Relationship of communication and information measures to colorectal cancer screening utilization: results from HINTS

Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use

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.

Exploring Why Financial Incentives Fail to Affect At-home Colorectal Cancer Screening: a Mixed Methods Study

BACKGROUND

Despite success in increasing other health behaviors, financial incentives have shown limited to no effect on colorectal cancer (CRC screening. Little is known about the factors shaping why and for whom incentives improve screening.

OBJECTIVE

To explore the perspective of participants enrolled in a larger, four-arm pragmatic trial at urban family medicine practices which assessed and failed to detect significant effects of financial incentives on at-home CRC screening completion.

DESIGN

We performed a mixed methods study with a subset of randomly selected patients, stratified by study arm, following completion of the pragmatic trial.

PARTICIPANTS

Sixty patients (46.9% enrollment rate) who were eligible and overdue for colorectal cancer screening at the time of trial enrollment and who continued to receive care at family medicine practices affiliated with an urban academic health system completed the interview and questionnaire.

MAIN MEASURES

Using Andersen's behavioral model, a semi-structured interview guide assessed motivators, barriers, and facilitators to screening completion and the impact of incentives on decision-making. Participants also completed a brief questionnaire evaluating demographics, screening beliefs, and clinical characteristics.

KEY RESULTS

The majority of patients (n = 49; 82%) reported that incentives would not change their decision to complete or not complete CRC screening, which was confirmed by qualitative data as largely due to high perceived health benefits. Those who stated financial incentives would impact their decision (n = 11) were significantly less likely to agree that CRC screening is beneficial (72.7% vs 95.9%; p < 0.05) or that CRC could be cured if detected early (63.6% vs 98.0%; p < 0.05).

CONCLUSIONS

Financial incentives are likely not an effective behavioral intervention to increase CRC screening for all but may be powerful for increasing short-term benefit and therefore completion for some. Targeting financial incentive interventions according to patient screening beliefs may prove a cost-effective strategy in primary care outreach programs to increase CRC screening.

Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial

Background

Even after a physician recommendation, many people remain unscreened for colorectal cancer (CRC). The proliferation of electronic health records (EHRs) and tethered online portals may afford new opportunities to embed patient-facing interventions within clinic workflows and engage patients following a physician recommendation for care. We evaluated the effectiveness of a patient-facing intervention designed to complement physician office-based recommendations for CRC screening.

Design

Using a 2-arm pragmatic, randomized clinical trial, we evaluated the intervention’s effect on CRC screening use as documented in the EHR (primary outcome) and the extent to which the intervention reached the target population. Trial participants were insured, aged 50 to 75 y, with a physician recommendation for CRC screening. Typical EHR functionalities, including patient registries, health maintenance flags, best practice alerts, and secure messaging, were used to support research-related activities and deliver the intervention to enrolled patients.

Results

A total of 1,825 adults consented to trial participation, of whom 78% completed a baseline survey and were exposed to the intervention. Most trial participants (>80%) indicated an intent to be screened on the baseline survey, and 65% were screened at follow-up, with no significant differences by study arm. One-third of eligible patients were sent a secure message. Among those, more than three-quarters accessed study material.

Conclusions

By leveraging common EHR functionalities, we integrated a patient-facing intervention within clinic workflows. Despite practice integration, the intervention did not improve screening use, likely in part due to portal-based interventions not reaching those for whom the intervention may be most effective.

Implications

Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population.

Highlights

Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study

PURPOSE

To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices.

APPROACH

Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire.

SETTING

Single urban academic healthcare system.

PARTICIPANTS

Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment.

METHOD

Using Andersen's Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method.

RESULTS

Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening.

CONCLUSIONS

Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.

Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey

INTRODUCTION

Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors.

METHODS

A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population.

RESULTS

Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79).

DISCUSSION

The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.

The Influence of Patient-Provider Communication on Cancer Screening

Few studies have examined how different qualities and modes (face-to-face vs electronic) of patient–provider communication (PPC) influence cancer screening uptake. Our objective was to determine whether receiving a breast, cervical, and colorectal cancer screening is influenced by (1) qualities of face-to-face and (2) the use of e-mail PPC. We analyzed Health Information National Trends Survey 4, cycles 1 to 4 data. To assess qualities of face-to-face PPC, adults reported how often physicians spent enough time with them, explained so they understood, gave them a chance to ask questions, addressed feelings and emotions, involved them in decisions, confirmed understanding, and helped them with uncertainty. Adults reported whether they used e-mail PPC. We used multivariable logistic regression to evaluate the odds of receiving cancer screenings based on face-to-face and e-mail PPC. Adults whose health-care providers involved them in decision-making had highest odds of receiving breast (odds ratio [OR] = 1.38; 95% confidence interval [CI] = 1.11-1.71), cervical (OR = 1.30; 95% CI = 1.06-1.60), and colorectal (OR = 1.25; 95% CI = 1.03-1.51) cancer screenings. No significant associations were observed between e-mail PPC and cancer screenings. More research is needed to explore this association.

Social Capital and Health Communication in Singapore: An Examination of the Relationships between Community Participation, Perceived Neighborliness and Health Communication Behaviors

Social capital is a collective characteristic of communities that determines the health and well-being of populations. There is ample evidence supporting the link between social capital and health; however, less is known about the relationship between social capital and health communication behaviors. Our study aimed to investigate the relationships between social capital and health communication in Singaporean adults aged 21 years and above. Cross-sectional data (N = 1,012) were collected from the Singapore Population Health Studies (SPHS) Online Panel. Three main outcome variables assessing health communication behaviors in the past 12 months were (1) health information-seeking; health information-sharing (2) with family members and (3) with friends and coworkers. Two components of social capital were assessed: structural component (i.e., community participation) and cognitive component (i.e., perceived neighborliness). Regression analyses found that community participation and perceived neighborliness were significantly associated with health information-seeking. The analyses also found that perceived cohesion was a significant correlate of health information-sharing with family members. Finally, moderation tests indicated that perceived neighborliness moderated the relationships between trust in information sources and health communication (health information-seeking and health information-sharing with friends/coworkers). Findings have implications for community-based health interventions and social policies to strengthen community participation and cohesion.

The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups

Our study aimed to estimate how associations between adults' perceptions of specific domains of PPC quality and their likelihood of receiving cancer screenings differed by race and ethnicity. We analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Samples included 7337 women ages 50-74 (breast), 13,276 women ages 21-65 (cervical), and 9792 adults ages ≥50 years (colorectal). To examine individual domains of PPC quality (independent variables), adults reported how often providers: listened; showed respect; spent enough time; explained things; gave specific instructions; and demonstrated health literate practices (gave clear instructions and asked them to "teach-back" how they will follow instructions). Dependent variables were breast, cervical, and colorectal cancer screenings. Multivariable logistic regression was used to evaluate the odds of receiving cancer screenings using a composite measure of PPC quality and separate domains. Hispanic and non-Hispanic black adults who reported their providers always demonstrated PPC quality had higher odds of receiving colorectal cancer screenings compared to those whose providers did not. Adults' perceptions of whether or not their provider gave them specific instructions increased their odds of receiving breast (Hispanics OR = 1.65, 95% CI = 1.09, 2.51; non-Hispanic blacks OR = 1.54, 95% CI = 1.06, 2.24) and colorectal (non-Hispanic whites OR = 1.37, 95% CI = 1.13, 1.66; Hispanics OR = 1.29, 95% CI = 1.01, 1.66; non-Hispanic blacks OR = 1.92, 95% CI = 1.39, 2.65) cancer screenings. Non-Hispanic Asian women who reported their health care providers demonstrated "teach-back" had higher odds (OR = 2.25; 95% CI = 1.10, 4.62) of receiving cervical cancer screenings. Efforts to improve cancer screenings should focus on training providers to demonstrate health literate practices to improve cancer screenings.

Alaska Native Patient and Provider Perspectives on the Multitarget Stool DNA Test Compared With Colonoscopy for Colorectal Cancer Screening

Objective: Alaska Native (AN) people have among the world's highest rate of colorectal cancer (CRC). We assessed perceptions of AN people and their health care providers of a new take-home multitarget stool DNA test (MT-sDNA; Cologuard) relative to colonoscopy. Methods: Cross-sectional surveys of AN people aged 40 to 75 years (mailed) and providers (online). Results: Participants included 1616 AN patients (19% response rate) and 87 providers (26% response rate; 57% AN people). Over half (58%) of patients preferred colonoscopy for CRC screening, while 36% preferred MT-sDNA. Unscreened patients were significantly more likely to state a preference for MT-sDNA than previously screened patients (42% vs 31%, P < .05) as were younger patients (<60 years old) compared with older patients (40% vs 30%, P < .05). Most providers thought that MT-sDNA would improve screening rates (69%), would recommend if available (79%), and be implementable (79%). Perceived barriers differed substantially between patients and providers in both type and magnitude. Leading colonoscopy barriers reported by patients were travel (44%) and bowel preparation (40%), while providers thought that fear of pain (92%) and invasiveness of the test (87%) were the primary barriers. For MT-sDNA, patients' belief that colonoscopy was better (56%) and not knowing how to do the test (40%) were primary barriers, while providers thought stool collection (67%) and having a stool sample in their home (63%) were leading barriers. Conclusions: This study found that MT-sDNA has potential acceptability among AN people and their health care providers. Both groups reported a willingness to use MT-sDNA and did not perceive major barriers to its use. This preference was especially true of unscreened and younger patients. The majority of providers indicated they would use MT-sDNA if available and that it would improve CRC screening rates. In this population, where colonoscopy access is limited, MT-sDNA has the potential to improve CRC screening adherence.

Correlates of Patient Intent and Preference on Colorectal Cancer Screening

INTRODUCTION

Information is limited on patient characteristics that influence their preference among screening options and intent to be screened for colorectal cancer (CRC). A mechanistic pathway to intent and preference was examined through a formal mediation analysis.

METHODS

From 2012 to 2014, a total of 570 adults aged 50-75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for CRC screening. Confirmatory factor, regression, and mediation analyses were performed in 2015-2016 on baseline cross-sectional data. Main outcomes were patient intent and preference. Perceived risk and self-efficacy were secondary outcomes. Covariates included demographic information, health status, previous CRC screening experience, patient attitudes, and knowledge.

RESULTS

Mean age was 57.7 years, 56.1% were women, and 55.1% white and 36.6% black. Women had 32% and 41% lower odds than men of perceiving CRC to be high/moderate risk (OR=0.68, 95% CI=0.47, 0.97, p=0.03) and having high self-efficacy (OR=0.59, 95% CI=0.42, 0.85, p=0.006), respectively. Whites had 63% and 47% lower odds than blacks of having high self-efficacy (OR=0.37, 95% CI=0.25, 0.57, p<0.001) and intent to undergo CRC screening (OR=0.53, 95% CI=0.34, 0.84, p=0.007), respectively. Younger age, higher knowledge, lower level of test worries, and medium/high versus low self-efficacy increased the odds of intent of being screened. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient screening intent.

CONCLUSIONS

Self-efficacy mediated the association between race, attitude, and test worries and patient intent.

Impact of provider-patient communication on cancer screening adherence: A systematic review

Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.

Cancer Information Seeking and Cancer-Related Health Outcomes: A Scoping Review of the Health Information National Trends Survey Literature

Cancer is a leading cause of death among adults in the United States. Only 54% of U.S. adults reported seeking cancer information in 2014. Cancer information seeking has been positively associated with cancer-related health outcomes such as screening adherence. We conducted a scoping review of studies that used data from the Health Information National Trends Survey (HINTS) in order to examine cancer information seeking in depth and the relationship between cancer information seeking and cancer-related health outcomes. We searched five databases and the HINTS website. The search yielded a total of 274 article titles. After review of 114 de-duplicated titles, 66 abstracts, and 50 articles, 22 studies met inclusion criteria. Cancer information seeking was the outcome in only four studies. The other 18 studies focused on a cancer-related health outcome. Cancer beliefs, health knowledge, and information seeking experience were positive predictors of cancer information seeking. Cancer-related awareness, knowledge, beliefs, preventive behaviors, and screening adherence were higher among cancer information seekers. Results from this review can inform other research study designs and primary data collection focused on specific cancer sites or aimed at populations not represented or underrepresented in the HINTS data (e.g., minority populations, those with lower socioeconomic status).

Health Information Seeking and Cancer Screening Adherence Rates

Effective screening tools are available for many of the top cancer killers in the USA. Searching for health information has previously been found to be associated with adhering to cancer screening guidelines, but Internet information seeking has not been examined separately. The current study examines the relationship between health and cancer Internet information seeking and adherence to cancer screening guidelines for breast, cervical, and colorectal cancer in a large nationally representative dataset. The current study was conducted using data from the Health Information National Trends Survey from 2003 and 2007. The study examined age-stratified models which correlated health and cancer information seeking with getting breast, cervical, and colorectal cancer screening on schedule, while controlling for several key variables. Internet health and cancer information seeking was positively associated with getting Pap screening on schedule, while information seeking from any sources was positively associated with getting colorectal screening on schedule. People who look for health or cancer information are more likely to get screened on schedule. Some groups of people, however, do not exhibit this relationship and, thus, may be more vulnerable to under-screening. These groups may benefit more from targeted interventions that attempt to engage people in their health care more actively.

African American patients' intent to screen for colorectal cancer: Do cultural factors, health literacy, knowledge, age and gender matter?

African Americans have higher colorectal cancer (CRC) mortality rates. Research suggests that CRC screening interventions targeting African Americans be based upon cultural dimensions. Secondary analysis of data from African-Americans who were not up-to-date with CRC screening (n=817) was conducted to examine: 1) relationships among cultural factors (i.e., provider trust, cancer fatalism, health temporal orientation (HTO)), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among the variables and CRC screening intention. Provider trust, fatalism, HTO, health literacy and CRC knowledge had significant relationships among study variables. The FOBT intention model explained 43% of the variance with age and gender being significant predictors. The colonoscopy intention model explained 41% of the variance with gender being a significant predictor. Results suggest that when developing CRC interventions for African Americans, addressing cultural factors remain important, but particular attention should be given to the age and gender of the patient.

Patients' perceptions of colorectal cancer screening tests and preparatory education in federally qualified health centers

This study explored federally qualified health center (FQHC) patients' perceptions about colorectal cancer screening (CRCS) tests, including immunochemical fecal occult blood tests (iFOBT), as well as preferences for receiving in-clinic education about CRCS. Eight mixed gender focus groups were conducted with 53 patients. Findings centered on three thematic factors: (1) motivators and impediments to CRCS, (2) test-specific preferences and receptivity to iFOBTs, and (3) preferences for entertaining and engaging plain language materials. Results informed the development of educational priming materials to increase CRCS using iFOBT in FQHCs.

Cancer Information Seeking Behaviors of Korean American Women: A Mixed-Methods Study Using Surveys and Focus Group Interviews

Despite the high risk of cancer to the population, Korean Americans are known to have lower knowledge about cancer related information and a lower level of adherence to cancer prevention guidelines. This indicates the necessity of cancer interventions targeting the Korean American population. To reach this population effectively, it is imperative to understand Korean Americans' cancer information seeking behaviors. This study (a) identified cancer information sources that are trusted and used by Korean American women and (b) examined how general media exposure and trust in cancer information sources are related to the use of these sources. It also (c) explored perceived usefulness and limitations of cancer information sources. A mixed methods study using seven focus group interviews with 34 Korean American women and surveys with 152 Korean American women was conducted in the Washington, DC, metropolitan area from 2011 to 2012. The results indicate that Korean American women viewed health care professionals as the most trusted cancer information source but used the Internet and Korean ethnic media more often for cancer information seeking because of language, cultural, and economic barriers. Korean American women were most likely to obtain cancer information from media they used frequently for general purposes. Correlations between usage frequency and trust in doctor/health providers and the Internet as cancer information sources were negligible. When seeking cancer information, important factors for Korean American women were accessibility, affordability, and language proficiency, cultural sensitivity, meeting immediate needs, understandability, convenience, and reliability of cancer information sources. Findings from this study support developing interventions using Korean language media, including print, television and the Internet for health promotion and cancer prevention targeting Korean American women.

Physician use of persuasion and colorectal cancer screening

The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N = 414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening.

Health information seeking and the World Wide Web: an uncertainty management perspective

Uncertainty management theory was applied in the present study to offer one theoretical explanation for how individuals use the World Wide Web to acquire health information and to help better understand the implications of the Web for information seeking. The diversity of information sources available on the Web and potential to exert some control over the depth and breadth of one's information-acquisition effort is argued to facilitate uncertainty management. A total of 538 respondents completed a questionnaire about their uncertainty related to cancer prevention and information-seeking behavior. Consistent with study predictions, use of the Web for information seeking interacted with respondents' desired level of uncertainty to predict their actual level of uncertainty about cancer prevention. The results offer evidence that respondents who used the Web to search for cancer information were better able than were respondents who did not seek information to achieve a level of uncertainty commensurate with the level of uncertainty they desired.

The influence of health disparities on targeting cancer prevention efforts

Despite the advances in cancer medicine and the resultant 20% decline in cancer death rates for Americans since 1991, there remain distinct cancer health disparities among African Americans, Hispanics, Native Americans, and the those living in poverty. Minorities and the poor continue to bear the disproportionate burden of cancer, especially in terms of stage at diagnosis, incidence, and mortality. Cancer health disparities are persistent reminders that state-of-the-art cancer prevention, diagnosis, and treatment are not equally effective for and accessible to all Americans. The cancer prevention model must take into account the phenotype of accelerated aging associated with health disparities as well as the important interplay of biological and sociocultural factors that lead to disparate health outcomes. The building blocks of this prevention model will include interdisciplinary prevention modalities that encourage partnerships across medical and nonmedical entities, community-based participatory research, development of ethnically and racially diverse research cohorts, and full actualization of the prevention benefits outlined in the 2010 Patient Protection and Affordable Care Act. However, the most essential facet should be a thoughtful integration of cancer prevention and screening into prevention, screening, and disease management activities for hypertension and diabetes mellitus because these chronic medical illnesses have a substantial prevalence in populations at risk for cancer disparities and cause considerable comorbidity and likely complicate effective treatment and contribute to disproportionate cancer death rates.

Patient-physician colorectal cancer screening discussion content and patients' use of colorectal cancer screening

OBJECTIVE

The US Preventive Services Task Force recommends using the 5As (i.e., Assess, Advise, Agree, Assist and Arrange) when discussing preventive services. We evaluate the association of the 5As discussion during primary care office visits with patients' subsequent colorectal cancer (CRC) screening use.

METHODS

Audio-recordings of n=443 periodic health exams among insured patients aged 50-80 years and due for CRC screening were joined with pre-visit patient surveys and screening use data from an electronic medical record. Association of the 5As with CRC screening was assessed using generalized estimating equations.

RESULTS

93% of patients received a recommendation for screening (Advise) and 53% were screened in the following year. The likelihood of screening increased as the number of 5A steps increased: compared to patients whose visit contained no 5A step, those whose visit contained 1-2 steps (OR=2.96 [95% CI 1.16, 7.53]) and 3 or more steps (4.98 [95% CI 1.84, 13.44]) were significantly more likely to use screening.

CONCLUSIONS

Physician CRC screening recommendations that include recommended 5A steps are associated with increased patient adherence.

PRACTICE IMPLICATIONS

A CRC screening recommendation (Advise) that also describes patient eligibility (Assess) and provides help to obtain screening (Assist) may lead to improved adherence to CRC screening.

Giant inflatable colon and community knowledge, intention, and social support for colorectal cancer screening

Introduction

Colorectal cancer (CRC) is the second-leading cause of deaths from cancer in the United States. Screening decreases CRC deaths through early cancer detection and through removal of precancerous lesions. We investigated whether a health exhibit consisting of a giant inflatable colon was an effective educational tool to increase community members’ knowledge, intention, and social support for CRC screening and prevention.

Methods

Alaska adults (N = 880) attending community events statewide from March 2011 through March 2012 completed a short survey to assess knowledge about CRC, intention to get screened, and level of social support before and after walking through a giant interactive model of a human colon. The survey used a combination of open-ended questions and a Likert scale, where 1 was “very unlikely,” 2 was “somewhat unlikely,” 3 was “neutral,” 4 was “somewhat likely,” and 5 was “very likely.” The model depicted CRC stages from normal tissue to advanced adenocarcinoma and displayed signs with CRC prevention tips. We used the McNemar test and paired sample t tests for univariate analyses.

Results

Respondents significantly improved their CRC knowledge (P < .05), intention to get screened (mean score increased from 4.3 to 4.5, P < .001), and comfort with talking to others about CRC screening (mean level of comfort increased from 3.8 to 3.9, P < .001). Multivariate analysis showed no significant differences by sex, age, or race for improvements in CRC screening knowledge, intention, or comfort.

Conclusion

Interactive exhibits can improve public knowledge and interest in CRC screening, which may lead to increased CRC screening rates and decreased CRC incidence and deaths.

Picking up the pace: changes in method and frame for the health information national trends survey (2011-2014)

Health communication and health information technology influence the ways in which health care professionals and the public seek, use, and comprehend health information. The Health Information National Trends Survey (HINTS) program was developed to assess the effect of health communication and health information technology on health-related attitudes, knowledge, and behavior. HINTS has fielded 3 national data collections with the fourth (HINTS 4) currently underway. Throughout this time, the Journal of Health Communication has been a dedicated partner in disseminating research based on HINTS data. Thus, the authors thought it the perfect venue to provide an historical overview of the HINTS program and to introduce the most recent HINTS data collection effort. This commentary describes the rationale for and structure of HINTS 4, summarizes the methodological approach applied in Cycle 1 of HINTS 4, describes the timeline for the HINTS 4 data collection, and identifies priorities for research using HINTS 4 data.

Effects of text cohesion on comprehension and retention of colorectal cancer screening information: a preliminary study

Increasing readability of written cancer prevention information is a fundamental step to increasing awareness and knowledge of cancer screening. Instead of readability formulas, the present study focused on text cohesion, which is the degree to which the text content ties together. The purpose of this study was to examine the effect of text cohesion on reading times, comprehension, and retention of colorectal cancer prevention information. English-speaking adults (50 years of age or older) were recruited from local communities. Participants were randomly assigned to read colorectal cancer prevention subtopics presented at 2 levels of text cohesion: from higher cohesion to lower cohesion, or vice versa. Reading times, word recognition, text comprehension, and recall were assessed after reading. Two weeks later, text comprehension and recall were reassessed. Forty-two adults completed the study, but five were lost to follow up. Higher text cohesion showed a significant effect on reading times and text comprehension but not on word recognition and recall. The effect of text cohesion was not found on text comprehension and recall after 2 weeks. Increasing text cohesion facilitates reading speed and comprehension of colorectal cancer prevention information. Further research on the effect of text cohesion is warranted.

Primary care colorectal cancer screening recommendation patterns: associated factors and screening outcomes

BACKGROUND

The relationship of a primary care provider's (PCP's) colorectal cancer (CRC) screening strategies to completion of screening is poorly understood.

OBJECTIVE

To describe PCP test recommendation patterns and associated factors and their relationship to patient test completion.

DESIGN

This cross-sectional study used a PCP survey, in-depth PCP interviews, and electronic medical records.

SETTING

Kaiser Permanente Northwest health maintenance organization.

PARTICIPANTS

Participants included 132 PCPs and 49,259 eligible patients aged 51 to 75.

MEASUREMENTS

The authors grouped PCPs by patterns of CRC screening recommendations based on reported frequency of recommending fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and colonoscopy. They then compared PCP demographics, reported CRC screening test influences, concerns, decision-making and counseling processes, and actual rates of patient CRC screening completion by PCP group.

RESULTS

The authors identified 4 CRC screening recommendation groups: a "balanced" group (n = 54; 40.9%) that recommended the tests nearly equally, an FOBT group (n = 31; 23.5%) that largely recommended FOBT, an FOBT + FS group (n = 25; 18.9%), and a colonoscopy + FOBT group (n = 22; 16.7%) that recommended these tests nearly equally. Internal medicine (v. family medicine) PCPs were more common in groups more frequently recommending endoscopy. The FOBT and FOBT + FS groups were most influenced by clinical guidelines. Groups recommending more endoscopy were most concerned that FOBT generates a relatively high number of false positives and FOBT can miss cancers. The FOBT and FOBT + FS groups were more likely to recommend a specific screening strategy compared to the colonoscopy + FOBT and balanced groups, which were more likely to let the patient decide. CRC screening rates were 63.9% balanced, 62.9% FOBT, 61.7% FOBT + FS, and 62.2% colonoscopy + FOBT; rates did not differ significantly by group.

LIMITATIONS

Small numbers within PCP groups.

CONCLUSIONS

Specialty, the influence of guidelines, test concerns, and the "jointness" of the test selection decision distinguished CRC screening recommendation patterns. All patterns were associated with similar overall screening rates.

The influence of sociocultural factors on colonoscopy and FOBT screening adherence among low-income Hispanics

Few studies have examined barriers and facilitators to colorectal cancer (CRC) screening among Hispanics, particularly sociocultural factors that may be relevant. This paper examines the influence of sociocultural factors on adherence to fecal occult blood testing (FOBT) and colonoscopy. A survey was conducted among a sample of 400 low-income Hispanics in East Harlem, New York. Fatalism and health literacy were both significantly associated with colonoscopy screening adherence in bivariate models, though fatalism became non-significant and health literacy became less significant in multivariable models. With respect to adherence to colonoscopy or FOBT, both fatalism and health literacy were associated in bivariate models, though only fatalism remained significant in multivariable models (p=.03; OR: .94; 95% CI: .881-.992). These findings suggest fatalism and health literacy may play a role in shaping CRC screening adherence among low-income Hispanics. Researchers should continue investigating how sociocultural factors influence screening adherence among Hispanics, using larger and more geographically diverse samples.

The influence of physicians on colorectal cancer screening behavior

BACKGROUND

Our aims were to determine clinical factors associated with colorectal cancer (CRC) screening and to evaluate the relative role of patient contact with physicians and the quality of these patient-physician interactions in affecting screening.

METHODS

Screening-eligible patients were identified from the Health Information National Trends Survey. Determinants of CRC screening were assessed with logistic regression, and a joint effects model that considered the frequency and quality of contact with physicians was developed to explore their influence on screening.

RESULTS

There were 4,615 respondents of whom only 66% reported receiving CRC screening. Older age, personal history of non-CRC, family history of any cancer, high-income earners, individuals who visited their physicians ≥5 times per year, and those who rated the interactions with their physicians highly were more likely to be screened (all p < 0.05). The joint effects model revealed that quality rather than frequency of physician contact was a stronger predictor of CRC screening, but the odds of screening was highest for those who experienced both frequent and high-quality interactions with their physicians.

CONCLUSIONS

Contact with physicians and the quality of this interaction are associated with screening behavior. Interventions to improve these provider-related factors may promote CRC screening.

The questions on the use of internet cancer support groups: instrument development

Recently, with advances in computer technologies, Internet cancer support groups became more popular than ever among people living with cancer. However, there is little information available on cancer patients' use of Internet cancer support groups, which may be partially due to a lack of instruments measuring cancer patients' use of Internet cancer support groups. Indeed, virtually no instrument measuring cancer patients' use of Internet cancer support groups can be identified through searches using multiple databases. In this study, a new instrument measuring the use of Internet cancer support groups was developed, and its psychometric properties were tested among 117 people living with cancer recruited through the Internet using a convenience sampling method. First, the development process of the new instrument, the Questions on the Use of Internet Cancer Support Groups, is described. Then, the pilot study on psychometric properties of the instrument is presented. Reliability was evaluated using internal consistency reliability testing, split-half reliability testing, and item analysis. Validity was assessed by using criterion validity, convergent validity, and face validity. The findings of the pilot study supported the reliability and validity of this new instrument. Based on the findings, some implications for future research are proposed.

Exploring digital divides: An examination of eHealth technology use in health information seeking, communication and personal health information management in the USA

Recent government initiatives to deploy health information technology in the USA, coupled with a growing body of scholarly evidence linking online heath information and positive health-related behaviors, indicate a widespread belief that access to health information and health information technologies can help reduce healthcare inequalities. However, it is less clear whether the benefits of greater access to online health information and health information technologies is equitably distributed across population groups, particularly to those who are underserved. To examine this issue, this article employs the 2007 Health Information National Trends Survey (HINTS) to investigate relationships between a variety of socio-economic variables and the use of the web-based technologies for health information seeking, personal health information management and patient-provider communication within the context of the USA. This study reveals interesting patterns in technology adoption, some of which are in line with previous studies, while others are less clear. Whether these patterns indicate early evidence of a narrowing divide in eHealth technology use across population groups as a result of the narrowing divide in Internet access and computer ownership warrants further exploration. In particular, the findings emphasize the need to explore differences in the use of eHealth tools by medically underserved and disadvantaged groups. In so doing, it will be important to explore other psychosocial variables, such as health literacy, that may be better predictors of health consumers’ eHealth technology adoption.

The Use of Internet Cancer Support Groups by Asian Americans and White Americans Living With Cancer

Purpose: To explore the use of Internet cancer support groups (UICSG) by Asians and Whites living with cancer and determine the factors influencing their UICSG. Design and Method: A cross-sectional Internet study among 30 Asians and 30 Whites. The instruments included (a) questions on sociodemographic and cultural factors, and disease status, (b) the Support Care Needs Survey-34 Short Form, (c) the 2003 Health Information National Trends Survey subscale on Internet usage, and (d) the UICSG Questionnaire. The data were analyzed using the Wilcoxon rank-sum test and nonparametric multiple regression analyses. Results: There was a significant ethnic difference in the UICSG, but there were no ethnic differences in general Internet use or needs for help. Across the ethnic groups, the significant factors influencing the UICSG included “self-reported ethnic identity,” “born in the United States,” and “general Internet use.” Conclusion: Nurses should consider the cultural factors that influence the UICSG.

Cancer patients' trust in their physician-a review

OBJECTIVE

Patient's trust in their physician is crucial for desirable treatment outcomes such as satisfaction and adherence. In oncology, trust is possibly even more essential, due to the life-threatening nature of cancer. A review was undertaken of the current knowledge of the conceptualization, assessment, correlates, and consequences of cancer patients' trust in their physician.

METHODS

The empirical literature published in peer-reviewed journals between October 1988 and October 2008 was searched, employing all combinations and variations of the following keywords: trust, physician-patient relations, and cancer.

RESULTS

The search identified 45 relevant papers, only 11 of which drew attention to the conceptualization of trust, and 5 of which focused on trust as the primary subject of interest. Trust in physicians was strong overall. Patients' trust appeared to be enhanced by the physician's perceived technical competence, honesty, and patient-centred behaviour. A trusting relationship between patient and physician resulted in facilitated communication and medical decision making, a decrease of patient fear, and better treatment adherence.

CONCLUSIONS

A lack of focus on trust and the conceptualization thereof, strong methodological variations between studies and a possible publication bias lead us to conclude that cancer patients' trust in their physician deserves more systematic, theoretically based, research attention. Consequently, studies are needed aimed at gaining a thorough understanding of the nature and impact of cancer patients' trust in their physician, and how the interaction between physician and patient may contribute to such trust.

Perceived risk of cancer and patient reports of participation in decisions about screening: the DECISIONS study

BACKGROUND

Health behavior theories suggest that high perceived risk for cancer will be associated with screening, but few studies have examined how perceived risk relates to the screening decision process.

OBJECTIVE

To examine relationships between perceived risk of cancer and behaviors during decision making for 3 screening tests.

DESIGN

Cross-sectional survey conducted between November 2006 and May 2007.

SETTING

Nationwide random-digit dial telephone survey.

PARTICIPANTS

A total of 1729 English-speaking US adults aged 40 y and older who reported making a cancer screening decision (about breast, colon, or prostate tests) in the previous 2 y.

MEASUREMENTS

Participants completed measures of perceived risk, information seeking, and shared decision-making tendencies.

RESULTS

As perceived risk for cancer increased, patients were more likely to seek information about screening on their own (e.g., 35% of participants who perceived a high risk of cancer searched the Internet compared with 18% for those who perceived a low risk, P < 0.001) and in interactions with their physicians. As perceived risk increased, patients were also more likely to consult with more than 1 provider. Gender moderated the shared decision-making preference such that men with high perceived risks were more likely than women with high perceived risks to report they would have preferred more involvement in the decision (35% v. 9%, P = 0.001).

LIMITATIONS

Cross-sectional data limit causal inferences.

CONCLUSIONS

Higher perceived risk was associated with greater patient participation, as shown by more information seeking and greater desire for decisional involvement (moderated by gender). The results suggest that perceived risk of cancer could influence patient behavior when deciding about screening.

Correlates of consumer trust in online health information: findings from the health information national trends survey

The past few decades have witnessed a dramatic increase in consumers seeking health information online. However, the quality of such information remains questionable, and the trustworthiness of online health information has become a hot topic, whereas little attention has been paid to how consumers evaluate online health information credibility. This study builds on theoretical perspectives of trust such as personal-capital-based, social-capital-based, and transfer-based, and it examines various correlates of consumer trust in online health information. The author analyzed the 2007 Health Information National Trends Survey data (N = 7,674). Results showed that consumer trust in online health information did not correlate with personal capital such as income, education, and health status. Social capital indicated by visiting social networking Web sites was not associated with trust in online health information either. Nevertheless, trust in online health information transferred from traditional mass media and government health agencies to the Internet, and it varied by such information features as easiness to locate and to understand. Age appeared to be a key factor in understanding the correlates of trust in online health information. Theoretical and empirical implications of the results are discussed.

Beyond reading alone: the relationship between aural literacy and asthma management

OBJECTIVES

to examine the relationship between literacy and asthma management with a focus on the oral exchange.

METHODS

study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression.

RESULTS

in bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR: 4.37, 95%CI: 1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management.

CONCLUSION

lower aural literacy skills seem to complicate asthma management capabilities.

PRACTICE IMPLICATIONS

greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.

Physicians' approaches to recommending colorectal cancer screening: a qualitative study

Little is known about strategies that physicians use to encourage receipt of colorectal cancer screening (CRCS). This study conducted focus groups with physicians. Twenty-seven physicians participated in four focus groups. Physicians described four categories of approaches: (1) why screening is important, (2) providing test information, (3) motivational strategies, and (4) tailoring strategies. Participants reported tailoring based on their relationship with a patient, as well as to patient gender, education, and language. Tailoring to cultural background or ethnicity was not prominent. Most physicians reported a typical approach to CRCS and reported some tailoring based on gender, education, and language, but not on ethnicity.

Exploring disparities and variability in perceptions and self-reported colorectal cancer screening among three ethnic subgroups of U. S. Blacks

PURPOSE/OBJECTIVES

To explore perceptions of colorectal cancer (CRC) and self-reported CRC screening behaviors among ethnic subgroups of U. S. blacks.

DESIGN

Descriptive, cross-sectional, exploratory, developmental pilot.

SETTING

Medically underserved areas in Hillsborough County, FL.

SAMPLE

62 men and women aged 50 years or older. Ethnic subgroup distribution included 22 African American, 20 English-speaking Caribbean-born, and 20 Haitian-born respondents.

METHODS

Community-based participatory research methods were used to conduct face-to-face individual interviews in the community.

MAIN RESEARCH VARIABLES

Ethnic subgroup, health access, perceptions of CRC (e.g., awareness of screening tests, perceived risk, perceived barriers to screening), healthcare provider recommendation, and self-reported CRC screening.

FINDINGS

Awareness of CRC screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening were low across all subgroups. However, only 55% of Haitian-born participants had heard about the fecal occult blood test compared to 84% for English-speaking Caribbean-born participants and 91% for African Americans. Similarly, only 15% of Haitian-born respondents had had a colonoscopy compared to 50% for the English-speaking Caribbean and African American subgroups.

CONCLUSIONS

This exploratory, developmental pilot study identified lack of awareness, low risk perception, and distinct barriers to screening. The findings support the need for a larger community-based study to elucidate and address disparities among subgroups.

IMPLICATIONS FOR NURSING

Nurses play a major role in reducing cancer health disparities through research, education, and quality care. Recognition of the cultural diversity of the U. S. black population can help nurses address health disparities and contribute to the health of the community.

Physician barriers to population-based, fecal occult blood test-based colorectal cancer screening programs for average-risk patients

BACKGROUND

Colorectal cancer (CRC) screening is an efficacious but underused means to reduce the burden of CRC. Population-based CRC screening programs are currently being implemented in Canada and physicians are key partners in increasing screening uptake. The current study identified physician attitudes and barriers that need to be addressed by provincial programs.

METHODS

A mailed survey of primary care physicians in Alberta.

RESULTS

The survey response rate was 42.4% (806 of 1903). The majority of physicians suggested CRC screening as part of a routine periodic examination; however, the approach to test selection and the type of tests recommended varied by geographical region. The majority of physicians agreed (48%) or strongly agreed (36%) that a provincewide screening program is the best approach to reducing mortality from CRC. However, there were many serious concerns identified - the most common was endoscopic capacity for follow-up of patients with a positive fecal occult blood test (FOBT), which was cited by 55% to 69% of the physicians surveyed. The barriers to three commonly available tests (FOBT, flexible sigmoidoscopy and colonoscopy) varied according to health region, and the types of barriers identified varied according to the specific test.

INTERPRETATION

Screening for CRC is gradually being accepted among primary care physicians in Alberta. A key finding of the present descriptive study was the regional variation in practices, perceived barriers and concerns about provincial population-based screening programs based on FOBT as the primary screening test. Provincial programs will need to address the issue of endoscopic capacity and perceived barriers to FOBT to gain primary care physician acceptance of FOBT-based CRC screening programs.

An evaluation of colonoscopy use: implications for health education

In this retrospective study, we examined factors that associated with colonoscopy test use among adults who did not have colorectal cancer (CRC) in the USA. A total of 2,150 non-CRC adults >or=55 were selected from the Health Information National Trends Survey, a random-digit telephone survey that collected data in 2003-2004. Participants were classified based on receiving CRC tests within the recommended time interval. Socio-demographic and cognitive factors that are associated with colonoscopy test use were examined. The results show that adults 55-64 years old were less likely to have a colonoscopy compared with those 65 years and older. Participants with higher levels of knowledge, greater access to care, greater perceived risk, and lower psychological barriers were more likely to report receiving a colonoscopy. The findings indicate a continuous effort to increase awareness and risk perception, and reduce psychological barriers through health education.

A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients

OBJECTIVE

To test a multimedia patient education program on colorectal cancer (CRC) screening that was designed specifically for the Hispanic/Latino community, and developed with input from community members.

METHODS

A total of 270 Hispanic/Latino adults, age 50-80 years, participated in Spanish for all phases of this pretest-posttest design. Patients were randomly assigned to a version of the multimedia program that opened with either a positive or negative introductory appeal. Structured interviews assessed screening relevant knowledge (anatomy and key terms, screening options, and risk information), past screening behavior, willingness to consider screening options, intention to discuss CRC screening with the doctor, and reactions to the multimedia patient education program.

RESULTS

The multimedia program significantly increased knowledge of anatomy and key terms (e.g., polyp), primary screening options (FOBT, flexible sigmoidoscopy, colonoscopy), and risk information as well as willingness to consider screening (p<.001 for all). No significant differences emerged between positive and negative introductory appeals on these measures, intention to discuss CRC screening with their doctor, or rating the multimedia program.

CONCLUSION

Multimedia tools developed with community input that are designed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic backgrounds. Additional research is needed to determine effects on actual screening behavior.

PRACTICE IMPLICATIONS

Despite promising results for engaging a difficult-to-reach audience, the multimedia program should not be considered a stand-alone intervention or a substitute for communication with physicians. Rather, it is a priming mechanism intended to prepare patients for productive discussions of CRC screening.

Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors: Results From the Childhood Cancer Survivor Study

Purpose/Objectives: To identify treatment, intrapersonal, and provider factors that influence childhood cancer survivors' adherence to recommended mammography screening.Design: Secondary analysis of data derived from three consecutive surveys within the Childhood Cancer Survivor Study.Sample: Female childhood cancer survivors: N = 335, X age = 30.92, X years after diagnosis = 21.79.Methods: T tests and structural equation modeling.Main Research Variables: Mammogram recency, health concerns, affect, motivation, and survivor-provider interaction.Findings: Forty-three percent of the variance was explained in mammogram recency. Survivors most likely to follow the recommended mammogram schedule were directly influenced by cancer treatment exposure to mantle radiation (p = 0.01), less intrinsic motivation (p = 0.01), positive affect (p = 0.05), recent visits to an oncology clinic (p = 0.01), discussion of subsequent cancer risks with a physician (p = 0.001), perceptions of more severe late effects (p = 0.05), age (40 years or older) (p Collapse

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Grants

• U24 CA055727 NCI NIH HHS
• R21 CA106972 NCI NIH HHS
• U24 CA055727-13 NCI NIH HHS
• R03 NR009203-02 NINR NIH HHS
• R03 NR009203 NINR NIH HHS

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Affiliation(s)

Cheryl L. Cox Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
Kevin Oeffinger Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
Michele Montgomery Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
Melissa M. Hudson Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
Wendy Leisenring Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
John Whitton
Leslie L. Robison Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee

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Medical screening participation in the childhood cancer survivor study

BACKGROUND

Despite their risk for serious late sequelae, survivors of childhood cancer do not adhere to recommended medical screening guidelines. We identified treatment, survivor, physician, and contextual factors that may influence survivor adherence to recommended echocardiography and bone densitometry screening.

METHODS

Structural equation modeling of data from the Childhood Cancer Survivor Study; 838 participants had received a diagnosis of and were treated for pediatric cancers between 1970 and 1986.

RESULTS

Survivors at risk of cardiac sequelae (n = 316; mean [SD] age, 31.01 [7.40] years; age at diagnosis, 9.88 [5.88] years; and time since diagnosis, 21.14 [4.37] years) who reported more cancer-related visits (P = .01), having discussed heart disease with a physician (P < or = .001), with a sedentary lifestyle (P = .05), and less frequent health fears (P = .05) were most likely to follow the recommended echocardiogram schedule (R(2) = 23%). Survivors at risk of osteoporosis (n = 324; age, 30.20 [7.09] years; age at diagnosis, 9 .01 [5.51]years; and time since diagnosis, 21.20 [4.27] years) who reported more cancer-related visits (P = .05), were followed up at an oncology clinic (P = .01), had discussed osteoporosis with a physician (P < or = .001), and had a lower body mass index (P = .05) were most likely to adhere to the recommended bone density screening guidelines (R(2) = 26%). Symptoms and motivation influenced screening frequency in both models.

CONCLUSIONS

Multiple factors influence survivor adherence to screening recommendations. It is likely that tailored interventions would be more successful in encouraging recommended screening in survivors of childhood cancer than would traditional health education approaches.

The applications of PROs in clinical practice: what are they, do they work, and why?

BACKGROUND

Precisely defining the different applications of patient-reported outcome measures (PROs) in clinical practice can be difficult. This is because the intervention is complex and varies amongst different studies in terms of the type of PRO used, how the PRO is fed back, and to whom it is fed back.

METHODS

A theory-driven approach is used to describe six different applications of PROs in clinical practice. The evidence for the impact of these applications on the process and outcomes of care are summarised. Possible explanations for the limited impact of PROs on patient management are then discussed and directions for future research are highlighted.

RESULTS

The applications of PROs in clinical practice include screening tools, monitoring tools, as a method of promoting patient-centred care, as a decision aid, as a method of facilitating communication amongst multidisciplinary teams (MDTs), and as a means of monitoring the quality of patient care. Evidence from randomised controlled trials suggests that the use of PROs in clinical practice is valuable in improving the discussion and detection of HRQoL problems but has less of an impact on how clinicians manage patient problems or on subsequent patient outcomes. Many of the reasons for this may lie in the ways in which PROs fit (or do not fit) into the routine ways in which patients and clinicians communicate with each other, how clinicians make decisions, and how healthcare as a whole is organised.

CONCLUSIONS

Future research needs to identify ways in with PROs can be better incorporated into the routine care of patients by combining qualitative and quantitative methods and adopting appropriate trial designs.

Informed decision-making and colorectal cancer screening: is it occurring in primary care?

BACKGROUND

Current recommendations advise patients to participate in the decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known.

OBJECTIVE

To assess the level of informed decision-making occurring during actual patient-provider communications on CRC screening and test for the association between informed decision-making and screening behavior.

RESEARCH DESIGN

Observational study of audiotaped clinic visits between patients and their providers in the primary care clinic at a Veterans Administration Medical Center.

SUBJECTS

Male patients, age 50-74 years, presenting to a primary care visit at the study site.

MEASURES

The Informed Decision-Making (IDM) Model was used to code the audiotapes for 9 elements of communication that should occur to prepare patients for participation in decision-making. The primary outcome is completion of CRC screening during the study period.

RESULTS

The analytic cohort consisted of 91 patients due for CRC screening who had a test ordered at the visit. Six of the 9 IDM elements occurred in < or =20% of the visits with none addressed in > or =50%. CRC screening occurred less frequently for those discussing "pros and cons" (12% vs. 46%, P = 0.01) and "patient preferences" (6% vs. 47%, P = 0.001) compared with those who did not.

CONCLUSIONS

We found that a lack of informed decision-making occurred during CRC screening discussions and that particular elements of the process were negatively associated with screening. Further research is needed to better understand the effects of informed decision-making on screening behavior.

Influence of patient-provider communication on colorectal cancer screening

BACKGROUND

Screening reduces incidence and mortality from colorectal cancer (CRC). Despite improved access, screening is suboptimal and disparate among minority groups. Quality of patient-provider communication may impact CRC screening.

OBJECTIVES

We examined the relationship between patient-provider communication and socioeconomic variables on the receipt of CRC screening using data from the Medical Expenditure Panel Survey.

SUBJECTS

All persons age 50 years or older (N = 8488).

MEASURES

Dependent measures were receipt of CRC screening, fecal occult blood testing, and colonoscopy or sigmoidoscopy. Independent variables included demographic characteristics, patient language, and patient-provider communication measures from the Consumer Assessment of Health Plan survey.

RESULTS

Patients who felt they had sufficient time with their healthcare provider were more likely to be screened for CRC. Receiving adequate explanation of healthcare needs from provider was a significant predictor of fecal occult blood testing screening. In addition, persons with less than a high school education, the uninsured, or those with low income were associated with reduced likelihood of receiving CRC screening. Asians and Hispanics had a significantly reduced likelihood of receiving screening in comparison with whites; however, after adjusting for language, no significant differences for race or ethnicity were observed.

CONCLUSIONS

Adequate time with a healthcare provider and receiving sufficient explanation of the healthcare processes by providers may improve screening rates. Patient-provider communication may be improved by addressing language needs of non-English speaking patients. Overall improved communication may increase CRC screening rates in underserved populations.

Local impact of the English arm of the UK Bowel Cancer Screening Pilot study

Background

The English arm of the UK Bowel Cancer Screening Pilot study recently concluded its third round. The primary aim was to assess the impact of faecal occult blood test (FOBT) screening on the detection of symptomatic (non-screen-detected) cancers within the target age group (50–69 years). The secondary aim was to assess differences between screened and non-screened cohorts in Dukes' classification at diagnosis.

Methods

This population-based study utilized retrospective analysis of existing validated colorectal cancer (CRC) data over 5 years (April 2000 to March 2005), encompassing rounds one and two of screening.

Results

There was a 23 per cent (P = 0·011) reduction in the diagnosis of over the 5 years. Presentations with symptomatic cancer reduced by 49 per cent (P = 0·049), with a proportionate (2·6-fold) rise in the detection of screened (asymptomatic) malignancy. Cancers were diagnosed at an earlier stage in the screened population, with significantly more Dukes' A tumours than in the non-screen-detected cohort (P &lt; 0·001) and an estimated odds ratio of 0·27 (95 per cent confidence interval 0·08 to 0·91) (P = 0·035) for Dukes' ‘D’ cancers.

Conclusion

FOBT screening resulted in a significant reduction in the number of symptomatic cancers detected within the target age group. Tumours detected by screening were diagnosed at an earlier pathological stage.

Gender and ethnic differences in cancer patients' needs for help: an Internet survey

BACKGROUND

Although a number of studies have reported different domains of cancer patients' needs for help, very little is known about gender and ethnic differences in those needs. Gender differences have been implicitly assumed in most studies, and specific ethnic groups have been focused on rather than comparing several ethnic groups.

OBJECTIVES

The purpose of this pilot study was to explore cancer patients' needs for help among four major ethnic groups in the US, to determine gender and ethnic differences in needs, and to provide direction for future studies.

DESIGN

This was a descriptive and comparative pilot study using a feminist perspective.

SETTINGS AND PARTICIPANTS

A total of 110 self-identified cancer patients were recruited through both Internet and community settings using a convenience sampling method.

METHODS

The instruments included sociodemographic questions, the Cancer Needs Questionnaire-Short Form, and the Supportive Care Needs Survey. The data were analyzed using descriptive statistics and inferential statistics including the Mann-Whitney U tests and Kruskal-Wallis tests.

RESULTS

The findings indicated that there was no significant gender difference in all domains of needs for help. There were significant ethnic differences in all domains of needs except communication and sexual needs. Asians reported the lowest scores in most domains of needs for help while Hispanics reported the highest scores in most domains of needs for help.

CONCLUSIONS

The findings indicated certain ethnic differences in cancer patients' needs for help and suggest further in-depth qualitative investigations on cultural beliefs and attitudes that may influence needs, with a careful examination of gender sensitivity and cultural competence of the instruments measuring cancer patients' needs for help.