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Manne SL, Hudson SV, Preacher KJ, Imanguli M, Pesanelli M, Frederick S, Singh N, Schaefer A, Van Cleave JH. Prevalence and correlates of fear of recurrence among oral and oropharyngeal cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01449-3. [PMID: 37584880 PMCID: PMC10921339 DOI: 10.1007/s11764-023-01449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Fear of recurrence (FoR) is a prevalent and difficult experience among cancer patients. Most research has focused on FoR among breast cancer patients, with less attention paid to characterizing levels and correlates of FoR among oral and oropharyngeal cancer survivors. The purpose was to characterize FoR with a measure assessing both global fears and the nature of specific worries as well as evaluate the role of sociodemographic and clinical factors, survivorship care transition practices, lifestyle factors, and depressive symptoms in FoR. METHODS Three hundred eighty-nine oral and oropharyngeal survivors recruited from two cancer registries completed a survey assessing demographics, cancer treatment, symptoms, alcohol and tobacco use, survivorship care practices, depression, and FoR. RESULTS Forty percent reported elevated global FoR, with similar percentages for death (46%) and health worries (40.3%). Younger, female survivors and survivors experiencing more physical and depressive symptoms reported more global fears and specific fears about the impact of recurrence on roles, health, and identity, and fears about death. Depression accounted for a large percent of the variance. Lower income was associated with more role and identity/sexuality worries, and financial hardship was associated with more role worries. CONCLUSIONS FoR is a relatively common experience for oral and oropharyngeal cancer survivors. Many of its correlates are modifiable factors that could be addressed with multifocal, tailored survivorship care interventions. IMPLICATIONS FOR CANCER SURVIVORS Assessing and addressing depressive symptoms, financial concerns, expected physical symptoms in the first several years of survivorship may impact FoR among oral and oropharyngeal cancer survivors.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA.
| | - Shawna V Hudson
- Institute for Health, Health Care Policy and Aging Research, Robert Wood Johnson Medical School, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Kristopher J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Matin Imanguli
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
- Department of Otolaryngology-Head and Neck Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Morgan Pesanelli
- Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Neetu Singh
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Alexis Schaefer
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Janet H Van Cleave
- NYU Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
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Caruso R, Dellafiore F, Arrigoni C, Bonetti L. Individual-Level Variables Associated with Self-Efficacy in Nutritional Care for Older People among Italian Nurses: A Multicenter Cross-Sectional Study. J Nutr Gerontol Geriatr 2023; 42:46-58. [PMID: 36946327 DOI: 10.1080/21551197.2023.2188340] [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: 03/23/2023]
Abstract
Malnutrition in older people is still an unsolved issue. Clinical nurses have a key role in malnutrition prevention. This study aims to describe the individual-level variables associated with self-efficacy in nutrition care for older adults among nurses. A cross-sectional descriptive observational study was performed involving nurses from four northern Italy hospitals. The self-efficacy scale for nursing nutrition care (SE-NNC) and Multiple linear regression (MLR) models were used, enrolling 305 nurses. The mean SE-NNC total score was 53.3 ± 19.7. Considering the three dimensions of the SE-NNC, mean scores were 45.9 ± 21.7 for boosting knowledge, 55.4 ± SD = 20.3 for assessment and evidence utilization, and 57.7 ± 21.1 for care delivery. To be a younger nurse, working in a chronic care setting, and being male were associated with a higher level of self-efficacy, both considering the SE-NNC total score and its dimensions. Working in acute care settings and being an older nurse was associated with lower nursing self-efficacy in nutrition care for older adults.
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Affiliation(s)
- Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Loris Bonetti
- Nursing Direction Department, Nursing Research Competence Centre, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Mavragani A, Imanguli M, Kashy D, Pesanelli M, Frederick S, Van Cleave JH, Paddock L, Hudson S, Steinberg M, Clifford P, Domider M, Singh N. Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial. JMIR Res Protoc 2023; 12:e39996. [PMID: 36662561 PMCID: PMC9898837 DOI: 10.2196/39996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care. OBJECTIVE The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL). METHODS This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation. RESULTS Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES. CONCLUSIONS This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations. TRIAL REGISTRATION ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39996.
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Affiliation(s)
| | - Matin Imanguli
- Division of Head and Neck Oncologic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Deborah Kashy
- College of Social Science, Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Morgan Pesanelli
- School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Sara Frederick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Janet H Van Cleave
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Shawna Hudson
- Department of Family Medicine and Community Health, Institute for Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Michael Steinberg
- Department of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Patrick Clifford
- Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Mara Domider
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Neetu Singh
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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Manne SL, Hudson SV, Kashy DA, Imanguli M, Pesanelli M, Frederick S, Van Cleave J. Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors. Eur J Cancer Care (Engl) 2022; 31:e13710. [PMID: 36151904 PMCID: PMC9788355 DOI: 10.1111/ecc.13710] [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: 04/25/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams. METHODS Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy. RESULTS Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams. CONCLUSION Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.
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Affiliation(s)
- Sharon L. Manne
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Shawna V. Hudson
- Institute for Health, Health Care Policy and Aging ResearchRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Deborah A. Kashy
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
| | - Matin Imanguli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA,Department of Otolaryngology‐Head and Neck SurgeryRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Morgan Pesanelli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Sara Frederick
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
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Parker AE, Scull TM, Morrison AM. DigiKnowIt News: Educating youth about pediatric clinical trials using an interactive, multimedia educational website. J Child Health Care 2022; 26:139-153. [PMID: 33836627 DOI: 10.1177/13674935211003774] [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] [Indexed: 11/15/2022]
Abstract
Pediatric clinical trials allow for the testing of appropriate and effective treatments for children. However, some challenges exist with recruitment. This study examined the effectiveness of DigiKnowIt News, an interactive, multimedia website (which includes activities, videos, and comic books) designed to educate children about clinical trials. A randomized controlled trial was conducted in 2018 with 91 participants (M age = 10.92 years; SD = 2.06). Participants were randomly assigned to intervention or wait-list control groups and completed questionnaires at pretest and posttest (1 week later) about their knowledge, attitudes, beliefs about clinical trials, and self-efficacy for participating in clinical trials. Participants in the intervention group received access to DigiKnowIt News between pretest and posttest and completed a satisfaction questionnaire at posttest. At the end of the study, participants in the wait-list control group were offered the option to use the website and complete a satisfaction questionnaire. At posttest, participants in the intervention group, compared to participants in the wait-list control group, had more knowledge about clinical trials and more reported confidence for participating in clinical trials. Participants reported high levels of satisfaction with DigiKnowIt News. The findings suggest that an educational website can improve factors related to increasing rates of participation in clinical trials.
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Rangel ML, Heredia NI, Reininger B, McNeill L, Fernandez ME. Educating Hispanics About Clinical Trials and Biobanking. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1112-1119. [PMID: 30112612 PMCID: PMC6377344 DOI: 10.1007/s13187-018-1417-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hispanics are under-represented in clinical research. To ensure that the Hispanic population benefits from advances in public health and medicine, including personalized medicine, there is a need to increase their participation in clinical trials and biobanking. There is a great need for improving awareness and addressing concerns individuals may have about participation. The purpose of this study was to adapt, implement, and evaluate educational materials about clinical trials and biobanking for Hispanic individuals. We adapted existing materials based on focus group data. We then trained four promotoras de salud to deliver education to Hispanic adults in community settings in Houston, TX. The promotoras educated 101 Hispanic adults, 51 on biobanking and 50 on clinical trials. Study staff administered brief pre- and post-test questionnaires that measured benefits, barriers, norms, self-efficacy, and intention to participate in either clinical trials or biobanking. Our sample was predominately female (83%) and Spanish-speaking (69%) and made less than $25,000 a year (87%). This intervention increased perceived benefits of participating in biobanking and clinical trials, self-efficacy for donating biospecimens, and intention to participate in biobanking if invited. Perceived barriers to participating declined. This study demonstrated that brief education can result in improved perceptions and attitudes related to participation in biobanking and clinical trials, and could increase participation. Researchers and practitioners could use these educational materials to educate Hispanic community members on clinical research potentially increasing participation rates in the future.
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Affiliation(s)
- M Lizette Rangel
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, USA.
| | - Natalia I Heredia
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Belinda Reininger
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Lorna McNeill
- Department of Health Disparities, MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
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Manne S, Smith B, Mitarotondo A, Frederick S, Toppmeyer D, Kirstein L. Decisional conflict among breast cancer patients considering contralateral prophylactic mastectomy. PATIENT EDUCATION AND COUNSELING 2019; 102:902-908. [PMID: 30553577 PMCID: PMC7666877 DOI: 10.1016/j.pec.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The study's goals were to characterize decisional conflict and preparedness for making the decision about having CPM among breast cancer patients considering CPM who do not carry cancer-predisposing mutation and to evaluate correlates of decisional conflict and preparedness. METHODS 93 women considering CPM completed a survey of decisional conflict and preparedness for the CPM decision, knowledge, perceived risk, self-efficacy, reasons for CPM, input from others and discussion with the doctor about CPM, and cancer worry. RESULTS Between 8% and 27% of women endorsed elevated decisional conflict. Most women were satisfied with preparatory information that they were provided. Knowledge was low. Top reasons for choosing CPM were the desire for peace of mind, lowering the chance of another breast cancer, and improving survival. CONCLUSIONS Decisional conflict is elevated in a subset of patients considering CPM. A more well-informed decision may be fostered by a comprehensive discussion about CPM with the patient's clinician, fostering self-efficacy in managing cancer worry, and helping patients understand their motivations for CPM. PRACTICE IMPLICATIONS Clinicians working with breast cancer patients considering CPM should discuss the CPM decision, foster self-efficacy in managing cancer worry, and help patients understand their motivations for the surgery.
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Affiliation(s)
- Sharon Manne
- Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, USA.
| | - Barbara Smith
- Center for Breast Cancer, Massachusetts General Hospital, Boston, USA
| | - Anna Mitarotondo
- Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Sara Frederick
- Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Deborah Toppmeyer
- Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
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Daly BJ, Nock N, Margevicious S, Meropol NJ. Importance of incorporating measures of attitude in planning and evaluating nursing education. JOURNAL OF NURSING EDUCATION AND PRACTICE 2018; 9:10.5430/jnep.v9n4p1. [PMID: 32864029 PMCID: PMC7453751 DOI: 10.5430/jnep.v9n4p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Learners' attitudes towards a topic or behavior has long been recognized as an important component in the evaluation of formal education as well as in achieving desired behavior change. However, attitudes are frequently neglected and evaluation of outcomes from continuing nursing education often includes only changes in knowledge and learner satisfaction. We describe measurement of attitudes of oncology nurses towards holding discussions with patients about the option of participating in a clinical trial, in comparison to what can be learned from measuring knowledge alone. This article illustrates important insights that can be gained through inclusion of measures of attitude in both designing and evaluating continuing education using data from a larger on-going study.
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Affiliation(s)
| | - Nora Nock
- Case Western Reserve University, Cleveland, Ohio
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Besharati F, Karimi-Shahanjarini A, Hazavehie S, Bashirian S, Faradmal J. Predictors of colorectal cancer screening intention among Iranian adults: an application of the preventive health model. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2018; 59:E159-E166. [PMID: 30083624 PMCID: PMC6069407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) is the third most common cancer among adults in Iran. CRC screening is an effective way in reducing mortality rate from this cancer. However, the screening rate of CRC is very low among Iranian adults. This study investigated predictors of Iranian average-risk adults ' intention to take up CRC screening with fecal occult blood test using a mediator model. METHODS Participants of this cross-sectional study comprised of 477 average-risk adults who were selected using a national sampling frame in Hamadan city, west of Iran. Data was collected through the questionnaire based on the preventive health model constructs. Structural Equation Modeling (SEM) was employed to test the relationship using Smart PLS 2.0 software. RESULTS All measures were robust in terms of the reliability and validity. Benefit (b = 0.12, p < 0.01), self- efficacy (b = 0.36, p < 0.01), social support (b = 0.10, p < 0.05) and barriers (b = -0.14, p < 0.01) predicted the intention to be screened for CRC. Self- efficacy partly mediated the effects of social support and perceived barriers on intention. The study model explained approximately 24% of the variance in CRC screening intention with fecal occult blood test. CONCLUSION Our findings indicated that the preventive health model constructs such as self -efficacy, social support and barriers are useful in understanding CRC screening intentions and can help health planners to develop effective interventions to encourage Iranian adults to undergo CRC screening.
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Affiliation(s)
- F. Besharati
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nursing, Guilan University of Medical Sciences, Rasht, Iran
| | - A. Karimi-Shahanjarini
- Social Determinants of Health Research Center & Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - S.M.M. Hazavehie
- Department of Public Health & Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - S. Bashirian
- Social Determinants of Health Research Center & Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - J. Faradmal
- Modeling of Noncommunicable Diseases Research Center & Department of Biostatistics an Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Sawatzky R, Russell L, Friberg F, Carlsson EK, Pettersson M, Öhlén J. Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ). PATIENT EDUCATION AND COUNSELING 2017; 100:827-835. [PMID: 27955903 DOI: 10.1016/j.pec.2016.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/28/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients' knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness. METHODS Elective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n=250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters. RESULTS The psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery. CONCLUSION The adapted version of the PCSQ can be used for longitudinal analyses. PRACTICE IMPLICATIONS The measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lara Russell
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada; School of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
| | - Febe Friberg
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Eva K Carlsson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Colorectal Surgery, Sahlgrenska University Hospital/East, SE_41685 Gothenburg, Sweden.
| | - Monica Pettersson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Vascular Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Joakim Öhlén
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden.
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Development and validation of the preparedness for Colorectal Cancer Surgery Questionnaire: PCSQ-pre 24. Eur J Oncol Nurs 2016; 25:24-32. [DOI: 10.1016/j.ejon.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
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Nipp RD, Lee H, Powell E, Birrer NE, Poles E, Finkelstein D, Winkfield K, Percac-Lima S, Chabner B, Moy B. Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program. Oncologist 2016; 21:467-74. [PMID: 26975867 DOI: 10.1634/theoncologist.2015-0481] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/15/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. METHODS We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. RESULTS After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). CONCLUSION CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. IMPLICATIONS FOR PRACTICE Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns.
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Affiliation(s)
- Ryan D Nipp
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Elizabeth Powell
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Nicole E Birrer
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Emily Poles
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Daniel Finkelstein
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Karen Winkfield
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Sanja Percac-Lima
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Bruce Chabner
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
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13
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Rogith D, Yusuf RA, Hovick SR, Fellman BM, Peterson SK, Burton-Chase AM, Li Y, Bernstam EV, Meric-Bernstam F. Patient knowledge and information-seeking about personalized cancer therapy. Int J Med Inform 2016; 88:52-7. [PMID: 26878762 DOI: 10.1016/j.ijmedinf.2016.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding patients' knowledge and prior information-seeking regarding personalized cancer therapy (PCT) may inform future patient information systems, consent for molecular testing and PCT protocols. We evaluated breast cancer patients' knowledge and information-seeking behaviors regarding PCT. METHODS Newly registered female breast cancer patients (n=100) at a comprehensive cancer center completed a self-administered questionnaire prior to their first clinic visit. RESULTS Knowledge regarding cancer genetics and PCT was moderate (mean 8.7±3.8 questions correct out of 16). A minority of patients (27%) indicated that they had sought information regarding PCT. Higher education (p=0.009) and income levels (p=0.04) were associated with higher knowledge scores and with seeking PCT information (p=0.04). Knowledge was not associated with willingness to participate in PCT research. CONCLUSION Educational background and financial status impact patient knowledge as well as information-seeking behavior. For most patients, clinicians are likely to be patients' initial source of information about PCT. Understanding patients' knowledge deficits at presentation may help inform patient education efforts.
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Affiliation(s)
- Deevakar Rogith
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States
| | - Rafeek A Yusuf
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States
| | - Shelley R Hovick
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The Ohio State University, Columbus, OH 43210, United States
| | - Bryan M Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Susan K Peterson
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Allison M Burton-Chase
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; Albany College of Pharmacy and Health Sciences, Albany, NY 12208, United States
| | - Yisheng Li
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Elmer V Bernstam
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States; Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, TX 77030, United States
| | - Funda Meric-Bernstam
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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14
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Meropol NJ, Wong YN, Albrecht T, Manne S, Miller SM, Flamm AL, Benson AB, Buzaglo J, Collins M, Egleston B, Fleisher L, Katz M, Kinzy TG, Liu TM, Margevicius S, Miller DM, Poole D, Roach N, Ross E, Schluchter MD. Randomized Trial of a Web-Based Intervention to Address Barriers to Clinical Trials. J Clin Oncol 2015; 34:469-78. [PMID: 26700123 DOI: 10.1200/jco.2015.63.2257] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lack of knowledge and negative attitudes have been identified as barriers to participation in clinical trials by patients with cancer. We developed Preparatory Education About Clinical Trials (PRE-ACT), a theory-guided, Web-based, interactive computer program, to deliver tailored video educational content to patients in an effort to overcome barriers to considering clinical trials as a treatment option. PATIENTS AND METHODS A prospective, randomized clinical trial compared PRE-ACT with a control condition that provided general clinical trials information produced by the National Cancer Institute (NCI) in text format. One thousand two hundred fifty-five patients with cancer were randomly allocated before their initial visit with an oncologist to PRE-ACT (n = 623) or control (n = 632). PRE-ACT had three main components: assessment of clinical trials knowledge and attitudinal barriers, values assessment with clarification back to patients, and provision of a video library tailored to address each patient's barriers. Outcomes included knowledge and attitudes and preparation for decision making about clinical trials. RESULTS Both PRE-ACT and control interventions improved knowledge and attitudes (all P < .001) compared with baseline. Patients randomly allocated to PRE-ACT showed a significantly greater increase in knowledge (P < .001) and a significantly greater decrease in attitudinal barriers (P < .001) than did their control (text-only) counterparts. Participants in both arms significantly increased their preparedness to consider clinical trials (P < .001), and there was a trend favoring the PRE-ACT group (P < .09). PRE-ACT was also associated with greater patient satisfaction than was NCI text alone. CONCLUSION These data show that patient education before the first oncologist visit improves knowledge, attitudes, and preparation for decision making about clinical trials. Both text and tailored video were effective. The PRE-ACT interactive video program was more effective than NCI text in improving knowledge and reducing attitudinal barriers.
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Affiliation(s)
- Neal J Meropol
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Yu-Ning Wong
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Terrance Albrecht
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Sharon Manne
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Suzanne M Miller
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Anne Lederman Flamm
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Al Bowen Benson
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Joanne Buzaglo
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Michael Collins
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Brian Egleston
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Linda Fleisher
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Michael Katz
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Tyler G Kinzy
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Tasnuva M Liu
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Seunghee Margevicius
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Dawn M Miller
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - David Poole
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Nancy Roach
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Eric Ross
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Mark D Schluchter
- Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center; Neal J. Meropol, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller, and Mark D. Schluchter, Case Comprehensive Cancer Center, Case Western Reserve University; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Yu-Ning Wong, Suzanne M. Miller, Michael Collins, Brian Egleston, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania Health System, Philadelphia, PA; Terrance Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Sharon Manne, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz, International Myeloma Foundation, North Hollywood, CA; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
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15
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Wong YN, Schluchter MD, Albrecht TL, Benson AB, Buzaglo J, Collins M, Flamm AL, Fleisher L, Katz M, Kinzy TG, Liu TM, Manne S, Margevicius S, Miller DM, Miller SM, Poole D, Raivitch S, Roach N, Ross E, Meropol NJ. Financial Concerns About Participation in Clinical Trials Among Patients With Cancer. J Clin Oncol 2015; 34:479-87. [PMID: 26700120 DOI: 10.1200/jco.2015.63.2463] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The decision to enroll in a clinical trial is complex given the uncertain risks and benefits of new approaches. Many patients also have financial concerns. We sought to characterize the association between financial concerns and the quality of decision making about clinical trials. METHODS We conducted a secondary data analysis of a randomized trial of a Web-based educational tool (Preparatory Education About Clinical Trials) designed to improve the preparation of patients with cancer for making decisions about clinical trial enrollment. Patients completed a baseline questionnaire that included three questions related to financial concerns (five-point Likert scales): "How much of a burden on you is the cost of your medical care?," "I'm afraid that my health insurance won't pay for a clinical trial," and "I'm worried that I wouldn't be able to afford the costs of treatment on a clinical trial." Results were summed, with higher scores indicating greater concerns. We used multiple linear regressions to measure the association between concerns and self-reported measures of self-efficacy, preparation for decision making, distress, and decisional conflict in separate models, controlling for sociodemographic characteristics. RESULTS One thousand two hundred eleven patients completed at least one financial concern question. Of these, 27% were 65 years or older, 58% were female, and 24% had a high school education or less. Greater financial concern was associated with lower self-efficacy and preparation for decision making, as well as with greater decisional conflict and distress, even after adjustment for age, race, sex, education, employment, and hospital location (P < .001 for all models). CONCLUSION Financial concerns are associated with several psychological constructs that may negatively influence decision quality regarding clinical trials. Greater attention to patients' financial needs and concerns may reduce distress and improve patient decision making.
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Affiliation(s)
- Yu-Ning Wong
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA.
| | - Mark D Schluchter
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Terrance L Albrecht
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Al Bowen Benson
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Joanne Buzaglo
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Michael Collins
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Anne Lederman Flamm
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Linda Fleisher
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Michael Katz
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Tyler G Kinzy
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Tasnuva M Liu
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Sharon Manne
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Seunghee Margevicius
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Dawn M Miller
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Suzanne M Miller
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - David Poole
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Stephanie Raivitch
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Nancy Roach
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Eric Ross
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
| | - Neal J Meropol
- Yu-Ning Wong, Michael Collins, Suzanne M. Miller, Stephanie Raivitch, and Eric Ross, Fox Chase Cancer Center, Temple University Health System; Joanne Buzaglo, Cancer Support Community Research and Training Institute; Linda Fleisher, Children's Hospital of Philadelphia; David Poole, University of Pennsylvania, Philadelphia, PA; Mark D. Schluchter, Tyler G. Kinzy, Tasnuva M. Liu, Seunghee Margevicius, Dawn M. Miller and Neal J. Meropol, Case Comprehensive Cancer Center, Case Western Reserve University; Neal J. Meropol, University Hospitals Case Medical Center, Seidman Cancer Center; Anne Lederman Flamm, Cleveland Clinic Foundation, Cleveland, OH; Terrance L. Albrecht, Karmanos Cancer Institute, Wayne State University, Detroit, MI; Al Bowen Benson III, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; Michael Katz,† International Myeloma Foundation, North Hollywood, CA; Sharon Manne, Cancer Institute of New Jersey, New Brunswick, NJ; and Nancy Roach, Fight Colorectal Cancer, Alexandria, VA
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Abstract
Adolescent and young adult (AYA) patients with cancer are a unique category of patients who, depending on age at time of diagnosis, might receive treatment from oncologists specializing either in the treatment of children or adults. In the USA, AYA oncology generally encompasses patients 15-39 years of age. AYA patients with cancer typically present with diseases that span the spectrum from 'paediatric' cancers (such as acute lymphoblastic leukaemia [ALL] and brain tumours) to 'adult' tumours (such as breast cancer and melanoma), as well as cancers that are largely unique to their age group (such as testicular cancer and bone tumours). Research indicates that outcomes of AYA patients with cancer are influenced not only by the treatment provided, but also by factors related to 'host' biology. In addition to the potential biological and cancer-specific differences between AYAs and other patients with cancer, AYA patients also often have disparate access to clinical trials and suffer from a lack of age-appropriate psychosocial support services and health services, which might influence survival as well as overall quality of life. In this Review, these issues are discussed, with a focus on two types of AYA cancer--ALL and melanoma--highlighting findings arising from the use of emerging technologies, such as whole-genome sequencing.
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Kaplan AL, Crespi CM, Saucedo JD, Connor SE, Litwin MS, Saigal CS. Decisional conflict in economically disadvantaged men with newly diagnosed prostate cancer: baseline results from a shared decision-making trial. Cancer 2014; 120:2721-7. [PMID: 24816472 DOI: 10.1002/cncr.28755] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Decisional conflict is a source of anxiety and stress for men diagnosed with prostate cancer given uncertainty surrounding myriad treatment options. Few data exist to help clinicians identify which patients are at risk for decisional conflict. The purpose of this study was to examine factors associated with decisional conflict in economically disadvantaged men diagnosed with prostate cancer before any treatment choices were made. METHODS A total of 70 men were surveyed at a Veterans Administration clinic with newly diagnosed localized prostate cancer enrolled in a randomized trial testing a novel shared decision-making tool. Baseline demographic, clinical, and functional data were collected. Independent variables included age, race, education, comorbidity, relationship status, urinary/sexual dysfunction, and prostate cancer knowledge. Tested outcomes were Decisional Conflict Scale, Uncertainty Subscale, and Perceived Effectiveness Subscale. Multiple linear regression modeling was used to identify factors associated with decisional conflict. RESULTS Mean age was 63 years, 49% were African American, and 70% reported an income less than $30,000. Poor prostate cancer knowledge was associated with increased decisional conflict and higher uncertainty (P < .001 and P = 0.001, respectively). Poor knowledge was also associated with lower perceived effectiveness (P = 0.003) whereas being in a relationship was associated with higher decisional conflict (P = 0.03). CONCLUSIONS Decreased patient knowledge about prostate cancer is associated with increased decisional conflict and lower perceived effective decision-making. Interventions to increase comprehension of prostate cancer and its treatments may reduce decisional conflict. Further work is needed to better characterize this relationship and identify effective targeted interventions.
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Affiliation(s)
- Alan L Kaplan
- Department of Urology, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California
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