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McDonnell GA, Peshkin BN, DeMarco TA, Peterson SK, Arun BK, Miesfeldt S, O’Neill SC, Schneider K, Garber J, Isaacs C, Luta G, Tercyak KP. Long-Term Adaptation Among Adolescent and Young Adult Children to Familial Cancer Risk. Pediatrics 2022; 150:e2022056339. [PMID: 35859209 PMCID: PMC10646493 DOI: 10.1542/peds.2022-056339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is important to examine adolescent and young adult (AYA) children's long-term psychosocial and behavioral adaptation to disclosure of maternal BRCA-positive carrier status (BRCA+) to inform approaches for familial cancer risk communication, education, and counseling. METHODS Mothers underwent BRCA genetic testing 1 to 5 years earlier. Group differences in AYAs' self-reported outcomes were analyzed by maternal health and carrier status, and child age and sex. RESULTS A total of N = 272 AYAs were enrolled: 76.1% of their mothers were breast or ovarian cancer survivors and 17.3% were BRCA+. AYAs' cancer risk behavior (tobacco and alcohol use, physical activity) and psychologic distress levels did not vary by maternal status. In bivariate analyses, AYAs of cancer-surviving mothers believed themselves to be at greater risk for, and were more knowledgeable about, cancer than AYAs of mothers without cancer. AYAs of BRCA+ mothers were more concerned about cancer, held stronger beliefs about genetic risk, and placed a higher value on learning about genetics. In adjusted models, maternal cancer history (not BRCA+) remained associated with AYAs' greater perceptions of cancer risk (P = .002), and knowledge about cancer (P = .03) and its causes (P = .002). CONCLUSIONS Disclosing maternal BRCA+ status did not influence children's lifestyle behavior or adversely affect quality of life long term. AYAs of BRCA+ mothers were more aware of and interested in genetic risk information. Such families may benefit from support to promote open communication about genetic testing choices.
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Affiliation(s)
- Glynnis A. McDonnell
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Beth N. Peshkin
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | | | | | - Suzanne C. O’Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Judy Garber
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Claudine Isaacs
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kenneth P. Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Lupatsch JE, Wengenroth L, Rueegg CS, Teuffel O, Gumy-Pause F, Kuehni CE, Michel G. Follow-up care of adolescent survivors of childhood cancer: The role of health beliefs. Pediatr Blood Cancer 2016; 63:318-25. [PMID: 26398593 DOI: 10.1002/pbc.25755] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about follow-up care attendance of adolescent survivors of childhood cancer, and which factors foster or hinder attendance. Attending follow-up care is especially important for adolescent survivors to allow for a successful transition into adult care. We aimed to (i) describe the proportion of adolescent survivors attending follow-up care; (ii) describe adolescents' health beliefs; and (iii) identify the association of health beliefs, demographic, and medical factors with follow-up care attendance. PROCEDURE Of 696 contacted adolescent survivors diagnosed with cancer at ≤ 16 years of age, ≥ 5 years after diagnosis, and aged 16-21 years at study, 465 (66.8%) completed the Swiss Childhood Cancer Survivor Study questionnaire. We assessed follow-up care attendance and health beliefs, and extracted demographic and medical information from the Swiss Childhood Cancer Registry. Cross-sectional data were analyzed using descriptive statistics and logistic regression models. RESULTS Overall, 56% of survivors reported attending follow-up care. Most survivors (80%) rated their susceptibility for late effects as low and believed that follow-up care may detect and prevent late effects (92%). Few (13%) believed that follow-up care is not necessary. Two health beliefs were associated with follow-up care attendance (perceived benefits: odds ratio [OR]: 1.56; 95% confidence interval [CI]: 1.07-2.27; perceived barriers: OR: 0.70; 95%CI: 0.50-1.00). CONCLUSIONS We show that health beliefs are associated with actual follow-up care attendance of adolescent survivors of childhood cancer. A successful model of health promotion in adolescent survivors should, therefore, highlight the benefits and address the barriers to keep adolescent survivors in follow-up care.
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Affiliation(s)
- Judith E Lupatsch
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laura Wengenroth
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Corina S Rueegg
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Oliver Teuffel
- Departement of Pediatric Hematology-Oncology, Bern University Hospital, Bern, Switzerland
| | - Fabienne Gumy-Pause
- Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Claudia E Kuehni
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gisela Michel
- Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Health Behaviors of Childhood Cancer Survivors. CHILDREN-BASEL 2014; 1:355-73. [PMID: 27417484 PMCID: PMC4928744 DOI: 10.3390/children1030355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/11/2014] [Accepted: 10/15/2014] [Indexed: 12/30/2022]
Abstract
There has been a dramatic increase in the number of childhood cancer survivors living to an old age due to improved cancer treatments. However, these survivors are at risk of numerous late effects as a result of their cancer therapy. Engaging in protective health behaviors and limiting health damaging behaviors are vitally important for these survivors given their increased risks. We reviewed the literature on childhood cancer survivors’ health behaviors by searching for published data and conference proceedings. We examine the prevalence of a variety of health behaviors among childhood cancer survivors, identify significant risk factors, and describe health behavior interventions for survivors.
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Ford JS, Puleo E, Sprunck-Harrild K, deMoor J, Emmons KM. Perceptions of risk among childhood and young adult cancer survivors who smoke. Support Care Cancer 2014; 22:2207-17. [PMID: 24659242 PMCID: PMC10360447 DOI: 10.1007/s00520-014-2165-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/05/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the fact that childhood and young adult cancer survivors are at increased risk for chronic health problems as a result of their cancer treatment, many use tobacco, thereby increasing their risks. Perceptions of risk related to tobacco use can be targeted for interventions aimed at improving health behaviors for childhood, adolescent, and young adult cancer survivors. Understanding the covariates of perceptions of health risks among young adult survivors who smoke will help to determine targets for intervention. METHOD Three hundred seventy-four participants who were diagnosed with cancer prior to age 35, currently between 18 and 55 years of age, and current smokers were recruited as part of a larger smoking cessation study, Partnership for Health-2 (PFH-2). Data were collected by telephone survey. RESULTS Overall, women had the highest perception of risk for serious health problems, a second cancer, and heart problems. Additionally, those participants who were dependent on nicotine endorsed that they were at higher risk of serious health problems and second cancers, but not heart problems. Finally, Hodgkin lymphoma survivors reported that they were at increased risk for second cancers and heart problems compared to their “healthy” peers. CONCLUSION Young adult cancer survivors who smoke correctly perceived some of their increased health risks. Additional motivation and education is needed for those young adult cancer survivors who perceive their increased health risks yet continue to smoke. Further education is needed for young survivors so they have a fully appropriate sense of risk, especially as it relates to their tobacco use.
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Tercyak KP, Mays D, Johnson SB, Ludvigsson J, Swartling U. Psychometric properties of the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D) for parents of children undergoing predictive risk screening. Pediatr Diabetes 2013; 14:602-10. [PMID: 23763537 PMCID: PMC3785558 DOI: 10.1111/pedi.12053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/26/2013] [Accepted: 05/03/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Examine the factor structure, reliability, and validity of the Pediatric Testing Attitudes Scale-Diabetes (P-TAS-D), a measure of parental attitudes about predictive risk screening for type 1 diabetes in children. METHODS Surveys were completed by 3720 Swedish parents of children participating in the adolescent follow-up of a birth cohort study of type 1 diabetes onset. Parents averaged 43.5 years, 42.3% were college-educated, and 10.6% of children had a family history of type 1 diabetes. The parent sample was randomly divided, an exploratory factor analysis (EFA; n = 1860) was conducted, followed by confirmatory factor analysis (CFA; n = 1860) and testing. RESULTS EFA/CFA revealed the P-TAS-D has three factors/scales: Attitudes and Beliefs toward type 1 diabetes predictive risk screening (α = 0.92), Communication about risk screening results (α = 0.71), and Decision Making (r = 0.19, p < 0.001). This solution fit the data well (χ(2) [42] = 536.0, RMSEA = 0.08, CFI = 0.95) and internal consistency for the full scale was high (α = 0.86, M = 36.2, SD = 8.2). After adjusting for covariates, more favorable attitudes toward children's risk screening were associated with greater worry about type 1 diabetes (B = 1.1, p < 0.001), less worry about health overall (B = -0.10, p = 0.001), and more positive attitudes toward (B = 0.28, p < 0.001) and less worry about (B = 0.41, p < 0.001) diabetes research. CONCLUSIONS The P-TAS-D is a stable, reliable, and valid measure for assessing parents' type 1 diabetes risk screening attitudes. Scale data can help target parent education efforts in risk screening trials.
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Affiliation(s)
- Kenneth P. Tercyak
- Department of Oncology, Georgetown University, Washington, District of Columbia,Department of Pediatrics, Georgetown University, Washington, District of Columbia
| | - Darren Mays
- Department of Oncology, Georgetown University, Washington, District of Columbia
| | - Suzanne Bennett Johnson
- Department of Medical Humanities & Social Sciences, Florida State University, Tallahassee, Florida
| | - Johnny Ludvigsson
- Department of Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
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Tercyak KP, Swartling U, Mays D, Johnson SB, Ludvigsson J. Behavioral Science Research Informs Bioethical Issues in the Conduct of Large-Scale Studies of Children's Disease Risk. AJOB PRIMARY RESEARCH 2013; 4:4-14. [PMID: 23977442 DOI: 10.1080/21507716.2013.806968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Birth cohort studies of the natural history of pediatric common disease risk raise many bioethical issues, including re-consenting participants over time as children mature and cohort retention. Understanding participants' study-specific knowledge, attitudes, beliefs, and behavior may offer insights into these issues from a psychological perspective. METHODS We conducted an analysis of factors associated with parent-child communication about minor children's participation in a population-based birth cohort; children's knowledge about their own participation; and parental willingness to be re-contacted for future study among Swedish parents (N = 3,605) of children originally enrolled at birth in a prospective study of type 1 diabetes risk. RESULTS More open parent-child communication about disease risk screening research and greater knowledge among children about their own research participation facilitated greater parent willingness to participate in further study. Parents' decisions about further study participation were most strongly favorable among those who communicated openly with their child and with high study-specific knowledge. CONCLUSIONS Epidemiologists, bioethicists, and others involved in the design and conduct of large-scale, prospective birth cohorts may consider embedding periodic assessments of participants' study-specific attitudes and behavior to address long-term retention and willingness to engage in future research.
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Affiliation(s)
- Kenneth P Tercyak
- Associate Professor, Director of Behavioral Prevention Research, Division of Population Sciences, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100 Washington, DC 20007, USA
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Herbert LJ, Walker LR, Sharff ME, Abraham AA, Tercyak KP. Are adolescents with ADHD interested in genetic testing for nicotine addiction susceptibility? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1694-707. [PMID: 20617054 PMCID: PMC2872360 DOI: 10.3390/ijerph7041694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 03/11/2010] [Accepted: 04/09/2010] [Indexed: 12/23/2022]
Abstract
It has been well-established that some adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking. Current research on the genetic basis of this association could ultimately translate into genetic tests capable of identifying smoking-prone adolescents with ADHD. In this study we examined 81 ADHD affected adolescents’ (age 13–21) interest in genetic testing for nicotine addiction susceptibility. Fifty-seven percent of adolescents indicated a fair amount of interest or more in testing. Most adolescents indicated that the personal information revealed from testing would be either useful (29%) or interesting (37%). Implications for genetically-informed smoking prevention and cessation interventions in high risk adolescents with ADHD are discussed.
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Affiliation(s)
- Linda J. Herbert
- University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA; E-Mail:
| | - Leslie R. Walker
- Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA; E-Mail:
| | - McKane E. Sharff
- Georgetown University Medical Center, 3300 Whitehaven Street, NW, Washington, DC 20007, USA; E-Mails:
(M.E.S.);
(A.A.A.)
| | - Anisha A. Abraham
- Georgetown University Medical Center, 3300 Whitehaven Street, NW, Washington, DC 20007, USA; E-Mails:
(M.E.S.);
(A.A.A.)
| | - Kenneth P. Tercyak
- Georgetown University Medical Center, 3300 Whitehaven Street, NW, Washington, DC 20007, USA; E-Mails:
(M.E.S.);
(A.A.A.)
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +1-202-687-0802; Fax: +1-202-687-8444
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Throckmorton-Belzer L, Tyc VL, Robinson LA, Klosky JL, Lensing S, Booth AK. Anti-Smoking Communication to Preadolescents with and without a Cancer Diagnosis: Parents and Healthcare Providers as Important Communicators. CHILDRENS HEALTH CARE 2009; 38:283-300. [PMID: 20368757 DOI: 10.1080/02739610903237329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health care providers have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt of anti-smoking messages from physicians and parents, and recalled more messages >/= 4 months post-diagnosis as compared to 1-3 months. Should anti-tobacco communications prove to influence smoking outcomes, parents and physicians may be uniquely positioned to provide smoking prevention interventions to these patients.
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Wakefield CE, McLoone J, Goodenough B, Lenthen K, Cairns DR, Cohn RJ. The Psychosocial Impact of Completing Childhood Cancer Treatment: A Systematic Review of the Literature. J Pediatr Psychol 2009; 35:262-74. [DOI: 10.1093/jpepsy/jsp056] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hall WD, Gartner CE, Carter A. The genetics of nicotine addiction liability: ethical and social policy implications. Addiction 2008; 103:350-9. [PMID: 18190673 DOI: 10.1111/j.1360-0443.2007.02070.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the promise and risks of technological applications of genetic research on liability to develop nicotine dependence. METHODS We reviewed (i) the evidence on the genetics of nicotine dependence; (ii) the technical feasibility of using genetic information to reduce smoking uptake and increase cessation; and (iii) policy and ethical issues raised by the uses of genetic information on addiction liability. RESULTS (i) Despite evidence from twin studies that genes contribute to addiction susceptibility, research to date has not identified commonly occurring alleles that are strongly predictive of developing nicotine addiction. Nicotine addiction is likely to involve multiple alleles of small effect that interact with each other and with the environment. (ii) Population screening for susceptibility alleles is unlikely to be effective or cost-effective. Tailoring of smoking cessation treatments with genetic information is more plausible but results to date have been disappointing. Population health strategies such as increased taxation and reduced opportunities to smoke are more efficient in reducing cigarette smoking. Tobacco harm reduction policies applied to populations may also play a role in reducing tobacco-related harm. (iii) Future uses of genomic information on addiction risk will need to assess the risks of medicalising addiction (e.g. pessimism about capacity to quit) and community concerns about genetic privacy. CONCLUSIONS Nicotine genomics is a very new and underdeveloped field. On the evidence to date, its advocates would be wise to avoid extravagant claims about its preventive applications.
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Affiliation(s)
- Wayne D Hall
- School of Population Health, The University of Queensland, Queensland, Australia.
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Klosky JL, Tyc VL, Garces-Webb DM, Buscemi J, Klesges RC, Hudson MM. Emerging issues in smoking among adolescent and adult cancer survivors. Cancer 2007; 110:2408-19. [DOI: 10.1002/cncr.23061] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tercyak KP, Peshkin BN, Wine LA, Walker LR. Interest of adolescents in genetic testing for nicotine addiction susceptibility. Prev Med 2006; 42:60-5. [PMID: 16260030 DOI: 10.1016/j.ypmed.2005.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 09/07/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Genetic tests for nicotine addiction susceptibility may someday offer preventive medicine specialists new tools to reduce smoking among adolescents. This paper examines adolescents' interest in, and reasons behind interest in, such testing and correlates of interest. METHODS The sample included 211 healthy patients (ages 13-21) recruited from Georgetown University Medical Center's adolescent medicine clinic. Subjects completed a one-time behavioral survey immediately prior to or following a general medical check-up during calendar years 2001-2005. A 4-point self-report survey item served as the dependent variable. RESULTS Sixty-two percent of adolescents were interested in genetic testing. Among the 72% of adolescents who provided a reason for their interest, 35% would find the information interesting for general or nonspecific reasons, 30% would find it personally useful, 8% noted it would be irrelevant, and 13% stated it would be unimportant; school performance and interest in cancer susceptibility testing were associated with interest in nicotine addiction susceptibility testing (adjusted r2 = 21%; P < 0.0001). CONCLUSIONS Adolescent primary care patients will likely be receptive to comprehensive tobacco control programs incorporating genetic testing. Higher levels of educational achievement and greater interest in DNA-based preventive medicine may characterize those most interested. Offering testing will be contingent upon the development of safe and effective genetic tests.
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Affiliation(s)
- Kenneth P Tercyak
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007-2401, USA.
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Tercyak KP, Beville KW, Walker LR, Prahlad S, Cogen FR, Sobel DO, Streisand R. Health Attitudes, Beliefs, and Risk Behaviors Among Adolescents and Young Adults With Type 1 Diabetes. CHILDRENS HEALTH CARE 2005. [DOI: 10.1207/s15326888chc3403_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tercyak KP, Donze JR, Prahlad S, Mosher RB, Shad AT. Identifying, Recruiting, and Enrolling Adolescent Survivors of Childhood Cancer into a Randomized Controlled Trial of Health Promotion: Preliminary Experiences in the Survivor Health and Resilience Education (SHARE) Program. J Pediatr Psychol 2005; 31:252-61. [PMID: 15758194 DOI: 10.1093/jpepsy/jsj013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To report on the identification, recruitment, and enrollment of adolescent survivors of childhood cancer into an ongoing randomized controlled trial (RCT) of health promotion. METHODS A total of 244 adolescents were contacted by mail and telephone to assess their trial eligibility. Data were collected with respect to each adolescent's demographics and trial recruitment efforts (frequency and intensity of telephone call contact); exclusion and randomization status were tracked throughout. RESULTS Thirty-one percent of adolescents were ultimately randomized in the trial and 69% were excluded from randomization (13% were ineligible, 33% refused to participate, 22% were unreachable or nonresponsive, that is, did not respond to trial mailings or telephone calls, and less than 1% were withdrawn prior to randomization). Among all eligible adolescents, the trial's consent rate was 49%. Adolescents excluded owing to refusal resided the farthest away from the intervention site and experienced the least amount of telephone call contact time. The primary reasons for trial refusal were lack of interest in health promotion (28%) and lack of time to participate (23%). CONCLUSIONS Health promotion RCTs among adolescent survivors of childhood cancer may help prevent and control the onset and severity cancer-treatment-related late effects. However, trial success may be contingent upon tracing nonresponsive adolescents and reducing and eliminating barriers to participation.
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Affiliation(s)
- Kenneth P Tercyak
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Avenue, NW, Suite 317, Washington, DC 20007-4104, USA.
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Abstract
TOPIC In spite of the significance of vulnerable as a phenomenon that affects the human condition, its essence remains complex and elusive. PURPOSE A conceptual analysis to clarify knowledge of this concept to explore the common and scientific usage. SOURCES OF INFORMATION A comprehensive and systematic review from bibliographic and abstract databases and online searches. CONCLUSIONS Findings contributed to the definition of vulnerable as a highly individualized dynamic process of being open to circumstances that positively or negatively influence outcomes, a definition based on a synthesis of knowledge concerning vulnerable, and offers a reconceptualization that expands its use in nursing scientific theory, research, and clinical practice.
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Affiliation(s)
- Isabell B Purdy
- High-Risk Infant Follow Clinic, University of California, Los Angeles, School of Nursing, School of Medicine, Los Angeles, CA, USA.
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