1
|
Ochoa-Dominguez CY, Pickering TA, Navarro S, Rodriguez C, Farias AJ. Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2024; 11:2224-2235. [PMID: 37369914 PMCID: PMC11236924 DOI: 10.1007/s40615-023-01690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality. METHODS We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group. RESULTS Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003). CONCLUSION Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.
Collapse
Affiliation(s)
- Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Claudia Rodriguez
- Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
- Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Alzahrani AM, Felix HC, Alzhrani AA, Alharbi KK, Arbaein TJ, Shahzad MW, Monshi SS. Patient satisfaction with Saudi community pharmacy services (Wasfaty System). J Taibah Univ Med Sci 2024; 19:711-719. [PMID: 39006372 PMCID: PMC11245964 DOI: 10.1016/j.jtumed.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/06/2024] [Accepted: 05/31/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction The healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. Methods This cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. Results The sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03-1.37) and waiting time (OR: 1.23; 95% CI: 1.03-1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85-0.99). Saudi patients had lower odds of being satisfied with multiple services. Conclusions The overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient-pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.
Collapse
Affiliation(s)
- Ali M Alzahrani
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, KSA
| | - Holly C Felix
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abdulrhman A Alzhrani
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, KSA
| | - Khulud K Alharbi
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, KSA
| | - Turky J Arbaein
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, KSA
| | | | - Sarah S Monshi
- Department of Health Administration and Hospitals, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, KSA
| |
Collapse
|
3
|
Park S, Kim DD. Patient-provider communication and access, use, and financial burden of care. Am J Prev Med 2024:S0749-3797(24)00230-7. [PMID: 39002888 DOI: 10.1016/j.amepre.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Effective patient-provider communication is a critical component of optimal patient care, but its potential impact on the delivery of health care services remains unclear. This study examines the association of patient-provider communication with access to care, health care utilization, and financial burden of care. METHODS Using the 2013-2021 Medical Expenditure Panel Survey longitudinal data, the level of patient-provider communication was measured across four domains (attentive listening, clear explanation, respectfulness, and time allocation) as a primary independent variable, categorized into low, moderate, and high. A lagged dependent model was employed to examine the associations of patient-provider communication at baseline with subsequent access to care, health care utilization, and financial burden of care, controlling for baseline sample characteristics and outcomes measured at the baseline. Analysis was conducted in February 2024. RESULTS Among 28,955 analytic samples (representing 709,547,678 US adults), 5.3%, 50.2%, and 44.3% reported low, moderate, and high levels of patient-provider communication. Marginalized populations, including racial/ethnic minorities, those with low education and income, and those lacking insurance, were more likely to report low patient-provider communication. Compared with adults with high patient-provider communication, those with low patient-provider communication were more likely to encounter difficulties in accessing medical care (2.6 percentage points; 95% CI: 1.2-3.9), experience delays in obtaining necessary medical care (2.8 percentage points; 1.3-4.4), have emergency room visits (4.2 percentage points; 1.9-6.4), and face difficulties paying medical bills (4.0 percentage points; 2.2-5.8) in the subsequent year. CONCLUSIONS Encouraging effective patient-provider communication is essential for advancing patient-centered care and mitigating health inequities.
Collapse
Affiliation(s)
- Sungchul Park
- Department of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea; L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - David D Kim
- Department of Medicine and Public Health Sciences, Division of Biological Sciences, University of Chicago, Chicago, IL.
| |
Collapse
|
4
|
Tsai MH, Bevel MS, Andrzejak SE, Moore JX. Receipt of follow-up care plans on colorectal cancer screening among breast, prostate, and lung cancer survivors. J Cancer Surviv 2024; 18:781-790. [PMID: 36574189 PMCID: PMC10293471 DOI: 10.1007/s11764-022-01309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Our study aimed to examine whether receipt of follow-up care plans is associated with greater guideline-concordant CRC screening stratified by breast, prostate, and lung cancer survivors. METHODS We used data from years 2016, 2018, and 2020 of the Behavioral Risk Factor Surveillance System on 3339 eligible treatment-utilizing cancer survivors with complete treatment. We performed descriptive statistics and multivariable logistic regression to examine the mentioned association. RESULTS We observed that 83.9% of breast and 88.2% of prostate cancer survivors with follow-care plans received CRC screening (p-value < 0.001). The lowest CRC screening use was observed among lung cancer (70.8%). In multivariable analysis, receipt of follow-up care plans was strongly associated with greater odds of receiving CRC screening in breast (OR, 2.67; 95% CI: 1.71-4.16) and prostate (OR, 3.81; 95% CI: 2.30-6.31) cancer survivors. Regardless of provider type, 84 to 88% reduced likelihood of receipt of CRC screening when they received follow-up care plans among lung cancer survivors. Among those without follow-up care plans, breast (OR, 0.29; 95% CI: 0.09-0.92) and lung (OR, 0.05; 95% CI: 0.01-0.25) cancer survivors who received care from general practices were less likely to receive CRC screening compared to those who received care from non-general practices. CONCLUSIONS Receipt of follow-up care plans was associated with greater CRC screening use in breast and prostate cancers. Lung cancer survivors demonstrated lower screening use despite receipt of follow-up care plans. IMPLICATION FOR CANCER SURVIVORS Patient and provider communication regarding CRC screening recommendation should be included in their follow-up care plans.
Collapse
Affiliation(s)
- Meng-Han Tsai
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA.
- Georgia Prevention Institute, Augusta University, 1457 Walton Way, Augusta, GA, 30901, USA.
| | - Malcolm S Bevel
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Sydney E Andrzejak
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
| | - Justin X Moore
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Department of Medicine, Medical College of Georgia, Augusta University, 1410 Laney Walker Boulevard CN-2116, Augusta, GA, 30912, USA
- Institute of Public and Preventive Health, Augusta University, 1120 15Th Street, Augusta, GA, 30912, USA
| |
Collapse
|
5
|
Patel A, Lebron VM, Pabalan A, Schueler SA, El-Bayoumi J, Onumah C, Borum ML. Engaging the community on colorectal cancer screening: Additional factors identified by African Americans as potential barriers during focus groups. J Natl Med Assoc 2023; 115:580-583. [PMID: 37852880 DOI: 10.1016/j.jnma.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE African-Americans have the highest rate of colorectal cancer deaths. Adherence to colorectal cancer screening guidelines can improve outcomes. The objective of this study was to evaluate physician trust and barriers to screening utilizing a unique bi-directional learning focus group involving African-American adults and health care learners. METHODS A focus group of African-American adults from a community church and university health care learners was conducted to identify colon cancer screening barriers. Health care learners were medical students, resident physicians and gastroenterology fellows. Pre-focus group surveys, including the Wake Forest Physician Trust Scale (WFPTS) and a colon cancer screening knowledge survey, were administered. Audio recording of the focus group was transcribed with subsequent thematic analysis. A post-focus group survey evaluated the colorectal cancer screening barriers identified during the focus group. Analysis of pre- and post- focus group surveys was performed using Fisher Exact test with significance set at p<0.05. RESULTS The focus group consisted of 18 members (7 African-American community members, 11 non-African American health care learners). WFPTS revealed that 83% (86% community members, 82% health care learners; p = 1.0) strongly agree / agree that their physician would advocate for their health. 77% (86% community members, 73% health care learners; p = 1.0) strongly agree / agree that they trusted their physician. 100% recognized that colon cancer screening is recommended. The focus group identified lack of awareness (81%), colonoscopy preparation (81%), trust in physician (60%), lack of insurance coverage (56%), transportation (56%), colonoscopy wait time (50%), insufficient physician discussion (50%) and fear of procedure or cancer (35%) as screening barriers. Post-focus group surveys revealed that community members more frequently identified racial disparity in health care (p = 0.0474), physician respect toward patients (p = 0.0128) and insufficient physician discussion (p = 0.0006) as screening barriers. CONCLUSIONS Focus group discussion identified multiple barriers for colorectal cancer screening. Notably, differences in the perceptions of African-American community members and non-African-American health care learners about racial disparity in health care, physician respect toward patients and insufficient physician discussion were revealed. The integration of bi-directional focus group learning can be considered as a potential strategy to assist in the development of focused screening interventions.
Collapse
Affiliation(s)
- Ankit Patel
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Valeria Martinez Lebron
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Ana Pabalan
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Samuel A Schueler
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Jehan El-Bayoumi
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Chavon Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Marie L Borum
- Division of Gastroenterology and Liver Diseases, Department of Medicine, The George Washington School of Medicine and Health Sciences, Washington DC, USA.
| |
Collapse
|
6
|
Dell'Imperio SG, Aboul-Hassan D, Batchelor R, Chambers-Peeple K, Clauw DJ, DeJonckheere M, Bergmans RS. Vaccine perceptions among Black adults with long COVID. ETHNICITY & HEALTH 2023; 28:853-873. [PMID: 37005013 PMCID: PMC10524107 DOI: 10.1080/13557858.2023.2191914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Low uptake of COVID vaccines within Black communities is a concern given the stark racial inequities associated with the pandemic. Prior research details COVID vaccine perceptions within the general population and Black communities specifically. However, Black individuals with long COVID may be more or less receptive to future COVID vaccination than their peers without long COVID. The impact of COVID vaccination on long COVID symptoms is still controversial, since some studies suggest that vaccination can improve long COVID symptoms, whereas other studies report no significant change in symptoms or a worsening of symptoms. In this study, we aimed to characterize the factors influencing perceptions of COVID vaccines among Black adults with long COVID to inform future vaccine-related policies and interventions. DESIGN We conducted 15 semi-structured, race-concordant interviews over Zoom with adults who reported physical or mental health symptoms that lingered for a month or more after acute COVID infection. We transcribed and anonymized the interviews and implemented inductive, thematic analysis to identify factors influencing COVID vaccine perceptions and the vaccine decision-making process. RESULTS We identified five themes that influenced vaccine perceptions: (1) Vaccine safety and efficacy; (2) Social implications of vaccination status; (3) Navigating and interpreting vaccine-related information; (4) Possibility of abuse and exploitation by the government and scientific community; and (5) Long COVID status. Safety concerns were amplified by long COVID status and mistrust in social systems due to mistreatment of the Black community. CONCLUSIONS Among the factors influencing COVID vaccine perceptions, participants reported a desire to avoid reinfection and a negative immune response. As COVID reinfection and long COVID become more common, achieving adequate uptake of COVID vaccines and boosters may require approaches that are tailored in partnership with the long COVID patient community.
Collapse
Affiliation(s)
| | - Deena Aboul-Hassan
- Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Daniel J Clauw
- Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Melissa DeJonckheere
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Rachel S Bergmans
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Oh KM, An K, Lee M, Shin C, Steves SL. Colorectal cancer screening disparities in Asian Americans: the influences of patient-provider communication and social media use. Cancer Causes Control 2023:10.1007/s10552-023-01720-z. [PMID: 37266764 PMCID: PMC10237058 DOI: 10.1007/s10552-023-01720-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE We examined the role of patient-provider communication (PPC) during in-person visits and via electronic communication and social media use on colorectal cancer (CRC) screening among Asian Americans (AAs) and Non-Hispanic Whites (NHWs) aged 50 and older. METHODS Health Information National Trends Survey 2017-2020 data were analyzed. RESULTS AAs tended to evaluate the quality of PPC during their in-person visits to a health care provider lower than NHWs. AAs' CRC screening rate was lower than the rate of NHWs (78.8% vs. 84.4%). After adjusting for sociodemographics, healthcare access, and health status, the quality of PPC was the only significant predictor associated with a lower probability of CRC screening among AAs (Adjusted OR 0.74; 95% CI 0.56, 0.96); while the Internet to communicate with a health care provider was the only significant predictor of CRC screening among NHWs (Adjusted OR 1.76; CI 1.11, 2.79). AAs were more likely to use YouTube to watch a health-related video than NHWs (43.5% vs, 24%). However, social media use was not associated with CRC screening in both AAs and NHWs. CONCLUSION Use of electronic communication technology may contribute to improve health information literacy and reduce the disparity. On-line communication may empower the culturally and linguistically diverse AAs by improving their confidence in communication with health care providers. Thus, communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities. Online communication technologies may reduce the disparities in PPC related to cancer screening and cancer burden experienced by AAs.
Collapse
Affiliation(s)
- Kyeung Mi Oh
- School of Nursing, George Mason University, Fairfax, VA, USA.
| | - Kyungeh An
- Graduate School of Biomedical Sciences & School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Moonju Lee
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Chanam Shin
- College of Nursing, Texas Woman's University, Denton, TX, USA
| | | |
Collapse
|
8
|
Daggett A, Abdollahi S, Hashemzadeh M. The Effect of Language Concordance on Health Care Relationship Trust Score. Cureus 2023; 15:e39530. [PMID: 37366455 PMCID: PMC10290885 DOI: 10.7759/cureus.39530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes. This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. OBJECTIVE To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who use professional or ad hoc interpreters. METHODS This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items. Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scores than the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). CONCLUSIONS The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.
Collapse
Affiliation(s)
- Alexandria Daggett
- Pediatrics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | | | - Mehrtash Hashemzadeh
- Biostatistics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| |
Collapse
|
9
|
Brown KK, Kindratt TB, Brannon GE, Sankuratri BYV, Boateng GO. Patient Experience with Their Health Care Provider Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus by Race and Ethnicity in the United States. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:20-30. [PMID: 36727093 PMCID: PMC9883667 DOI: 10.1089/whr.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
Objectives The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity. Design This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 763; weighted n = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction. Results After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women. Conclusion There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes.
Collapse
Affiliation(s)
- Kyrah K. Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA.,Address correspondence to: Kyrah K. Brown, PhD, Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX 76019, USA,
| | - Tiffany B. Kindratt
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Grace Ellen Brannon
- Department of Communication, University of Texas at Arlington, Arlington, Texas, USA
| | | | - Godfred O. Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| |
Collapse
|
10
|
Lindström M, Pirnouzifard M. Trust in the healthcare system and mortality: A population-based prospective cohort study in southern Sweden. SSM Popul Health 2022; 18:101109. [PMID: 35535209 PMCID: PMC9077527 DOI: 10.1016/j.ssmph.2022.101109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022] Open
Abstract
Aims To investigate associations between trust in the healthcare system and all-cause, cardiovascular, cancer and other causes mortality. Study design Prospective cohort study. Methods A public health questionnaire was conducted in 2008 in Scania, the southernmost part of Sweden, with a 54.1% participation rate with a postal questionnaire and three reminders. In this study 24,833 respondents were included. The baseline questionnaire study was linked to prospective 8.3-year follow-up cause-specific mortality register data. Survival (Cox) regression analyses were conducted. Results A 15.2% proportion of respondents reported very high, 59.1% rather high, and 21.7% not particularly high trust in the healthcare system, while 3.2% reported no trust at all and 0.9% did not know. The groups with rather high and not particularly high trust in the healthcare system had significantly lower all-cause mortality than the reference group with very high trust in the healthcare system. These statistically significant results remained throughout the multiple analyses, and were explained by lower cancer mortality in both the rather high and not particularly high trust respondent groups, and lower cardiovascular mortality in the not particularly high trust respondent group. No significant results were observed in the adjusted models for other causes mortality. No significant results were observed for the no trust and don't know categories in the multiple adjusted models, but these groups are small. Conclusions The results suggest a comparative advantage of moderate trust compared to very high trust in this setting of long waiting times for cancer and CVD treatment. Trust in the healthcare system and mortality was investigated. Rather high and not particularly high trust groups had lower all-cause mortality than the very high trust group. The lower mortality was mainly explained by lower cancer mortality. The lower mortality was partly explained by lower CVD mortality. The findings are associated with long-term queueing for particularly cancer treatment.
Collapse
|
11
|
Stoltzfus KC, Popalis ML, Reiter PL, Moss JL. Perspectives on self-sampling for cancer screening among rural and urban women: Multilevel factors related to acceptability. J Rural Health 2022; 38:391-397. [PMID: 34002407 PMCID: PMC8599503 DOI: 10.1111/jrh.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Self-sampling tests may be used to overcome barriers to screening that are more prevalent in rural populations compared to urban populations. This study aims to qualitatively examine the attitudes toward established and novel self-sampling tests for cervical and colorectal cancer among women, comparing themes from rural versus urban areas. METHODS We recruited women (ages 45-65) from 28 counties in Pennsylvania. Four focus groups were conducted with women from metropolitan counties, and 7 focus groups were conducted with women from nonmetropolitan counties. A brief survey was conducted prior to the focus group regarding general health and willingness to complete self-sampling tests for cervical and colorectal cancer. FINDINGS We identified 3 themes about the potential for self-sampling for cancer screening: advantages and disadvantages of self-sampling compared to traditional testing, impact of self-sampling on patient interactions with their health care providers/clinics, and implications for improving/worsening access to quality health care services. We detected differences in responses from rural versus urban participants in the potential impact of self-sampling for cancer screening. CONCLUSIONS There are several barriers and facilitators at the individual, interpersonal, and organizational levels that influence the feasibility of implementing self-sampling for cancer screening in routine clinical practice. Rural participants face unique barriers to cancer screening across all levels. These findings can be used to guide interventions aimed at increasing the use of self-sampling methods.
Collapse
Affiliation(s)
- Kelsey C. Stoltzfus
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Madyson L. Popalis
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Paul L. Reiter
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - Jennifer L. Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| |
Collapse
|
12
|
Earl V, Beasley D, Ye C, Halpin SN, Gauthreaux N, Escoffery C, Chawla S. Barriers and Facilitators to Colorectal Cancer Screening in African-American Men. Dig Dis Sci 2022; 67:463-472. [PMID: 33811563 DOI: 10.1007/s10620-021-06960-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND African-Americans rank last among all racial groups for age-adjusted colorectal cancer mortality, 5-year survival rates, and rates of screening. Access to care does not fully explain racial disparities in rates of CRC and mortality. Sociocultural attitudes can predict probabilities of CRC screening. AIMS The objective of this study is to identify factors that influence colorectal cancer screening behavior in African-American men. METHODS Semi-structured interviews were conducted among 32 African-American men. Transcripts were analyzed using MAXQDA software. We then conducted a cross-sectional survey of 103 African-American men, using previously validated scales related to colorectal cancer screening and determinants. Data were analyzed with SPSS. RESULTS In the interview phase, beliefs relating to masculinity emerged as factors that hindered participation in screening. Overwhelmingly, participants felt that having an in-depth discussion about colorectal cancer with their provider was critical to enabling them to get screened. The survey phase demonstrated that most participants had poor colorectal cancer knowledge, as only 16% passed the knowledge test. Forty-eight percentage agreed that their provider did not recommend getting screened. Those who had been previously screened for colorectal cancer scored higher in total and on all subsets of the masculinity index than those who had not (p < .01). The most persuasive messages were those related to themes of masculinity. CONCLUSION This study provides a novel sociocultural perspective about colorectal cancer screening in African-American men. Our findings highlight the importance of family, masculinity, and community when promoting colorectal cancer screening to this population.
Collapse
Affiliation(s)
- Victoria Earl
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Derrick Beasley
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Chengcheng Ye
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean N Halpin
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nicole Gauthreaux
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Saurabh Chawla
- Department of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
13
|
Cueva K, Cueva M, Revels L, Hensel M, Dignan M. Culturally Relevant Online Cancer Education Supports Tribal Primary Care Providers to Reduce Their Cancer Risk and Share Information About Cancer. Health Promot Pract 2021; 23:631-639. [PMID: 34416831 DOI: 10.1177/15248399211027827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Culturally relevant education is an opportunity to reduce health disparities, and online learning is an emerging avenue for health promotion. In 2014-2019, a team based at the Alaska Native Tribal Health Consortium developed, implemented, and evaluated culturally relevant online cancer education modules with, and for, Alaska's tribal primary care providers. The project was guided by Indigenous Ways of Knowing and the principles of community-based participatory action research and was evaluated in alignment with empowerment theory. About 265 unique learners completed 1,898 end-of-module evaluation surveys between March 2015 and August 2019, and 13 people completed a follow-up survey up to 28 months post module completion. KEY FINDINGS Learners described the modules as culturally respectful and informative and reported feeling more knowledgeable and comfortable talking about cancer as a result of the modules. About 98% of the learners planned to reduce their cancer risk because of the modules, and all follow-up survey respondents had reduced their risk, including by quitting smoking, getting screened for cancer, eating healthier, and exercising more. About 98% of the learners planned to share information with their patients, families, friends, and community members because of the modules, with all follow-up survey respondents indicating that they had shared information about cancer from the modules. IMPLICATIONS FOR PRACTICE AND FURTHER RESEARCH Culturally relevant online modules have the capacity for positive behavioral change and relatively high correlations between intent and behavior change. Future research could determine which aspects of the modules catalyzed reduced cancer risk and increased dissemination of cancer information.
Collapse
Affiliation(s)
- Katie Cueva
- University of Alaska Anchorage, Anchorage, AK, USA
| | - Melany Cueva
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Laura Revels
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | |
Collapse
|
14
|
Kindratt TB, Allicock M, Atem F, Dallo FJ, Balasubramanian BA. Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study. JMIR Cancer 2021; 7:e23790. [PMID: 34328421 PMCID: PMC8367146 DOI: 10.2196/23790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/12/2021] [Accepted: 06/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services. Objective The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months. Methods Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted. Results Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC. Conclusions Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.
Collapse
Affiliation(s)
- Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health Dallas, UTHealth, The University of Texas Health Science Center at Houston, Dallas, TX, United States.,Center for Health Promotion and Prevention Research, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Folefac Atem
- Department of Biostatistics and Data Science, School of Public Health Dallas, UTHealth, The University of Texas Health Science Center at Houston, Dallas, TX, United States
| | - Florence J Dallo
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, United States
| | - Bijal A Balasubramanian
- Center for Health Promotion and Prevention Research, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Epidemiology, Human Genetics, and Environmental Health Sciences, School of Public Health Dallas, UTHealth, The University of Texas Health Science Center at Houston, Dallas, TX, United States
| |
Collapse
|
15
|
Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ. Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis. JCO Oncol Pract 2021; 17:e645-e653. [PMID: 33974829 DOI: 10.1200/op.21.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.
Collapse
Affiliation(s)
- Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Aisa Iyawe-Parsons
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Stephanie Navarro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA
| |
Collapse
|
16
|
Sohn YJ, Chang CY, Miles RC. Current Gaps in Breast Cancer Screening Among Asian and Asian American Women in the United States. J Am Coll Radiol 2021; 18:1376-1383. [PMID: 34174207 DOI: 10.1016/j.jacr.2021.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
Over the past two decades, the US Asian population has increased 72%, representing the fastest growth rate of any major racial group. Currently, there are over 20 million Asian and Asian American women in the United States, who identify with at least 1 of 19 different origin groups. Although women of Asian ancestry have traditionally been considered low risk for experiencing adverse breast cancer-specific outcomes, aggregated data may mask health disparities seen among subgroups. In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socioeconomic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.
Collapse
Affiliation(s)
| | - Connie Y Chang
- Associate Professor of Radiology, Department of Radiology, Boston, Massachusetts; Radiology Wellbeing Officer, Department of Radiology, Boston, Massachusetts
| | - Randy C Miles
- Clinical Service Chief, Division of Breast Imaging, Department of Radiology, Boston, Massachusetts.
| |
Collapse
|
17
|
Cueva K, Cueva M, Revels L, Hensel M, Dignan M. An Evaluation of Cancer Education Webinars in Alaska. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:484-490. [PMID: 31776892 PMCID: PMC7250721 DOI: 10.1007/s13187-019-01651-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Culturally relevant health promotion is an opportunity to reduce health inequities in the cancer burden, and online learning is an emerging avenue for health promotion. To address a desire for synchronous online cancer education, a project team offered ten 1-hr cancer education webinars for Alaska's rural tribal health workers. The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. The evaluation of this community-based intervention included end-of-webinar surveys. Between February and April 2018, 41 surveys were completed by 11 unique participants. All participants reported that, as a result of the webinars, they planned both to change their own behavior to reduce cancer risk, and to talk with their patients more often about cancer prevention strategies such as screenings, physical activity, tobacco cessation, and eating healthy. While the webinars addressed desires for synchronous actions to support cancer learning, and led to intentions to positive change behaviors, the ten webinars engaged far fewer unique learners than the team's asynchronous cancer education modules. This experience may inform other cancer educators' efforts to develop, implement, and evaluate online learning opportunities. Despite the small numbers, these webinars resulted in increased learners' intent to reduce cancer risk behaviors, share cancer information, and improved learners' capacity to talk about cancer in their communities.
Collapse
Affiliation(s)
- Katie Cueva
- Institute of Social and Economic Research, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, AK, 99508, USA.
| | - Melany Cueva
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Laura Revels
- Clinical & Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Michelle Hensel
- Community Health Aide Program, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Mark Dignan
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
18
|
Role of Stress-Survival Pathways and Transcriptomic Alterations in Progression of Colorectal Cancer: A Health Disparities Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115525. [PMID: 34063993 PMCID: PMC8196775 DOI: 10.3390/ijerph18115525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 12/09/2022]
Abstract
Every year, more than a million individuals are diagnosed with colorectal cancer (CRC) across the world. Certain lifestyle and genetic factors are known to drive the high incidence and mortality rates in some groups of individuals. The presence of enormous amounts of reactive oxygen species is implicated for the on-set and carcinogenesis, and oxidant scavengers are thought to be important in CRC therapy. In this review, we focus on the ethnicity-based CRC disparities in the U.S., the negative effects of oxidative stress and apoptosis, and gene regulation in CRC carcinogenesis. We also highlight the use of antioxidants for CRC treatment, along with screening for certain regulatory genetic elements and oxidative stress indicators as potential biomarkers to determine the CRC risk and progression.
Collapse
|
19
|
Wolbert T, Barry R, Gress T, Arrington A, Thompson E. Assessing Colorectal Cancer Screening Barriers in Rural Appalachia. South Med J 2021; 114:293-298. [PMID: 33942114 DOI: 10.14423/smj.0000000000001252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The age-appropriate colorectal cancer (CRC) screening rate in the rural Appalachian area is low compared with the national rate, which may account for the overall higher incidence of CRC in this area. The purpose of this study was to explore potential barriers to CRC screening in the West Virginia Appalachian area. METHODS A cross-sectional survey was designed to identify patient-reported barriers to CRC screening using the health belief model to assess their attitudes and behaviors. Autonomous paper-based surveys were randomly handed to individuals older than 50 years at various locations, including healthcare and nonhealthcare facilities. All of the responses were then categorized into two groups: the screened group and the unscreened group. Differences among both groups were statistically analyzed. RESULTS There were three main areas that significantly accounted for the discrepancies between the screened and unscreened groups: perceptions of discomfort from screening tests, psychological and behavior deterrents in CRC screening and diagnosis, and limited resources for accessing care, especially transportation. In particular, psychological and behavioral deterrents in CRC screening appeared to play a role in promoting aversion to CRC screening. CONCLUSIONS Lack of CRC screening awareness and knowledge may be responsible for fatalism regarding CRC and aversion to screening. Thus, multidisciplinary interventions that provide education about CRC screening, early intervention prognosis, and treatment options, as well as addressing systemic barriers to screening, such as assistance with scheduling, prep instructions, and transportation, can improve the screening rate in Appalachia and eventually lead to better outcomes through the early diagnosis of CRC.
Collapse
Affiliation(s)
- Thao Wolbert
- From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, the Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, the Department of Translational Research, Hershel "Woody" Williams Veterans Affairs Medical Center, Huntington, West Virginia, and the Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Rahman Barry
- From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, the Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, the Department of Translational Research, Hershel "Woody" Williams Veterans Affairs Medical Center, Huntington, West Virginia, and the Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Todd Gress
- From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, the Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, the Department of Translational Research, Hershel "Woody" Williams Veterans Affairs Medical Center, Huntington, West Virginia, and the Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Amanda Arrington
- From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, the Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, the Department of Translational Research, Hershel "Woody" Williams Veterans Affairs Medical Center, Huntington, West Virginia, and the Department of Surgery, University of Arizona College of Medicine, Tucson
| | - Errington Thompson
- From the Department of Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, the Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, the Department of Translational Research, Hershel "Woody" Williams Veterans Affairs Medical Center, Huntington, West Virginia, and the Department of Surgery, University of Arizona College of Medicine, Tucson
| |
Collapse
|
20
|
Fioravante N, Deal JA, Willink A, Myers C, Assi L. Preventive Care Utilization among Adults with Hearing Loss in the United States. Semin Hear 2021; 42:37-46. [PMID: 33883790 DOI: 10.1055/s-0041-1725999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hearing loss (HL) can negatively impact patient-provider communication and limit access to health promotion information, which may lead to decreased preventive care utilization. Using data from the 2015 and 2018 National Health Interview Survey, we examined the association between perceived HL with and without hearing aid use with self-reported age-appropriate uptake of breast and colon cancer screening, and influenza and pneumococcal vaccination. In models adjusted for sociodemographic characteristics, access to care, and health status, people with HL had lower odds of receiving breast cancer screening (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.72-0.96) and higher odds of receiving pneumococcal vaccination (OR = 1.11, 95% CI = 1.00-1.24) relative to those without HL. There were no differences in their colon cancer or influenza vaccination uptake. Compared with those without HL, people with HL who used hearing aids had increased odds of colon cancer screening and influenza and pneumococcal vaccination, while people with HL who did not use hearing aids were less likely to report cancer screening. Overall, Americans with untreated HL were less likely to report completing cancer screening. Hearing aid use may modify the association between HL and preventive care uptake. Screening for HL in primary care settings and communication trainings for providers may help reduce cancer screening disparities.
Collapse
Affiliation(s)
- Nicholas Fioravante
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Amber Willink
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Mcnzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Clarice Myers
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
21
|
Sato K, Kondo N, Murata C, Shobugawa Y, Saito K, Kondo K. Association of pneumococcal and influenza vaccination with patient-physician communication in older adults: A nationwide cross-sectional study from the JAGES 2016. J Epidemiol 2021; 32:401-407. [PMID: 33551389 PMCID: PMC9359899 DOI: 10.2188/jea.je20200505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient–physician communication and whether this variable was associated with increased odds of vaccination. Methods We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination. Results Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians’ listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients’ questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination. Conclusion The results suggest that promotion of having a family physician, better patient–physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.
Collapse
Affiliation(s)
- Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University.,Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University.,Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo
| | - Chiyoe Murata
- Department of Nutrition, School of Health and Nutrition, Tokai Gakuen University
| | - Yugo Shobugawa
- Department of Active Aging, Graduate School of Medical and Dental Sciences, Niigata University
| | - Kousuke Saito
- Department of Active Aging, Graduate School of Medical and Dental Sciences, Niigata University
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology
| |
Collapse
|
22
|
Golding H, Webber CE, Groome PA. Factors contributing to time to diagnosis in symptomatic colorectal cancer: A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13397. [PMID: 33377574 DOI: 10.1111/ecc.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/11/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common cancer worldwide (Ferlay et al., 2015, International Journal of Cancer, 136, E359), and delayed diagnosis is associated with mortality (Tørring et al., 2011, British Journal of Cancer, 104, 934; Tørring et al., 2012, Journal of Clinical Epidemiology, 65, 669). The purpose of this review was to determine the factors associated with time to diagnosis in symptomatic CRC using scoping review methods. METHODS We performed database and citation searches to identify studies which examine the length of any interval from symptom presentation to diagnosis. Study selection was conducted by two independent reviewers. Factors contributing to time to diagnosis were extracted from selected articles and mapped onto a conceptual framework consisting of four levels: patient and disease factors, provider factors, organisation/setting factors and sectors of influence. RESULTS From the 31 studies included in this review, we identified 138 unique factors, 17 of which were investigated by at least three studies and 11 of which had consistent results. Patient and disease factors were most commonly studied. Patient perception that their symptoms were benign, a non-urgent referral, female sex and rectal tumour location were each associated with a longer time to diagnosis. CONCLUSION Thus far, the literature has focused on patient or disease-related factors, while other levels of influence have been relatively understudied.
Collapse
Affiliation(s)
- Haley Golding
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Colleen E Webber
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| |
Collapse
|
23
|
Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol. Implement Sci 2020; 15:96. [PMID: 33121536 PMCID: PMC7599111 DOI: 10.1186/s13012-020-01045-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov (NCT04514341) on 14 August 2020.
Collapse
|
24
|
Jun J. Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups. ETHNICITY & HEALTH 2020; 25:960-981. [PMID: 29792075 DOI: 10.1080/13557858.2018.1478952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated. Design: Data comes from a nationally representative sample of 2011-2014 Health Information National Trends Surveys (HINTS). Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans' greater cancer/health information seeking, Japanese' higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans' odds of cancer screening were increased. Especially, Asian Americans' odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites. Conclusion: This research demonstrates that health organizations, providers, and Asian American patients' collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.
Collapse
Affiliation(s)
- Jungmi Jun
- The School of Journalism and Mass Communications, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
25
|
Lewis-Thames MW, Carnahan LR, James AS, Watson KS, Molina Y. Understanding Posttreatment Patient-Provider Communication and Follow-Up Care Among Self-Identified Rural Cancer Survivors in Illinois. J Rural Health 2020; 36:549-563. [PMID: 31925854 PMCID: PMC7351605 DOI: 10.1111/jrh.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE As disparities in rural-urban cancer survivorship rates continue to widen, optimizing patient-provider communication regarding timely follow-up care is a potential mechanism to improving survivorship-related outcomes. The current study examines sociodemographic and health predictors of posttreatment patient-provider communication and follow-up care and associations between written communication and timely follow-up care for cancer survivors who identify as rural. METHODS Data were analyzed from posttreatment cancer survivor respondents of the Illinois Rural Cancer Assessment Study. The current study tested associations between sociodemographic variables and health factors on the quality of patient-provider communication and timely posttreatment follow-up care, defined as visits ≤ 3 months posttreatment, and associations between the receipt of written patient-provider communication on timely posttreatment follow-up care. RESULTS Among 90 self-identified rural cancer survivors, respondents with annual incomes < $50,000 and ≤ High School diploma were more likely to report a high quality of posttreatment patient-provider communication. Posttreatment written communication was reported by 62% of the respondents and 52% reported timely follow-up visits during the first 3 years of posttreatment care. Patients who reported receiving written patient-provider communication were more likely to have timely posttreatment follow-up care after completing active treatment than patients who had not received written patient-provider communication. CONCLUSIONS Our findings suggest that written patient-provider communication improved timely follow-up care for self-identified rural cancer survivors. This research supports policy and practice that recommend the receipt of written survivorship care plans. Implementation of written survivorship care recommendations has the potential to improve survivorship care for rural cancer survivors.
Collapse
Affiliation(s)
- Marquita W. Lewis-Thames
- Washington University in St. Louis School of Medicine, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri
- Northwestern University Feinberg School of Medicine, Department of Medical Social Science, Center for Community Health, Chicago, Illinois
| | - Leslie R. Carnahan
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
- Division of Community Health Sciences, School of Public Health, Chicago, Illinois
| | - Aimee S. James
- Northwestern University Feinberg School of Medicine, Department of Medical Social Science, Center for Community Health, Chicago, Illinois
| | - Karriem S. Watson
- Division of Community Health Sciences, School of Public Health, Chicago, Illinois
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | - Yamilé Molina
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
- Division of Community Health Sciences, School of Public Health, Chicago, Illinois
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
26
|
Kindratt TB, Atem F, Dallo FJ, Allicock M, Balasubramanian BA. The Influence of Patient-Provider Communication on Cancer Screening. J Patient Exp 2020; 7:1648-1657. [PMID: 33457626 PMCID: PMC7786660 DOI: 10.1177/2374373520924993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Tiffany B Kindratt
- Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Folefac Atem
- Department of Biostatistics and Data Science, UT Health, School of Public Health Dallas, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Florence J Dallo
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, UT Health, School of Public Health Dallas, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Center for Health Promotion and Prevention Research, UT Southwestern-Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Bijal A Balasubramanian
- Center for Health Promotion and Prevention Research, UT Southwestern-Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health, School of Public Health Dallas, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
27
|
Kindratt TB, Dallo FJ, Allicock M, Atem F, Balasubramanian BA. The influence of patient-provider communication on cancer screenings differs among racial and ethnic groups. Prev Med Rep 2020; 18:101086. [PMID: 32309115 PMCID: PMC7155227 DOI: 10.1016/j.pmedr.2020.101086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Tiffany B Kindratt
- University of Texas at Arlington, Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, 500 West Nedderman Drive, Arlington, TX 76019-0259, United States
| | - Florence J Dallo
- Oakland University, Department of Public and Environmental Wellness, School of Health Sciences, United States
| | - Marlyn Allicock
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Health Promotion and Behavioral Sciences, United States
| | - Folefac Atem
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Biostatistics and Data Science, United States
| | - Bijal A Balasubramanian
- UT Health, The University of Texas Health Science Center at Houston, School of Public Health Dallas, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Health Promotion and Prevention Research, UT Southwestern - Harold C. Simmons Comprehensive Cancer Center, United States
| |
Collapse
|
28
|
Litwin O, Sontrop JM, McArthur E, Tinmouth J, Rabeneck L, Vinden C, Sood MM, Baxter NN, Tanuseputro P, Welk B, Garg AX. Uptake of Colorectal Cancer Screening by Physicians Is Associated With Greater Uptake by Their Patients. Gastroenterology 2020; 158:905-914. [PMID: 31682852 DOI: 10.1053/j.gastro.2019.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Physicians' own screening practices might affect screening in their patients. We conducted a population-based study to evaluate whether family physicians who underwent colorectal cancer testing were more likely to have patients who underwent colorectal cancer testing. METHODS We collected demographic and health care information on residents of Ontario, Canada from administrative databases; the sample was restricted to individuals at average risk of colorectal cancer who were 52-74 years old as of April 21, 2016. We obtained a list of all registered physicians in the province; physicians (n = 11,434) were matched with nonphysicians (n = 45,736) on age, sex, and residential location. Uptake of colorectal tests was defined by a record of a fecal occult blood test in the past 2 years, flexible sigmoidoscopy in the past 5 years, or colonoscopy in the past 10 years. Patients were assigned to family physicians based on billing claim frequency, and then the association between colorectal testing in family physicians and their patients was examined using a modified Poisson regression model. RESULTS Uptake of colorectal tests by physicians and nonphysicians (median age 60 years; 71% men) was 67.9% (95% confidence interval [CI], 67.0%-68.7%) and 66.6% (95% CI, 66.2%-67.1%), respectively. Physicians were less likely than nonphysicians to undergo fecal occult blood testing and were more likely to undergo colonoscopy; prevalence ratios were 0.44 (95% CI, 0.42-0.47) and 1.24 (95% CI, 1.22-1.26), respectively. Uptake of colorectal tests by family physicians was associated with greater uptake by their patients (adjusted prevalence ratio, 1.10; 95% CI, 1.08-1.12). CONCLUSIONS Approximately one-third of physicians and nonphysicians are overdue for colorectal cancer screening. Patients are more likely to be tested if their family physician has been tested. There is an opportunity for physicians to increase their participation in colorectal cancer screening, which could, in turn, motivate their patients to undergo screening.
Collapse
Affiliation(s)
- Owen Litwin
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada
| | | | - Jill Tinmouth
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Rabeneck
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Vinden
- ICES Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Manish M Sood
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy N Baxter
- ICES Toronto, Ontario, Canada; Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- ICES Toronto, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES Toronto, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
| |
Collapse
|
29
|
AlRuthia Y, Sales I, Almalag H, Alwhaibi M, Almosabhi L, Albassam AA, Alharbi FA, Bashatah A, Asiri Y. The Relationship Between Health-Related Quality of Life and Trust in Primary Care Physicians Among Patients with Diabetes. Clin Epidemiol 2020; 12:143-151. [PMID: 32104098 PMCID: PMC7008194 DOI: 10.2147/clep.s236952] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background Trust is pivotal for a productive relationship between patients and healthcare providers and is positively correlated with multiple clinical and humanistic outcomes. However, the impact of trust in healthcare providers on different domains of health-related quality of life (HRQoL) among diabetic patients has not been studied in detail. Purpose The aim of this study was to examine the association between the physical, mental or psychological, social, and environmental domains of HRQoL with the patients’ trust in their primary care physicians while controlling for several sociodemographic and clinical factors. The study was conducted among a sample of diabetic patients. Patients and Methods This study had a prospective questionnaire-based, multi-center, cross-sectional design. The patients were recruited from three public hospitals in Saudi Arabia. Patients’ experiences and trust in their primary care physicians were assessed using the Health Care Relationship Trust (HCR-Trust) scale. HRQoL was assessed using the Arabic version of the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression was conducted to assess the relationship between HCR-Trust and the WHOQOL-BREF physical, psychological, social, and environmental domains controlling for age, Charlson Comorbidity Index (CCI) score, health literacy, sex, education, annual income, nationality, and illness duration. Results Three hundred and sixty-four patients participated in the study. The scores in all four domains of WHOQOL-BREF were positively associated with HCR-Trust scores of the diabetic patients. Additionally, the scores in the physical (β = −10.26; 95% CI: −13.77 to −6.74; P < 0.0001) and psychological (β = −3.91; 95% CI: −7.44 to −0.38; P < 0.0001) domains were negatively associated with female gender. Furthermore, the physical domain score was negatively associated with the duration of illness (β = −0.26; 95% CI: −0.506 to −0.02; P = 0.032). The environmental domain score was positively associated with annual income (β = 2.31; 95% CI: 1.05 to 3.56; P = 0.030). Other patient characteristics, such as age and education, were not associated with the scores of any of the WHOQOL-BREF domains. Conclusion Patient trust in healthcare providers is positively associated with different domains of HRQoL. Therefore, building and maintaining trust with patients is important to achieve favorable treatment outcomes.
Collapse
Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Latifa Almosabhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed A Albassam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Adel Bashatah
- Department of Nursing Education and Administration, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
30
|
Culturally-Relevant Online Education Improves Health Workers' Capacity and Intent to Address Cancer. J Community Health 2019; 43:660-666. [PMID: 29368103 DOI: 10.1007/s10900-018-0465-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To address a desire for timely, medically-accurate cancer education in rural Alaska, ten culturally-relevant online learning modules were developed, implemented, and evaluated with, and for, Alaska's Community Health Aides/Practitioners (CHA/Ps). The project was guided by the framework of Community-Based Participatory Action Research, honored Indigenous Ways of Knowing, and was informed by Empowerment Theory. Each learner was invited to complete an end-of-module evaluation survey. The survey asked about changes in intent to share cancer information with patients as a result of the module. In 1 year, August 1, 2016-July 31, 2017, 459 surveys were completed by 79 CHA/Ps. CHA/Ps reported that, because of the modules, they felt more knowledgeable about cancer, and more comfortable, confident, and prepared to talk about cancer with their patients, families, and communities. All learners shared that because of the modules, they intended to talk with their patients more often about cancer screenings, tobacco cessation, physical activity, or nutrition. These findings suggest that the application of this collaboratively developed, culturally-relevant, health promotion intervention has supported increased CHA/P capacity and intent to interact with patients about cancer. In the words of a learner: "Doing all these courses makes me a ton times more comfortable in talking about cancer with anyone. I didn't know too much about it at first but now I know a whole lot. Thank you".
Collapse
|
31
|
Bridge E, Conn LG, Dhanju S, Singh S, Moody L. The patient experience of ambulatory cancer treatment: a descriptive study. ACTA ACUST UNITED AC 2019; 26:e482-e493. [PMID: 31548816 DOI: 10.3747/co.26.4191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patient experience is often measured quantitatively, but that approach has limitations for understanding the entire experience. Qualitative methods can help to understand more complex issues most important to patients and their families. The purpose of the present work was to use a qualitative analysis examining the patient experience of ambulatory cancer care in Ontario to generate a deeper understanding of the patient experience and to lead to solutions for improvement. Methods Data from the Ambulatory Oncology Patient Satisfaction Survey (aopss) for 2013-2015 were used to conduct a qualitative content analysis. The aopss is a retrospective paper-based survey, mailed to patients who are currently receiving cancer treatment or who have received cancer treatment within the preceding 6 months, that is designed to capture their experiences. Patients who were surveyed were asked, "Is there anything else you would like to tell us about your cancer care services?" The National Research Corporation Canada's patient-centred care framework was used to guide the analysis. Results From the 5391 patients who responded, 7328 coded responses were generated, of which 3658 (49.9%) were related to the patient-centred care framework. New subthemes were identified: diagnosis sensitivity; emotional support resources; care delivery with care, compassion, and comfort; continuity of care between departments and in the community; access to cancer centre personnel; patient-health care provider communication; confidence in the health care provider; wait times; health care provider and treatment coordination; and parking. Conclusions The results identify facilitators and barriers to the patient experience in the ambulatory cancer treatment setting from the patient perspective and identify opportunities to improve the patient experience.
Collapse
Affiliation(s)
- E Bridge
- Cancer Care Ontario, Toronto, ON
| | - L Gotlib Conn
- Cancer Care Ontario, Toronto, ON.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON
| | - S Dhanju
- Cancer Care Ontario, Toronto, ON
| | - S Singh
- Cancer Care Ontario, Toronto, ON.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
| | - L Moody
- Cancer Care Ontario, Toronto, ON
| |
Collapse
|
32
|
Abstract
Purpose
The purpose of this paper is to investigate the clinical communication using Tamale Teaching Hospital as a case.
Design/methodology/approach
The paper is based on the Reassure, Explain, Listen, Answer, Take Action and Express Appreciation (RELATE) model and the Four Habits models of Clinical Communication.
Findings
The results of the study indicate that leadership conducted staff meetings with some of the components of the RELATE model. These include staff meetings, employee rounding and communication/notice boards. The results of the study also suggest that much as some parts of the Four Habits model was used in provider–patient communication, certain aspects of the model were absent. The study identified some communication challenges including poor dissemination, lack of unity among some health workers, poor attendance in meetings and, with respect to patients, language barrier, patients’ reluctance to disclose their actual health problems to health providers, lack of privacy and lack of a friendly environment.
Practical implications
Providers, especially physicians, should be given training on the local languages in areas where they perform their services. Health service providers should receive as part of their learning in-depth training on the Four Habits model of Clinical Communication, especially the Medical Officers.
Originality/value
It is imperative to embrace evidence-based practices/models aimed at securing proper communication in all hospitals but most especially teaching hospitals.
Collapse
|
33
|
Redwood DG, Blake ID, Provost EM, Kisiel JB, Sacco FD, Ahlquist DA. Alaska Native Patient and Provider Perspectives on the Multitarget Stool DNA Test Compared With Colonoscopy for Colorectal Cancer Screening. J Prim Care Community Health 2019; 10:2150132719884295. [PMID: 31646933 PMCID: PMC6820167 DOI: 10.1177/2150132719884295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Ian D. Blake
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | | | - Frank D. Sacco
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | |
Collapse
|
34
|
Jones AL, Mor MK, Haas GL, Gordon AJ, Cashy JP, Schaefer JH, Hausmann LRM. The Role of Primary Care Experiences in Obtaining Treatment for Depression. J Gen Intern Med 2018; 33:1366-1373. [PMID: 29948804 PMCID: PMC6082202 DOI: 10.1007/s11606-018-4522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. OBJECTIVE In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. DESIGN AND PARTICIPANTS We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. MAIN MEASURES We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. KEY RESULTS Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. CONCLUSIONS In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.
Collapse
Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
35
|
Kiviniemi MT, Klasko-Foster LB, Erwin DO, Jandorf L. Decision-making and socioeconomic disparities in colonoscopy screening in African Americans. Health Psychol 2018; 37:481-490. [PMID: 29595298 PMCID: PMC5920714 DOI: 10.1037/hea0000603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Socioeconomic status (SES) disparities in colorectal cancer screening are persistent. Lower education and income are both associated with lower screening rates. Both cognitive (e.g., perceived barriers) and affective (e.g., disgust, fear) decision-making constructs are known determinants of colorectal cancer screening behavior. This study tests the hypotheses that SES may be related to decision-making constructs and that this SES-decision-making construct relation may contribute to explaining the SES-screening behavior disparity. METHOD Surveys assessing perceived benefits and barriers to screening, self-efficacy, positive and negative affective associations with colonoscopy, fear of colonoscopy, colorectal cancer knowledge, past screening behavior, and demographics including education and income were completed by 2,015 African American participants ages 50 and older. Both univariable and multivariable relations of SES to decision-making constructs were examined, as were univariable and multivariable models of the indirect effect of SES on screening via decision-making constructs. RESULTS Socioeconomic status was related to both screening compliance and the decision-making constructs. Bootstrap modeling of the indirect effect showed that the total effect of the SES-screening behavior relation included an indirect effect via social cognitive decision-making constructs. CONCLUSION These findings suggest that cognitive and affective decision-making constructs account for at least some of the SES disparities in colorectal cancer screening behavior. As such, more research is needed to explore the intra individual-level influences of disparities in colorectal cancer screening. In addition, work is needed to develop effective intervention approaches to address the relation of SES to decision-making constructs. (PsycINFO Database Record
Collapse
Affiliation(s)
| | | | - Deborah O Erwin
- Office of Cancer Health Disparities Research, Roswell Park Cancer Institute
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai
| |
Collapse
|
36
|
Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
Collapse
|
37
|
Kim SB. Unraveling the Determinants to Colorectal Cancer Screening Among Asian Americans: a Systematic Literature Review. J Racial Ethn Health Disparities 2017; 5:683-699. [PMID: 28779479 DOI: 10.1007/s40615-017-0413-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/26/2022]
Abstract
Colorectal cancer (CRC) is one of the top three cancers experienced among Asian American (AA) men and women. One effective way to decrease incidence and mortality from CRC is the adherence of regular CRC screening; however, AA continue to receive the lowest screening rates compared to other racial/ethnic groups. When disaggregating this heterogeneous population, further disparities exist between subgroups. Examination of facilitators and barriers to cancer screening among AA subgroups is fairly recent and the synthesis of this information is limited. As such, a systematic review was conducted examining the facilitators and the barriers among Chinese, Filipino, Korean, and Japanese Americans using a systematic literature review method. The Health Belief Model served as the primary theoretical framework for this study and used to organize and synthesize the facilitators and barriers to CRC screening. In total, 22 articles yielded 29 examinations of each of the AA subgroups. Different facilitators and barriers to screening uptake for each subgroup were revealed; however, consistent across all the subgroups was physician recommendation as a facilitator and participants' unawareness of screening tests and those stating having no problems/symptoms of CRC as a barrier across screening modalities. Tailored approach in outreach and intervention efforts are suggested when achieving to improve CRC screening in AA ethnic subgroups.
Collapse
Affiliation(s)
- Sophia B Kim
- University of Hawaii at Manoa, Myron B. Thompson School of Social Work, 2430 Campus Road, Gartley Hall, Honolulu, HI, 96822, USA.
| |
Collapse
|
38
|
Kim K, Kim S, Gallo JJ, Nolan MT, Han H. Decision making about Pap test use among Korean immigrant women: A qualitative study. Health Expect 2017; 20:685-695. [PMID: 27687295 PMCID: PMC5513020 DOI: 10.1111/hex.12507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Understanding how individuals make decisions about Pap tests concerning their personal values helps health-care providers offer tailored approaches to guide patients' decision making. Yet research has largely ignored decision making about Pap tests among immigrant women who experience increased risk of cervical cancer. OBJECTIVE To explore decision making about Pap tests among Korean immigrant women. METHODS We conducted a qualitative descriptive study using 32 semi-structured, in-depth interviews with Korean immigrant women residing in a north-eastern metropolitan area. Data were audio-recorded, transcribed verbatim and analysed using inductive coding. RESULTS Although most women with positive decisions made their own decisions, some women deferred to their providers, and others made decisions in collaboration with their providers and significant others. While women making positive decisions tended to consider both barriers to and facilitators of having Pap tests, women making negative decisions predominantly discussed the barriers to having Pap tests, such as modesty and differences between the South Korean and US health-care systems. The women's reflections on their decisions differed regarding their Pap test decisions. CONCLUSIONS Women's desired roles in the decision-making process and reflection on their decision outcome appeared to vary, although most participants with positive decisions made their own decisions and were satisfied with their decisions. Future research should conduct longitudinal, quantitative studies to test our findings regarding decision-making processes and outcomes about Pap tests. IMPLICATIONS The findings should be incorporated into cervical cancer screening practices to fulfil the unmet needs of immigrant women in patient-provider communication and to facilitate women's decision making about Pap tests.
Collapse
Affiliation(s)
- Kyounghae Kim
- School of NursingUniversity of ConnecticutStorrsCTUSA
| | - Soohyun Kim
- Department of Community‐Public HealthSchool of NursingJohns Hopkins UniversityBaltimoreMDUSA
| | - Joseph J. Gallo
- Department of Mental HealthBloomberg School of Public HealthJohns Hopkins University BaltimoreBaltimoreMDUSA
| | - Marie T. Nolan
- Department of Acute and Chronic CareSchool of NursingJohns Hopkins UniversityBaltimoreMDUSA
| | - Hae‐Ra Han
- Department of Community‐Public HealthSchool of NursingJohns Hopkins UniversityBaltimoreMDUSA
| |
Collapse
|
39
|
Lin SC, McKinley D, Sripipatana A, Makaroff L. Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient-provider communication. Cancer 2017; 123:4185-4192. [PMID: 28708933 DOI: 10.1002/cncr.30855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are low among underserved populations. High-quality patient-physician communication potentially influences patients' willingness to undergo CRC screening. Community health centers (HCs) provide comprehensive primary health care to underserved populations. This study's objectives were to ascertain national CRC screening rates and to explore the relations between sociodemographic characteristics and patient-provider communication on the receipt of CRC screening among HC patients. METHODS Using 2014 Health Center Patient Survey data, bivariate and multivariate analyses examined the association of sociodemographic variables (sex, race/ethnicity, age, geography, preferred language, household income, insurance, and employment status) and patient-provider communication with the receipt of CRC screening. RESULTS Patients between the ages of 65 and 75 years (adjusted odds ratio [aOR], 2.49; 95% confidence interval [CI], 1.33-4.64) and patients not in the labor force (aOR, 2.32; 95% CI, 1.37-3.94) had higher odds of receiving CRC screening, whereas patients who were uninsured (aOR, 0.33; 95% CI, 0.18-0.61) and patients who were non-English-speaking (aOR, 0.42; 95% CI, 0.18-0.99) had lower odds. Patient-provider communication was not associated with the receipt of CRC screening. CONCLUSIONS The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Sue C Lin
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Duane McKinley
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | | |
Collapse
|
40
|
Sicsic J, Franc C. Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:609-621. [PMID: 27329654 DOI: 10.1007/s10198-016-0813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. OBJECTIVE Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. METHODS Based on an administrative database of 50,752 women aged 50-74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). RESULTS Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41-2.35 %)], but the effect was not significantly different following the implementation of the contract. CONCLUSION The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.
Collapse
Affiliation(s)
- Jonathan Sicsic
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France.
| | - Carine Franc
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
| |
Collapse
|
41
|
Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
42
|
Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
| |
Collapse
|
43
|
Burt J, Abel G, Elmore N, Newbould J, Davey A, Llanwarne N, Maramba I, Paddison C, Benson J, Silverman J, Elliott MN, Campbell J, Roland M. Rating Communication in GP Consultations: The Association Between Ratings Made by Patients and Trained Clinical Raters. Med Care Res Rev 2016; 75:201-218. [PMID: 27698072 PMCID: PMC5858640 DOI: 10.1177/1077558716671217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient evaluations of physician communication are widely used, but we know little about how these relate to professionally agreed norms of communication quality. We report an investigation into the association between patient assessments of communication quality and an observer-rated measure of communication competence. Consent was obtained to video record consultations with Family Practitioners in England, following which patients rated the physician’s communication skills. A sample of consultation videos was subsequently evaluated by trained clinical raters using an instrument derived from the Calgary-Cambridge guide to the medical interview. Consultations scored highly for communication by clinical raters were also scored highly by patients. However, when clinical raters judged communication to be of lower quality, patient scores ranged from “poor” to “very good.” Some patients may be inhibited from rating poor communication negatively. Patient evaluations can be useful for measuring relative performance of physicians’ communication skills, but absolute scores should be interpreted with caution.
Collapse
Affiliation(s)
- Jenni Burt
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gary Abel
- 2 University of Exeter Medical School, Exeter, Devon, UK
| | - Natasha Elmore
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jenny Newbould
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Nadia Llanwarne
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - John Benson
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - John Campbell
- 2 University of Exeter Medical School, Exeter, Devon, UK
| | - Martin Roland
- 1 University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
44
|
Brenner AT, Hoffman R, McWilliams A, Pignone MP, Rhyne RL, Tapp H, Weaver MA, Callan D, de Hernandez BU, Harbi K, Reuland DS. Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions. Am J Prev Med 2016; 51:454-62. [PMID: 27242081 PMCID: PMC5501711 DOI: 10.1016/j.amepre.2016.03.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Low-income, low-literacy, limited English-proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient-provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits. STUDY DESIGN RCT with data collected from patients at baseline and immediately after the provider encounter. SETTING/PARTICIPANTS Patients aged 50-75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014-September 2015; analysis, 2015). INTERVENTION Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter. MAIN OUTCOME MEASURES CRC screening-related knowledge, discussion, intent, test preferences, and test ordering. RESULTS The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%). CONCLUSIONS Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02054598.
Collapse
Affiliation(s)
- Alison T Brenner
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Richard Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael P Pignone
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Robert L Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
| | - Mark A Weaver
- Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Danelle Callan
- University of New Mexico Cancer Center, Albuquerque, New Mexico
| | | | - Khalil Harbi
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Daniel S Reuland
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
45
|
Pathirana IN, Albert DM, Young PE, Womeldorph CM. Colorectal Cancer Screening: a North American Point of View. CURRENT COLORECTAL CANCER REPORTS 2016; 12:241-250. [DOI: 10.1007/s11888-016-0330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
46
|
Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Cruz-Correa M, Ortiz AP. Factors associated with late stage at diagnosis among Puerto Rico's government health plan colorectal cancer patients: a cross-sectional study. BMC Health Serv Res 2016; 16:344. [PMID: 27488381 PMCID: PMC4971714 DOI: 10.1186/s12913-016-1590-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients. Methods We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study. Results There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage. Conclusions These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
Collapse
Affiliation(s)
- Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marcia Cruz-Correa
- Department of Surgery, Biochemistry and Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| |
Collapse
|
47
|
Chan ZCY, Lai CKY. The nurse-patient communication: voices from nursing students. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2016-0023/ijamh-2016-0023.xml. [PMID: 27371819 DOI: 10.1515/ijamh-2016-0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/30/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Effective communication skills have been found to be one of the pivotal factors in building positive interpersonal relationships. Little is known about nursing undergraduates' perspectives on communicating with patients. OBJECTIVE This study aimed to explore nursing students' perspectives and experiences of nurse-patient communication in their clinical placement. METHODS The participants included 21 second-year undergraduates and 21 first-year master's students. Interviews were conducted in Cantonese and then transcribed in Chinese and translated into English. A content analysis approach was adopted to analyze the data. RESULTS Five themes emerged from the interview data. 'The necessity of nurse-patient communication' reveals why the students valued nurse-patient communication. 'The conversation contents' describes the content of the conversations that students typically had with patients. The third theme is 'self-reflection on the nurse-patient communication'. The last two themes, 'the communication pattern in different hospital settings' and 'the obstacles impeding nurse-patient communication', are about the students' communication styles in different hospitals and the barriers they encounter. DISCUSSION To improve students' communication skills, educators and clinical staff should listen to students, enhance students' reflective skills and strengthen their confidence. CONCLUSION Through understanding students' difficulties in the nurse-patient communication experience and the skills that they lack, educators can provide them with helpful recommendations to improve their communication skills in clinical practice. PRACTICE IMPLICATIONS The results of this study reveal that students' nurse-patient communication skills need to be improved.
Collapse
|
48
|
Jackson CS, Oman M, Patel AM, Vega KJ. Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol 2016; 7:S32-43. [PMID: 27034811 DOI: 10.3978/j.issn.2078-6891.2015.039] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the 2010 Census, just over one-third of the United States (US) population identified themselves as being something other than being non-Hispanic white alone. This group has increased in size from 86.9 million in 2000 to 111.9 million in 2010, representing an increase of 29 percent over the ten year period. Per the American Cancer Society, racial and ethnic minorities are more likely to develop cancer and die from it when compared to the general population of the United States. This is particularly true for colorectal cancer (CRC). The primary aim of this review is to highlight the disparities in CRC among racial and ethnic minorities in the United States. Despite overall rates of CRC decreasing nationally and within certain racial and ethnic minorities in the US, there continue to be disparities in incidence and mortality when compared to non-Hispanic whites. The disparities in CRC incidence and mortality are related to certain areas of deficiency such as knowledge of family history, access to care obstacles, impact of migration on CRC and paucity of clinical data. These areas of deficiency limit understanding of CRC's impact in these groups and when developing interventions to close the disparity gap. Even with the implementation of the Patient Protection and Affordable Healthcare Act, disparities in CRC screening will continue to exist until specific interventions are implemented in the context of each of racial and ethnic group. Racial and ethnic minorities cannot be viewed as one monolithic group, rather as different segments since there are variations in incidence and mortality based on natural history of CRC development impacted by gender, ethnicity group, nationality, access, as well as migration and socioeconomic status. Progress has been made overall, but there is much work to be done.
Collapse
Affiliation(s)
- Christian S Jackson
- 1 Section of Gastroenterology, Loma Linda VA Medical Center, Loma Linda, CA 92357, USA ; 2 Department of Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA ; 3 Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Matthew Oman
- 1 Section of Gastroenterology, Loma Linda VA Medical Center, Loma Linda, CA 92357, USA ; 2 Department of Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA ; 3 Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Aatish M Patel
- 1 Section of Gastroenterology, Loma Linda VA Medical Center, Loma Linda, CA 92357, USA ; 2 Department of Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA ; 3 Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kenneth J Vega
- 1 Section of Gastroenterology, Loma Linda VA Medical Center, Loma Linda, CA 92357, USA ; 2 Department of Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA ; 3 Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loma Linda University Medical Center, Loma Linda, CA, USA
| |
Collapse
|
49
|
Muliira JK, D'Souza MS, Ahmed SM, Al-Dhahli SN, Al-Jahwari FRM. Barriers to Colorectal Cancer Screening in Primary Care Settings: Attitudes and Knowledge of Nurses and Physicians. Asia Pac J Oncol Nurs 2016; 3:98-107. [PMID: 27981145 PMCID: PMC5123546 DOI: 10.4103/2347-5625.177391] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Healthcare providers (HCPs) play a critical role in reducing colorectal cancer (CRC) related morbidity and mortality. This study aimed at exploring the attitudes and knowledge of nurses and physicians working in primary care settings regarding CRC screening. Methods: A total of 142 HCPs (57.7% nurses and 42.3% physicians) participated in a cross-sectional survey. Data were collected using a Self-administered Questionnaire. The participants were clinically experienced (mean = 9.39 years; standard deviation [SD] = 6.13), regularly taking care of adults eligible for CRC screening (62%) and had positive attitudes toward CRC screening (83.1%). Most participants (57%) had low levels of knowledge about CRC screening (mean = 3.23; SD = 1.50). The participants were most knowledgeable about the recommended age for initiating screening (62.7%) and the procedures not recommended for screening (90.8%). Results: More than 55% did not know the frequency of performing specific screening procedures, the upper age limit at which screening is not recommended, and the patients at high-risk for CRC. There were no significant differences between nurses’ and physicians’ attitudes and knowledge. The participants’ perceptions about professional training (odds ratio [OR] = 2.17, P = 0.003), colonoscopy (OR = 2.60, P = 0.014), and double-contrast barium enema (OR = 0.53, P = 0.041), were significantly associated with knowledge about CRC screening. Conclusions: The inadequate knowledge levels among nurses and physicians may be one of the barriers affecting CRC screening. Enhancing HCPs knowledge about CRC screening should be considered a primary intervention in the efforts to promote CRC screening and prevention.
Collapse
Affiliation(s)
- Joshua Kanaabi Muliira
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Melba Sheila D'Souza
- Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | - Samira Maroof Ahmed
- Department of Community and Mental Health, College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | | |
Collapse
|
50
|
Ferron P, Asfour SS, Metsch LR, Antoni MH, Rodriguez AE, Duncan R, Findlay SM. Impact of a Multifaceted Intervention on Promoting Adherence to Screening Colonoscopy Among Persons in HIV Primary Care: A Pilot Study. Clin Transl Sci 2015; 8:290-7. [PMID: 25996255 DOI: 10.1111/cts.12276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
HIV-positive patients have lower colon cancer screening rates and are at increased risk for colon adenocarcinoma. We tested a transdisciplinary prevention model to increase provider and patient adherence to screening colonoscopy. Of 1,339 HIV-positive patients with scheduled clinic appointments during the period September to November 2009, we identified 400 records of eligible patients ≥50 years and retrospectively reviewed for screening colonoscopy referral; if never referred, flagged for referral at next visit. Providers referred 43.5% (174/400) patients and 36.2% (63/174) kept appointment. Within 6 months before the study, 337 patients attended clinic and providers referred 18%. Note that 211/226 patients with flagged records attended clinic at least once during the study 6-month period and providers referred (43.6%). The referral rate for flagged records was significantly different from that for the prior 6 months (p < 0.0001). A randomized trial compared the efficacy of patient decision support versus usual care on screening adherence. Among patients randomized to intervention 17 (51.5%) compared to usual care only 16 (48.5%), intervention group showed significant adherence of 70.6% (12/17) versus 29.4% (5/16), (p = 0.024). In addition, intervention patients had good bowel preparation of 76.9% (10/13) versus usual care 23.1% (3/13), (p = 0.05). This transdisciplinary intervention model significantly increased provider and patient screening colonoscopy behavior.
Collapse
Affiliation(s)
- Pansy Ferron
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Lisa R Metsch
- University of Miami, Miller School of Medicine, Miami, Florida, USA.,Columbia University, New York, USA
| | - Michael H Antoni
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Robert Duncan
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sheila M Findlay
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|