empathic communication skills training intervention to reduce patients' experience of stigma in Nigeria and conducted a pilot study examining the feasibility and acceptability of the empathic communication skills training. Thirty health care providers, recruited from University College Hospital, Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, participated in a 2.25-hour didactic and experiential training session. Participant surveys were completed before and after the training. Overall, participants reported highly favorable training evaluations, with at least 85% of health care providers agreeing or strongly agreeing to survey items assessing training relevance, novelty, clarity, and facilitator effectiveness. Self-efficacy to communicate empathically with patients increased significantly from before-training (Mean [SD] = 3.93 [0.28]) to after-training (Mean [SD] = 4.55 [0.15]; t29 = 3.51, P < .05). Significant improvements were observed in health care provider reports of empathy toward lung cancer survivors and attitude toward lung cancer care as well as significant reductions in lung cancer blame were noted. The empathic communication skills training was feasible, well received by oncology clinicians in Nigeria, and demonstrated improvements in health care provider-reported outcomes from before- to after-training.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chioma Asuzu
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Blessing Olunloyo
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Emeka Odiaka
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Oluwafemi B Daramola
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Jaime Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Israel Adeyemi Owoade
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olusegun I Alatise
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Grace Fitzgerald
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rivka Kahn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Olcese
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Pack A, Russell A, Kircher S, Weldon C, Bailey SC, Lockwood K, Marquart T, Afonso AS, Payakachat N, Wolf M. Current communication practices for biomarker testing in non-small cell lung cancer: Exploring patient and clinician perspectives. PATIENT EDUCATION AND COUNSELING 2023; 114:107839. [PMID: 37321114 PMCID: PMC10528088 DOI: 10.1016/j.pec.2023.107839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/13/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES We qualitatively explored patient and clinician experiences with biomarker testing in one academic health system to identify current communication practices and unmet testing information needs. METHODS We conducted 1:1 in-depth interviews with 15 clinicians (i.e., nurses, oncologists, pathologists) and 12 patients diagnosed with non-small cell lung cancer between January and May 2022. Participants described experiences with biomarker testing as well as associated communication practices and needs. Interviews were audio-recorded and transcribed. Analysis was informed by the Framework Method. RESULTS Patients described challenges retaining information early in their patient journey. While patients were generally aware of biomarkers and their effect on treatment options, they expressed limited knowledge of expected time delays between testing and receiving results. Additionally, many did not know their testing results. Clinicians and patients both noted no standard education material on biomarker testing is currently available. They suggested such materials could support patient knowledge and decision-making. CONCLUSIONS Communication between patients and clinicians about biomarker testing is largely delivered through verbal counseling at a time when patients may be cognitively compromised. All participants supported the idea of delivering standard, tangible education materials on biomarker testing to patients. PRACTICE IMPLICATIONS Education materials may enhance counseling efforts and patient knowledge.
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Affiliation(s)
- Allison Pack
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
| | - Andrea Russell
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Sheetal Kircher
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Christine Weldon
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA; Division of Obstetrics and Gynecology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA; The Center for Business Models in Healthcare, Glencoe, IL, USA
| | - Stacy C Bailey
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | | | | | | | | | - Michael Wolf
- The Center for Applied Health Research on Aging and The Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Mokhnatkin JV, Bae M, Dale W, Tiwari A, Patanapirom J, Sedrak MS. Facilitators and Barriers to Older Adult Participation in Cancer Trials: A Qualitative Study Exploring Patient-Caregiver Dyad Congruence. JCO Oncol Pract 2023; 19:484-492. [PMID: 37079865 PMCID: PMC10337716 DOI: 10.1200/op.22.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 04/22/2023] Open
Abstract
PURPOSE Family caregivers play an integral role in caring for older adults with cancer. Few studies have examined older adults with cancer and their family caregivers as a unit in a relationship or a dyad. Dyad congruence, or consistency in perspective, is relevant to numerous aspects of living with cancer, including the decision to enroll in a cancer clinical trial. METHODS Semistructured interviews of 32 older women (age ≥ 70 years) with breast cancer and their family caregivers (16 dyads) were conducted at both academic and community settings from December 2019 to March 2021 to explore perceived facilitators and barriers to cancer trials. Dyad congruence was defined as aligned (matching) perspectives, and incongruence was defined as misaligned (nonmatching) perspectives. RESULTS Five (31%) of 16 patients were age ≥80 years, 11 (69%) had nonmetastatic breast cancer, and 14 (88%) were treated in an academic setting. Six (38%) of 16 caregivers were in the 50-59 age group, 10 (63%) were female, and seven (44%) were daughters. Dyad congruence centered on the clinical benefit of trials and physician recommendation. However, compared with caregivers, patients were more motivated to contribute to science. Patients and caregivers also differed on the perceived extent to which the caregiver influenced enrollment. CONCLUSION Older patients with cancer and their caregivers generally agree about the facilitators and barriers to cancer trial enrollment, but some perceptions are misaligned. Further research is needed to understand whether misaligned perspectives between patients and caregivers influence clinical trial participation of older adults with cancer.
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Oh KM, An K, Lee M, Shin C, Steves SL. Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use. Cancer Causes Control 2023:10.1007/s10552-023-01720-z. [PMID: 37266764 PMCID: PMC10237058 DOI: 10.1007/s10552-023-01720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.
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Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, VA, USA.
| | - Kyungeh An
- Graduate School of Biomedical Sciences & School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Moonju Lee
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Chanam Shin
- College of Nursing, Texas Woman's University, Denton, TX, USA
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Schrimpff C, Link E, Fisse T, Baumann E, Klimmt C. Communication matters when it comes to adverse events: Associations of adverse events during implant treatment with patients' communication quality and trust assessments. PATIENT EDUCATION AND COUNSELING 2023; 110:107675. [PMID: 36827880 DOI: 10.1016/j.pec.2023.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Because patients' trust in their physicians is a critical factor in improving health outcomes and patient response to adverse events, it is important to analyze the determinants of trust. One of these determinants is patient-centered communication. Because the occurrence of adverse events must be communicated to the patient, we asked whether the perceived quality of patient-physician communication acts as an isolating factor between adverse events and patient trust. METHODS We proposed and tested a structural equation model linking the occurrence of adverse events to the mediator patient-provider communication quality and to the outcome patient trust. The model was controlled for sociodemographic and health-related factors. We used online survey data from German implant patients (n = 1312), as implant treatment is associated with frequent adverse events such as infections. RESULTS Our results show that adverse events during implant treatment are associated with small but significantly lower trust levels. Patient-provider communication quality partially mediates this association. CONCLUSIONS Patient trust does not appear to be immune to deterioration from adverse events. Patient-provider communication plays a role in mitigating this association. PRACTICE IMPLICATIONS To improve the quality of care, attention should be paid to how adverse events are communicated in a patient-centered manner.
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Affiliation(s)
- Charlotte Schrimpff
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany.
| | - Elena Link
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Tanja Fisse
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Eva Baumann
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
| | - Christoph Klimmt
- Hanover Center for Health Communication, University of Music, Drama & Media, Hanover, Germany
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Kim J, Linos E, Fishman DA, Dove MS, Hoch JS, Keegan TH. Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study. JMIR Cancer 2023; 9:e44339. [PMID: 37074951 DOI: 10.2196/44339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited. OBJECTIVE Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID. METHODS Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID. CONCLUSIONS Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. CLINICALTRIAL Not applicable.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Ave, Davis, US
| | - Eleni Linos
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, US
- Department of Dermatology, School of Medicine, Stanford University, Stanford, US
| | - Debra A Fishman
- Health Management and Education, UC Davis Health Cardiac Rehabilitation, Davis, US
| | - Melanie S Dove
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, US
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, Center for Healthcare Policy and Research, University of California, Davis, Davis, US
| | - Theresa H Keegan
- Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, US
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Liu PL, Yeo TED. How Online Patient-Provider Communication Impacts Quality of Life: Examining the Role of Patient-Centered Care and Health Competence. HEALTH COMMUNICATION 2023; 38:562-567. [PMID: 34340609 DOI: 10.1080/10410236.2021.1961971] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system.
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Pisegna JL, BrintzenhofeSzoc K, Shahrokni A, Canin B, Plotkin E, Boehmer LM, Chien L, Malone MV, MacKenzie AR, Krok-Schoen JL. Differences in urban and suburban/rural settings regarding care provision and barriers of cancer care for older adults during COVID-19. Support Care Cancer 2022; 31:78. [PMID: 36562819 PMCID: PMC9780617 DOI: 10.1007/s00520-022-07544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Care for older adults with cancer became more challenging during the COVID-19 pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of as well as barriers to cancer care for older adults with cancer between urban and suburban/rural settings. METHODS Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Respondents were recruited through organizational listservs, email blasts, and social media messages. Descriptive statistics and chi-square tests were used. RESULTS Complete data was available from 271 respondents (urban (n = 144), suburban/rural (n = 127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and > 85, respectively, compared to 13% and 15.4% of suburban/rural providers (Ps = 0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults over older adults than suburban/rural providers (10.4% vs. 3.1%, p = 0.04) during the pandemic. The top concerns reported were similar between the groups and related to patient safety, treatment delays, personal safety, and healthcare provider mental health. CONCLUSION These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Janell L. Pisegna
- Physical Therapy Program, Geriatric Research Education and Clinical Center VA Eastern Colorado Healthcare System, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | - Armin Shahrokni
- Department of Medicine, Gastrointestinal Oncology and Geriatrics Services, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Elana Plotkin
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leigh M. Boehmer
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leana Chien
- City of Hope Comprehensive Cancer Center, Duarte, CA USA
| | - Mariuxi Viteri Malone
- Division of Hematology, Florida Cancer Specialists and Research Institute, Venice, FL USA
| | - Amy R. MacKenzie
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA USA
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10Th Ave., Columbus, OH 43210 USA
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Association between Patient-Provider Communication and Self-Perceived Mental Health in US Adults with Cancer: Real-World Evidence through Medical Expenditure Panel Survey. Diseases 2022; 10:diseases10040088. [PMID: 36278587 PMCID: PMC9590007 DOI: 10.3390/diseases10040088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
Using real-world data, this retrospective cross-sectional study aimed to analyze the association between patient–physician communication and self-reported mental health from cancer patients using publicly available 2019 Medical Expenditure Panel Survey (MEPS) household component data. Four adjusted logistic regression models were conducted to analyze the association between patient–physician communication and self-perceived mental health among United States adult cancer patients, with each model assessing different aspects of patient–physician communication: being respected (respect), being listened to (listen), spending enough time (time), and being explained (explain). The main finding from this study was that only the time model showed a statistical significance, where patients who reported that their physician always spent enough time perceived their mental health as good. Other covariates that showed statistical significance with self-perceived mental health in cancer patients included age, income level, physical limitation, and limitation from pain. In conclusion, there were generally no statistically significant associations between patient–physician communication and mental health among cancer patients.
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Sorice-Virk S, Patel V, Christopher AN, Morris MP, Broach RB, Rothman JD, Serletti JM. Patient Perceptions of Cancer and Reconstructive Care During the COVID-19 Pandemic. Plast Surg (Oakv) 2022. [PMCID: PMC9240721 DOI: 10.1177/22925503221101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The Coronavirus-2019 (COVID-19) pandemic profoundly
impacted care for breast cancer patients. Oncologic and reconstructive surgeries
were delayed as hospitals attempted to preserve personal protective equipment
and bed capacity. Little is known about how this unprecedented time has affected
breast cancer patients’ mental health and perceptions regarding their care.
Methods: A survey was sent to surgical oncology and plastic
surgery patients who received breast cancer care between March and May 2020,
during which our institution suspended elective surgery. The survey questions
included patient demographics, as well as questions focused on worries related
to COVID-19, individualized cancer and reconstructive care, and patient
satisfaction with telemedicine. Descriptive statistics were used to assess
patient responses. Results: 56 breast cancer patients completed the
survey, which reflected a 25% response rate. A majority of patients expressed
moderate concern about contracting COVID-19, accessing high-quality cancer care
(78%), and receiving timely surgical care (68%). Only 43% of patients reported
delays in their surgical cancer and reconstructive care, when in actuality 57%
of patients experienced surgical delays. Overall, patients were satisfied with
telemedicine and did not feel it negatively impacted their care (69%).
Conclusions: The COVID-19 pandemic has led to disruptions of
routine oncologic and reconstructive care for breast cancer patients. Patients
were concerned about receiving high-quality cancer and reconstructive care, and
the results of this study uncovered gaps in patient–physician communication. The
implementation of telemedicine was received positively. These data can be used
to improve future health system practices as the medical community faces new
potential shutdowns of surgical services.
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Affiliation(s)
- Sarah Sorice-Virk
- Department of Surgery, University of Florida Health Division of Plastic Surgery, Gainesville, FL, USA
| | - Viren Patel
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrienne N. Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martin P. Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B. Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jami D. Rothman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M. Serletti
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Brual J, Abdelmutti N, Agarwal A, Arisz A, Benea A, Lord B, Massey C, Giuliani M, Stuart-McEwan T, Papadakos J. Developing an Education Pathway for Breast Cancer Patients Receiving Rapid Diagnostic Testing: Investigating Informational and Supportive Care Needs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:568-577. [PMID: 32737830 DOI: 10.1007/s13187-020-01847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several studies have examined the informational needs of patients undergoing the breast diagnostic process where needs are highest during testing and prior to receiving a diagnosis. To aid in the development of an education pathway, we identified patient information needs. A multi-method approach to identify areas of need and to understand when and how information should be provided to patients was undertaken. The methods included an environmental scan of consumer health information, ethnographic observation of the patient clinical experience, key informant interviews, and a needs assessment survey. The data collected from the environmental scan, ethnography, and interviews were used to develop the items in the survey. The survey was developed around four domains: (1) Medical Procedures and Tests, (2) Understanding the Rapid Diagnostic Process, (3) Breast Cancer and Other Breast Conditions, and (4) Support and Coping. A total of 101 patients completed the survey. Mean importance scores were significantly different between domains of information need (p < .0001) and significantly higher for the 'Medical Procedures and Tests' domain compared with all others. Multivariate analysis suggested that participants with higher levels of education (p = .02) and a preference to speak English at home (p = .009) tended to rate the importance of 'Support and Coping' information lower than other participants. Information about medical procedures and tests are most important for the patients undergoing rapid diagnostic testing in our sample. Education materials that are tailored to patient needs should be provided to patients during this stage of the cancer journey to help meet informational needs.
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Affiliation(s)
- Janette Brual
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nazek Abdelmutti
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angela Arisz
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Internal Medicine Residency Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
| | - Bridgette Lord
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, Canada
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christine Massey
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Radiation Oncology Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Terri Stuart-McEwan
- Gattuso Rapid Diagnostic Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Education Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Beer JM, Owens OL. Human Factors and Ergonomics Considerations for Aging-in-Place Part 1: The Intersection of Users and Tasks. ERGONOMICS IN DESIGN 2022. [DOI: 10.1177/10648046221096018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article is part 1 of a two-part series. The term aging-in-place has been increasingly used over the past 40 years to describe the process of remaining in one’s home. In attempt to advance the discussion on the future of aging-in-place, this feature series provides an overview of the grand challenges to aging-in-place with an emphasis on human factors and ergonomics considerations. Part 1 will discuss a variety of ways to conceptualize “aging,” and describe tasks related to healthy aging into three categories: home maintenance, health management, and socialization.
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13
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Bourque MA, Loiselle CG. Patients' cancer care perceptions conceptualized through the Cancer Experience Measurement Framework. BMC Health Serv Res 2022; 22:693. [PMID: 35606765 PMCID: PMC9125953 DOI: 10.1186/s12913-022-07946-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on patients' perceptions of cancer care often documents sub-optimal experiences. Cancer care quality issues include restricted service access, lack of care coordination, gaps in follow-up and "generic" rather than person-centered care. Recent reports underscore that proactively and periodically seeking user feedback is crucial for timely care quality improvement. The present study aimed to analyze and thematically organize a large amount of feedback from patients who had been treated for cancer within the last 6 months. METHODS Randomly selected participants (N = 3,278) from 3 University-affiliated cancer centres in Montreal, Quebec, Canada completed the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) and an open-ended question on their perceptions of the care they received. 692 participants responded to the latter. Guided by the Cancer Experience Measurement Framework (CEMF), their feedback was analyzed using a qualitative thematic approach. RESULTS Cancer care perceptions included sub-themes of care access and coordination, continuity/transition, and perceived appropriateness/personalisation of care. The most salient theme was captured by care access and coordination with 284 comments (44%) directly addressing these issues. The ways in which health care services were structured including setting, schedule, and location were often raised as cause for concerns. Issues surrounding cancer information/education, emotional support, and physical comfort were frequently reported as unmet needs. In addition, limited access to cancer services led patients to seek alternatives such as going to emergency departments and/or private care. CONCLUSIONS These findings are timely as they show that most patients are well aware of quality issues in cancer care and are willing to report candidly on these. Patient feedback also underscore the importance for cancer care institutions to periodically gather patient-reported data so that systems can re-calibrate their service offerings according to these data. Ultimately, patient reports will translate into enhanced quality, personalization, and safer cancer care provision.
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Affiliation(s)
- Michaela A Bourque
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Psychology, Crandall University, Moncton, Canada
| | - Carmen G Loiselle
- Department of Oncology, McGill University, Montreal, Canada.
- Ingram School of Nursing, McGill University, Montreal, Canada.
- Segal Cancer Centre, Jewish General Hospital, Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS), 680 Sherbrooke, Centre-Ouest, Montreal, QC, Canada.
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Starr LT, Bullock K, Washington K, Aryal S, Parker Oliver D, Demiris G. Anxiety, Depression, Quality of Life, Caregiver Burden, and Perceptions of Caregiver-Centered Communication among Black and White Hospice Family Caregivers. J Palliat Med 2022; 25:596-605. [PMID: 34793244 PMCID: PMC8982115 DOI: 10.1089/jpm.2021.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anxiety, depression, and reduced quality of life (QOL) are common problems for hospice family caregivers, but it is unknown if disparities in these experiences exist among Black and White caregivers. Objectives: To compare anxiety, depression, QOL, caregiver burden, and perceptions of caregiver-centered hospice team communication between Black and White hospice family caregivers. Design: Secondary analysis of baseline data from two randomized clinical trials. Setting/Subjects: Seven hundred twenty-two Black and White hospice family caregivers ages 18+ from Midwestern and Northeastern United States. Measurements: Measures included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Caregiver Quality-of-Life Index-Revised (CQLI-R), Zarit Burden Interview (ZBI-7), and Caregiver-Centered Communication Questionnaire (CCCQ). Results: Black and White caregivers differed across demographic and socioeconomic variables. Nearly one-third of hospice family caregivers reported moderate-to-severe anxiety (32.1%) and moderate-to-severe depressive symptoms (32.0%). White caregivers reported lower QOL than Black caregivers (p = 0.04), specifically in emotional (p = 0.02) and social (p = 0.0005) domains. In multiple regression analyses controlling for caregiver and patient factors, we found no racial differences in depression, anxiety, QOL, caregiver burden, or perceptions of caregiver-centered hospice communication. Conclusions: Despite demographic and socioeconomic differences, Black and White hospice family caregivers experience similarly high levels of anxiety, depression, burden, and perceptions of hospice communication. Interventions to support hospice family caregivers across racial groups and research that identifies factors that mediate social determinants of health in this population are needed. The development and validation of culture-concordant mental health screening tools in racially diverse populations is recommended. Trial registration: ClinicalTrials.gov NCT02929108 and ClinicalTrials.gov NCT01444027.
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Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral and Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen Bullock
- Department of Social Work, College of Humanities and Social Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Karla Washington
- Division of Palliative Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Subhash Aryal
- BECCA (Biostatistics * Evaluation * Collaboration * Consultation * Analysis) Lab, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Barnes Jewish College, Goldfarb School of Nursing, St. Louis, Missouri, USA
| | - George Demiris
- Department of Biobehavioral and Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Kotha NV, Kumar A, Qiao EM, Qian AS, Voora RS, Nalawade V, Karim Kader A, McKay RR, Stewart TF, Rose BS. Association of Health-Care System and Survival in African American and Non-Hispanic White Patients With Bladder Cancer. J Natl Cancer Inst 2021; 114:600-608. [PMID: 34918091 PMCID: PMC9002275 DOI: 10.1093/jnci/djab219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND African American patients with bladder cancer have inferior outcomes compared with non-Hispanic White (White) patients. We hypothesize that access to health care is a primary determinant of this disparity. We compared outcomes by race for patients with bladder cancer receiving care within the predominant hybrid-payer health-care model of the United States captured in the Surveillance, Epidemiology, and End Results (SEER) database with those receiving care within the equal-access model of the Veterans' Health Administration (VHA). METHODS African American and White patients diagnosed with bladder cancer were identified in SEER and VHA. Stage at presentation, bladder cancer-specific mortality (BCM), and overall survival (OS) were compared by race within each health-care system. RESULTS The SEER cohort included 122 449 patients (93.7% White, 6.3% African American). The VHA cohort included 36 322 patients (91.0% White, 9.0% African American). In both cohorts, African American patients were more likely to present with muscle-invasive disease and metastases, but the differences between races were statistically significantly smaller in VHA. In SEER multivariable models, African American patients had worse BCM (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.15 to 1.29) and OS (HR = 1.26, 95% CI = 1.20 to 1.31). In contrast within the VHA, African American patients had similar BCM (HR = 0.97, 95% CI = 0.88 to 1.07) and OS (HR = 0.99, 95% CI = 0.93 to 1.05). CONCLUSIONS In this study of contrasting health-care models, receiving medical care in an equal-access system was associated with reduced differences in stage at presentation and eliminated disparities in survival outcomes for African American patients with bladder cancer. Our findings highlight the importance of reducing financial barriers to care to notably improve health equity and oncologic outcomes for African American patients.
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Affiliation(s)
- Nikhil V Kotha
- School of Medicine, University of California San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Edmund M Qiao
- School of Medicine, University of California San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Alex S Qian
- School of Medicine, University of California San Diego, La Jolla, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rohith S Voora
- School of Medicine, University of California San Diego, La Jolla, CA, USA,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Vinit Nalawade
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA,Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - A Karim Kader
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Rana R McKay
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Tyler F Stewart
- Division of Hematology-Oncology, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brent S Rose
- Correspondence to: Brent S. Rose, MD, Department of Radiation Medicine and Applied Sciences, Altman Clinical and Translational Research Institute, University of California San Diego, 9452 Medical Center Dr, La Jolla, CA 92037, USA (e-mail: )
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16
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Anderson JN, Graff C, Krukowski RA, Schwartzberg L, Vidal GA, Waters TM, Paladino AJ, Jones TN, Blue R, Kocak M, Graetz I. "Nobody Will Tell You. You've Got to Ask!": An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer. HEALTH COMMUNICATION 2021; 36:1331-1342. [PMID: 32336140 PMCID: PMC7606266 DOI: 10.1080/10410236.2020.1751383] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Patient-provider communication is a critical component of healthcare and is associated with treatment quality and outcomes for women with breast cancer. This qualitative study examines similarities and differences in patient perspectives of communication needs between Black and White breast cancer survivors. We conducted four focus groups (N = 28) involving women with early-stage breast cancer on adjuvant endocrine therapy (AET), stratified by race and length of time on AET (< 6 months and >6 months). Each group was moderated by a race-concordant moderator and analyzed by emergent themes. Participants expressed common patient-provider communication needs, namely increased sensitivity from oncologists during the initial cancer diagnosis, personalized information to facilitate treatment decisions, emotional support during the transition from active treatment to maintenance, and rapid provider responses to mobile app-based queries. Communication differences by race also emerged. Black women were less likely than White women to describe having their informational needs met. White women praised longstanding relationships with providers, while Black women shared personal stories of disempowered interactions and noted the importance of patient advocates. White women more often reported privacy concerns about technology use. Unlike White women, Black women reported willingness to discuss sensitive topics, both online and offline, but believed those discussions made their providers feel uncomfortable. Early-stage breast cancer patients on AET, regardless of race, have similar needs for patient-centered communication with their oncologists. However, Black women were more likely to report experiencing poorer communication with providers than White women, which may be improved by technology and advocates.
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Affiliation(s)
- Janeane N. Anderson
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Carolyn Graff
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Rebecca A. Krukowski
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Lee Schwartzberg
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Gregory A. Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Teresa M. Waters
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Kentucky, College of Public Health, Department of Health Management and Policy, 111 Washington Ave., Lexington, KY 40536
| | - Andrew J. Paladino
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Tameka N. Jones
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Ryan Blue
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Mehmet Kocak
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Ilana Graetz
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- Emory University, Rollins School of Public Health, Department of Health Policy and Management; 1518 Clifton Road NE, Atlanta, GA 30322
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17
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Yu L, Zheng F, Xiong J, Wu X. Relationship of patient-centered communication and cancer risk information avoidance: A social cognitive perspective. PATIENT EDUCATION AND COUNSELING 2021; 104:2371-2377. [PMID: 33583647 DOI: 10.1016/j.pec.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We examined the relationship between patient-centered communication and cancer risk information avoidance and estimated the mediating role of self-efficacy in this relationship. METHODS Using nationally representative cross-sectional data from the U.S. Health Information National Trends Survey (N = 2033), this study aims to provide a comprehensive understanding of the relationship between patient-centered communication and cancer risk information avoidance via correlation analysis, stepwise regression models, and mediation analysis. RESULTS Patient-centered communication was significantly negatively associated with cancer risk information avoidance (β= -0.09, p < 0.01) after controlling for gender, income, education, and cancer risk perception. Self-efficacy fully mediated the relationship of patient-centered communication with cancer risk information avoidance. CONCLUSION Patient-centered communication can improve patients' self-efficacy, thereby preventing them from avoiding cancer risk information. PRACTICE IMPLICATIONS The negative relationship between patient-centered communication and cancer risk information avoidance substantiates that improving patient-centered communication is a promising approach to support caregivers in their activities, reduce patients' subjective cancer burden, and even improve their health. To address cancer-related issues, policymakers can consider interventions from the external environment and internal personal cognition perspectives.
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Affiliation(s)
- Lei Yu
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
| | - Feiyang Zheng
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
| | - Jie Xiong
- Department of Strategy, Entrepreneurship & International Business, ESSCA School of Management, 49003 Angers, France.
| | - Xiang Wu
- School of Medicine and Health Management, Huazhong University of Science and Technology, 430030 Wuhan, China.
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18
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Conley CC, Otto AK, McDonnell GA, Tercyak KP. Multiple approaches to enhancing cancer communication in the next decade: translating research into practice and policy. Transl Behav Med 2021; 11:2018-2032. [PMID: 34347872 DOI: 10.1093/tbm/ibab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Communicating risk and other health information in a clear, understandable, and actionable manner is critical for the prevention and control of cancer, as well as the care of affected individuals and their family members. However, the swift pace of development in communication technologies has dramatically changed the health communication landscape. This digital era presents new opportunities and challenges for cancer communication research and its impact on practice and policy. In this article, we examine the science of health communication focused on cancer and highlight important areas of research for the coming decade. Specifically, we discuss three domains in which cancer communication may occur: (a) among patients and their healthcare providers; (b) within and among families and social networks; and (c) across communities, populations, and the public more broadly. We underscore findings from the prior decade of cancer communication research, provide illustrative examples of future directions for cancer communication science, and conclude with considerations for diverse populations. Health informatics studies will be necessary to fully understand the growing and complex communication settings related to cancer: such works have the potential to change the face of information exchanges about cancer and elevate our collective discourse about this area as newer clinical and public health priorities emerge. Researchers from a wide array of specialties are interested in examining and improving cancer communication. These interdisciplinary perspectives can rapidly advance and help translate findings of cancer communication in the field of behavioral medicine.
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Affiliation(s)
- Claire C Conley
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Amy K Otto
- Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Glynnis A McDonnell
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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19
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Jazowski SA, Sico IP, Lindquist JH, Smith VA, Bosworth HB, Danus S, Provenzale D, Kelley MJ, Zullig LL. Transportation as a barrier to colorectal cancer care. BMC Health Serv Res 2021; 21:332. [PMID: 33849524 PMCID: PMC8045363 DOI: 10.1186/s12913-021-06339-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/31/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Transportation barriers limit access to cancer care services and contribute to suboptimal clinical outcomes. Our objectives were to describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits. METHODS Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed a mailed survey to assess perceived barriers to recommended care. Participants who reported difficulty with transportation to or from CRC care appointments were categorized as experiencing transportation barriers. We assessed pairwise correlations between transportation barriers, transportation-related factors (e.g., mode of travel), and chaotic lifestyle (e.g., predictability of schedules), and used logistic regression to examine the association between the reporting of transportation difficulties, distance traveled to the nearest Veterans Affairs (VA) facility, and life chaos. RESULTS Of the 115 Veterans included in this analysis, 18% reported experiencing transportation barriers. Distance to the VA was not strongly correlated with the reporting of transportation barriers (Spearman's ρ = 0.12, p = 0.19), but chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman's ρ = 0.22, p = 0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant. CONCLUSIONS Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience greater life chaos. Identifying Veterans who experience chaotic lifestyles would allow for timely engagement in behavioral interventions (e.g., organizational skills training) and with support services (e.g., patient navigation).
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Affiliation(s)
- Shelley A Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
| | - Jennifer H Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Susanne Danus
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Dawn Provenzale
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham, NC, USA
| | - Michael J Kelley
- Department of Veterans Affairs, Specialty Care Services, Washington, DC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
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20
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Strayhorn SM, Lewis-Thames MW, Carnahan LR, Henderson VA, Watson KS, Ferrans CE, Molina Y. Assessing the relationship between patient-provider communication quality and quality of life among rural cancer survivors. Support Care Cancer 2021; 29:1913-1921. [PMID: 32803725 PMCID: PMC7882640 DOI: 10.1007/s00520-020-05674-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We explored relationships between patient-provider communication quality (PPCQ) and three quality of life (QOL) domains among self-identified rural cancer survivors: social well-being, functional well-being, and physical well-being. We hypothesized that high PPCQ would be associated with greater social and functional well-being, but be less associated with physical well-being, due to different theoretical mechanisms. METHODS All data were derived from the 2017-2018 Illinois Rural Cancer Assessment (IRCA). To measure PPCQ and QOL domains, we respectively used a dichotomous measure from the Medical Expenditure Panel Survey's Experience Cancer care tool (high, low/medium) and continuous measures from the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS Our sample of 139 participants was largely female, non-Hispanic White, married, and economically advantaged. After adjusting for demographic and clinical variables, patients who reported high PPCQ exhibited greater social well-being (Std. β = 0.20, 95% CI: 0.03, 0.35, p = 0.02) and functional well-being (Std. β = 0.20, 95% CI: 0.05, 0.35, p = 0.03) than patients with low/medium PPCQ. No association was observed between PPCQ and physical well-being (Std. β = 0.06, 95% CI: - 2.51, 0.21, p = 0.41). Sensitivity analyses found similar, albeit attenuated, patterns. CONCLUSION Our findings aligned with our hypotheses. Future researchers should explore potential mechanisms underlying these differential associations. Specifically, PPCQ may be associated with social and functional well-being through interpersonal mechanisms, but may not be as associated with physical well-being due to multiple contextual factor rural survivors disproportionately face (e.g., limited healthcare access, economic hardship) and stronger associations with clinical factors.
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Affiliation(s)
- Shaila M Strayhorn
- University of Illinois at Chicago Institute for Health Research and Policy, 1747 W. Roosevelt Rd., Chicago, IL, 60608, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N. St. Clair St., Chicago, IL, 60611, USA
- Center of Community Health, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., Chicago, IL, 60611, USA
| | - Leslie R Carnahan
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
| | - Vida A Henderson
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Karriem S Watson
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA
| | - Carol E Ferrans
- University of Illinois at Chicago College of Nursing, 845 S. Damen Ave., Chicago, IL, 60612, USA
| | - Yamilé Molina
- University of Illinois at Chicago Center for Research on Women and Gender, 1640 W. Roosevelt Rd., Chicago, IL, 60608, USA.
- Division of Community Health Sciences, School of Public Health, 1603 W. Taylor St., MC 923, Chicago, IL, USA.
- University of Illinois Cancer Center, 914 S. Wood St., Chicago, IL, 60612, USA.
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21
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Anderson JN, Krukowski RA, Paladino AJ, Graff JC, Schwartzberg L, Curry AN, Vidal GA, Jones TN, Waters TM, Graetz I. THRIVE intervention development: using participatory action research principles to guide a mHealth app-based intervention to improve oncology care. ACTA ACUST UNITED AC 2021; 5. [PMID: 34308256 PMCID: PMC8302021 DOI: 10.21037/jhmhp-20-103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence. Methods: We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial. Results: Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients’ reported symptoms. Nurses reported no negative feedback or usability concerns with the app. Conclusions: THRIVE app content reflects researchers’ partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.
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Affiliation(s)
- Janeane N Anderson
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Paladino
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - J Carolyn Graff
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lee Schwartzberg
- West Cancer Center Research Institute, Germantown, TN, USA.,Division of Hematology/Oncology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrea N Curry
- West Cancer Center Research Institute, Germantown, TN, USA
| | - Gregory A Vidal
- West Cancer Center Research Institute, Germantown, TN, USA.,Division of Hematology/Oncology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tameka N Jones
- West Cancer Center Research Institute, Germantown, TN, USA.,Baylor Scott & White McClinton Cancer Center, Waco, TX, USA
| | - Teresa M Waters
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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22
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Asare M, Fakhoury C, Thompson N, Culakova E, Kleckner AS, Adunlin G, Reifenstein K, Benavidez GA, Kamen CS. The Patient-Provider Relationship: Predictors of black/African American Cancer Patients' Perceived Quality of Care and Health Outcomes. HEALTH COMMUNICATION 2020; 35:1289-1294. [PMID: 31167572 PMCID: PMC6893107 DOI: 10.1080/10410236.2019.1625006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We examined whether the patient-provider relationship (PPR) is associated with Black survivors' health outcomes and whether this association was mediated by the quality of care. The outcome variables were survivors' quality of care and health outcome, and the predictor variable was PPR (communication, emotional support, time spent, and survivors' shared-decision making). A sample of 223 Black cancer survivors (age 63.0 ± 14.0 years) provided evaluable data. The most common cancer types reported by the participants were: gynecologic (32.7%), genitourinary (21.5%), and gastrointestinal cancers (11.2%). After controlling for covariates. A Structural Equation Model (SEM) showed that PPR was significantly associated with both health outcome (p = .015) and quality of care (p = .002). When PPR and quality of care were tested in the mediation model, the direct association between PPR and health outcome was attenuated, and it was no longer significant (b = -0.05, SE = 0.11, p = .65). However, indirectly, there was a strong association between PPR and health outcome through the quality of care (b = 0.22, SE = 0.08, p = .003), indicating full mediation. Providers' interpersonal relationships had a significant influence on the health of Black survivors, and this influence may be due to the increased positive perception of the quality of care. The implications of these findings for further research are discussed.
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Affiliation(s)
- Matthew Asare
- Baylor University, Department of Public Health, Waco, TX
| | | | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY
| | | | - Georges Adunlin
- Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy Samford University Birmingham, AL
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23
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Owens OL, Smith KN, Beer JM, Gallerani DG, McDonnell KK. A Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile Application for Lung Cancer Survivors and Their Families. Oncol Nurs Forum 2020; 47:331-341. [PMID: 32301935 DOI: 10.1188/20.onf.331-341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the cultural sensitivity of the Breathe Easier mobile health application for African American lung cancer survivors and their families. Breathe Easier is an intervention designed to teach strategies to combat symptoms related to lung cancer. PARTICIPANTS & SETTING 12 African American lung cancer survivors and their family members were recruited from an American College of Surgeons-approved cancer program in South Carolina. METHODOLOGIC APPROACH Participants completed in-depth interviews, which were guided by the Cultural Sensitivity Assessment Tool and the Cultural Sensitivity Checklist. Two researchers performed open and axial coding to conceptually organize the data. FINDINGS Multiple culturally relevant themes emerged, including benefits, concerns, and suggestions related to content literacy and inclusiveness, as well as acceptability of and motivations for using the mobile application. However, lung cancer survivors and their family members reported being more concerned about accessing accurate survivorship information. IMPLICATIONS FOR NURSING Attention to health literacy, eHealth literacy, and cultural sensitivity may enhance patient outcomes, and nurses can advocate for patients regarding these communication issues.
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24
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Hong YA, Hossain MM, Chou WS. Digital interventions to facilitate patient‐provider communication in cancer care: A systematic review. Psychooncology 2020; 29:591-603. [DOI: 10.1002/pon.5310] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/12/2019] [Accepted: 12/01/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Y. Alicia Hong
- Department of Health Administration and Policy, College of Health and Human ServicesGeorge Mason University Fairfax Virginia
| | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public HealthTexas A&M University College Station Texas
| | - Wen‐Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Division of Cancer Control and Population ScienceNational Cancer Institute Bethesda Maryland
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25
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Samuel CA, Mbah O, Schaal J, Eng E, Black KZ, Baker S, Ellis KR, Guerrab F, Jordan L, Lightfoot AF, Robertson LB, Yongue CM, Cykert S. The role of patient-physician relationship on health-related quality of life and pain in cancer patients. Support Care Cancer 2019; 28:2615-2626. [DOI: 10.1007/s00520-019-05070-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/02/2019] [Indexed: 01/28/2023]
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26
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Li CC, Matthews AK, Asthana A, Shah RC. The impact of neighborhood disadvantage on health-related quality of life among African American and White cancer survivors. Transl Cancer Res 2019; 8:S313-S322. [PMID: 31511823 PMCID: PMC6738963 DOI: 10.21037/tcr.2019.05.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Following improvements in cancer survival rates quality of life (QOL) has become a key health outcome among cancer survivors. Neighborhood disadvantage has been shown to have a detrimental effect on health outcomes. To date, little is known regarding the influence of neighborhood disadvantage on the health-related QOL of cancer survivors. This study aimed to examine the associations between neighborhood disadvantage and health-related QOL among African American and White cancer survivors. Data were obtained from a retrospective survey study of African American (n=248) and White (n=244) cancer survivors. Physical (PHQOL) and mental health (MHQOL) QOL was measured by the Rand 36-Item Short Form. The neighborhood disadvantage index was created based four components, including prevalence of poverty, mother-only households, home ownership and the prevalence of college educated individuals living in the area. Covariates included demographic characteristics and clinical factors. To adjust the nesting effects of participants living in neighborhoods, a mixed effect linear regression model was conducted to test the association between neighborhood disadvantage and PHQOL and MHQOL after controlling for covariates. Regression results showed that patients living in more disadvantaged neighborhoods reported lower PHQOL than those in more advantaged places (β =−1.21, P=0.020). However, this relationship was not observed for MHQOL outcomes (β =−0.06, P=0.49). Race did not exert an independent influence on observed relationships. Study results contribute to a growing body of research documenting the detrimental effects of neighborhood disadvantage on cancer related outcomes.
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Affiliation(s)
- Chien-Ching Li
- Department of Health Systems Management, Rush University, Chicago, IL, USA
| | - Alicia K Matthews
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Anjali Asthana
- Department of Health Systems Management, Rush University, Chicago, IL, USA
| | - Raj C Shah
- Rush Medical College, Department of Family Medicine, Rush Alzheimer's Disease Center, and Center for Community Health Equity, Chicago, IL, USA
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27
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Rhodes RL, Ukoha NCE, Williams KA, Elwood B, Knox-Rice T, Lee SC, Tiro JA, Skinner CS, Halm EA. Understanding Underuse of Advance Care Planning Among a Cohort of African American Patients With Advanced Cancer: Formative Research That Examines Gaps in Intent to Discuss Options for Care. Am J Hosp Palliat Care 2019; 36:1057-1062. [PMID: 31006248 DOI: 10.1177/1049909119843276] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Advance care planning (ACP), palliative care (PC), and hospice are often underutilized by African Americans (AAs). This study assessed the impact of stage of intent to discuss ACP options as key potential barriers. METHODS We examined intent to discuss completion of ACP, PC, and hospice among 22 AA patients with cancer admitted to a local safety net hospital. Participants were asked about intent to discuss an advanced directive or living will (AD/LW), medical power of attorney (MPOA), PC, and hospice with their doctors. Intent to discuss these ACP components was based on the transtheoretical model. Electronic health records were reviewed at various intervals to assess completion of ACP behaviors and survival. RESULTS Participants had colorectal (33%), breast (44%), and lung (23%) cancer, and 82% had stage III/IV disease. Low percentages of patients were in the precontemplation stage for AD/LW completion (4.6%), MPOA completion (13.6%), and PC discussions (27.2%), but 77.2% were in the precontemplation stage for hospice discussions. At 1 year, only 5% completed an AD/LW, 36.4% appointed an MPOA, 42.9% were referred to PC, and 12.5% were referred to hospice. More than half (54.6%) were deceased by the study's conclusion. Most (81%) of these died within 6 months of their baseline study assessment. CONCLUSIONS Despite being hospitalized with advanced cancer and having poor prognosis, intent to discuss ACP options, PC, and hospice in this population was variable, and completion of these activities was low. This formative research is needed to develop education and counseling interventions for this high-risk, vulnerable population.
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Affiliation(s)
- Ramona L Rhodes
- 1 Division of Geriatric Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,2 Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Kimberly A Williams
- 4 Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bryan Elwood
- 5 Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Simon C Lee
- 2 Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,7 Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- 2 Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,7 Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Celette Sugg Skinner
- 2 Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,7 Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- 2 Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,5 Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.,7 Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
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28
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Racial and Income Disparities in Health-Related Quality of Life among Smokers with a Quit Attempt in Louisiana. ACTA ACUST UNITED AC 2019; 55:medicina55020048. [PMID: 30781893 PMCID: PMC6410197 DOI: 10.3390/medicina55020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/27/2019] [Accepted: 02/10/2019] [Indexed: 12/25/2022]
Abstract
Background and objectives: Smoking is associated with a lower health-related quality of life (HRQOL). However, there is little information about the association between HRQOL in relation to race, income, and smoking status. The present study aimed to assess the association between HRQOL and smoking status for those of different races and income levels. Materials and Methods: This study applied a cross-sectional design using data from the 2017 patient survey of the Louisiana Tobacco Control Initiative. We obtained 1108 responses from patients at eight Louisiana public hospitals. The EuroQol (EQ-5D) US index score assessed HRQOL. Smoking status was classified into four groups: never smoked, former smoker, current smoker with a quit attempt, and current smoker without a quit attempt. Multivariate linear regression analyses were used to estimate the HRQOL for black or African Americans and whites. Results: The patients were predominantly black or African American (58.9%) with lower-income (71.2%). Bivariate analyses showed that there were differences in income levels between black or African Americans and whites (p = 0.006). Moreover, black or African Americans (median = 0.80) had a higher mean of HRQOL than whites (median = 0.76). Among lower-income black or African Americans, current smokers with a quit attempt had a lower HRQOL than current smokers (coefficient = −0.12; p < 0.01). Conclusions: Racial and income disparities were evident with regards to HRQOL, with lower-income black or African Americans who were current smokers with a quit attempt having a lower HRQOL. Intervention programs for smoking cessation should target lower-income black or African American smokers who have a prior quit attempt and provide effective cessation services to help them quit smoking and improve their HRQOL.
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29
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Choi SK, Seel JS, Yelton B, Steck SE, McCormick DP, Payne J, Minter A, Deutchki EK, Hébert JR, Friedman DB. Prostate Cancer Information Available in Health-Care Provider Offices: An Analysis of Content, Readability, and Cultural Sensitivity. Am J Mens Health 2018; 12:1160-1167. [PMID: 29649921 PMCID: PMC6131445 DOI: 10.1177/1557988318768599] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and
African American men have the highest incidence among men in the United States. Little is
known about the PrCA-related educational materials being provided to patients in
health-care settings. Content, readability, and cultural sensitivity of materials
available in providers’ practices in South Carolina were examined. A total of 44
educational materials about PrCA and associated sexual dysfunction was collected from 16
general and specialty practices. The content of the materials was coded, and cultural
sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading
Ease, Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook were used to
assess readability. Communication with health-care providers (52.3%), side effects of PrCA
treatment (40.9%), sexual dysfunction and its treatment (38.6%), and treatment options
(34.1%) were frequently presented. All materials had acceptable cultural sensitivity
scores; however, 2.3% and 15.9% of materials demonstrated unacceptable cultural
sensitivity regarding format and visual messages, respectively. Readability of the
materials varied. More than half of the materials were written above a high-school reading
level. PrCA-related materials available in health-care practices may not meet patients’
needs regarding content, cultural sensitivity, and readability. A wide range of
educational materials that address various aspects of PrCA, including treatment options
and side effects, should be presented in plain language and be culturally sensitive.
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Affiliation(s)
- Seul Ki Choi
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jessica S Seel
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Brooks Yelton
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Susan E Steck
- 3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Johnny Payne
- 5 UsTOO Greenville and Upstate Prostate Cancer Alliance, Easley, USA
| | - Anthony Minter
- 6 USToo Columbia and ZERO Prostate Cancer, Columbia, SC, USA
| | - Elizabeth K Deutchki
- 7 Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- 2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,2 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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