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Rost M, De Clercq E, Arnold L, Rakic M. Interventions to enhance cross-cultural competence in oncology: A meta-analysis of effectiveness studies and a qualitative review. Eur J Oncol Nurs 2023; 64:102277. [PMID: 36944274 DOI: 10.1016/j.ejon.2023.102277] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Cross-cultural competence of healthcare providers is crucial to create a culturally safe environment. Cancer poses special challenges to cross-culturally competent communication and decision-making. Yet, no research synthesis on cross-cultural competence interventions has focused specifically on oncology. METHODS We conducted a meta-analysis and qualitative review of literature on the effectiveness of cross-cultural competence interventions in oncology. No limitations were placed on publication date, language, oncology setting, or geographic region. Of 1.565 citations identified, 15 articles met the inclusion criteria. Information on study design, samples, measured outcomes, and effectiveness statistics were coded. Average weighted effects were calculated applying meta-analysis methodology. RESULTS Studies were published between 2000 and 2020; more than half in the last seven years; two thirds in the USA. Overall study quality was at a low to moderate level, notably only one study provided a control-group-design. In sum, nurses constituted the largest occupational group among participants. Results of the meta-analysis indicate that cross-cultural competence interventions have differential effects. While the overall effect of cross-cultural competence interventions was not statistically significant, results showed that the cross-cultural competence dimensions of knowledge and behavior did improve. Effects beyond that remain unclear. CONCLUSIONS We provide valuable information on research gaps. The lack of studies and insufficient methodological rigor of available studies show that more research is needed to support the claim that interventions actually improve the various dimensions of cross-cultural competence in oncology. To build a stronger evidence base, it is necessary to include patient-reported outcomes and to center their experiences in future research.
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland.
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
| | - Louisa Arnold
- Institute of Psychology, Friedrich-Schiller-University of Jena, 07743, Germany
| | - Milenko Rakic
- Institute for Biomedical Ethics, University of Basel, 4056, Switzerland
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2
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Conley CC, Rivera Rivera JN, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Ricker C, Quinn GP, Soliman H, Vadaparampil ST. Provider discussion of genetic counseling among high-risk Spanish-preferring Latina breast cancer survivors. Transl Behav Med 2022; 12:900-908. [PMID: 36205471 PMCID: PMC9540969 DOI: 10.1093/tbm/ibac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Among high-risk breast cancer (BC) survivors, genetic counseling (GC) and genetic testing (GT) may inform cascade testing and risk management. Compared to non-Hispanic White BC survivors, Spanish-preferring Latina BC survivors are less likely to report discussing GC with a healthcare provider. However, few studies have examined Latinas' experiences with GC/GT, particularly outside of the mainland USA. This study aimed to compare frequency of provider discussion of GC between Spanish-preferring Latina BC survivors living in Florida (FL) and Puerto Rico (PR). We conducted secondary data analysis of baseline assessments from a randomized pilot of an educational intervention for Spanish-preferring Latina BC survivors. Participants (N = 52) were GC/GT-naive, but met clinical criteria for GC/GT referral. Participants self-reported sociodemographic, clinical, and cultural variables, including previous provider discussion of GC. Descriptive statistics characterized frequency of GC discussion. Logistic regression examined the relationships between sociodemographic, clinical, and cultural characteristics and GC discussion. Only 31% of participants reported previous GC discussion. More participants from PR reported having GC discussions (43% vs. 21% in the mainland USA). In multivariable analyses, greater likelihood of GC discussion was associated with PR (vs. mainland USA) residence (odds ratio [OR] = 6.00, p = .03), older age at baseline (OR = 1.19, p = .04), and younger age at BC diagnosis (OR = 0.80, p = .03). Few high-risk Spanish-preferring Latina BC survivors in the mainland USA and PR had discussed GC with their providers. These results highlight a gap in the implementation of evidence-based genetics guidelines. Provider-directed interventions may be needed to increase uptake of GC/GT among Latina BC survivors.
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Affiliation(s)
- Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | | | | | | | - Julie Dutil
- Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | | | - Charité Ricker
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Gwendolyn P Quinn
- Grossman School of Medicine, New York University, New York, NY 10016, USA
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Patel PB, Marcaccio CL, de Guerre LEVM, Patel VI, Wang G, Giles K, Schermerhorn ML. Complications after thoracic endovascular aortic repair for ruptured thoracic aortic aneurysms remain high compared with elective repair. J Vasc Surg 2022; 75:842-850. [PMID: 34655686 PMCID: PMC8863631 DOI: 10.1016/j.jvs.2021.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) for ruptured thoracic aortic aneurysms is associated with increased perioperative mortality and morbidity compared with intact repair. The purpose of our study was to evaluate the factors associated with the presentation of ruptured aneurysms and adverse outcomes after repair. METHODS The Vascular Quality Initiative (VQI) registry was queried (2010-2020) to identify patients who had undergone TEVAR for ruptured and intact thoracic aortic aneurysms. The primary outcome was to identify the factors associated with ruptured thoracic aortic aneurysms. The secondary outcomes included perioperative mortality and morbidity, 5-year survival, and the identification of factors associated with adverse outcomes after TEVAR. RESULTS Of the 3039 patients identified with a thoracic aortic aneurysm, 2806 (92%) had undergone repair for an intact aneurysm and 233 (8%) had undergone repair for a ruptured aneurysm. Chronic kidney disease was associated with a greater odds of a presentation with a ruptured aneurysm (odds ratio [OR], 3.1; 95% confidence interval [CI], 2.0-4.9; P < .001). The factors associated with a lower odds of rupture included prior aortic aneurysm repair (OR, 0.71; 95% CI, 0.49-0.97; P = .05), prior smoker (OR, 0.36; 95% CI, 0.24-0.53; P < .001), preoperative beta-blocker therapy (OR, 0.57; 95% CI, 0.41-0.80; P = .001), and preoperative statin therapy (OR, 0.68; 95% CI, 0.49-0.94; P = .020). TEVAR for ruptured thoracic aortic aneurysms was associated with higher perioperative mortality (rupture vs intact, 27% vs 4.6%; OR, 6.6; 95% CI 4.3-10; P < .001) and the composite outcome of mortality, new dialysis, paralysis, and stroke (38% vs 9.5%; OR, 5.1; 95% CI, 3.5-7.4; P < .001). The 5-year survival was significantly lower after TEVAR for ruptured thoracic aortic aneurysms (50% vs 76%; P < .001; hazard ratio, 0.39; 95% CI, 0.29-0.52; P < .001). Preoperative statin therapy was associated with higher 5-year survival (hazard ratio, 1.3; 95% CI, 1.0-1.6; P = .021). CONCLUSIONS TEVAR for ruptured thoracic aortic aneurysms results in increased perioperative mortality and morbidity and lower 5-year survival compared with TEVAR for intact aneurysms. Patients with prior aortic aneurysm repair, prior smoking, and preoperative beta-blocker or statin therapy were less likely to present with ruptured thoracic aneurysms. This correlation might be attributed to increased exposure to cardiovascular healthcare providers and, thus, subsequently increased screening and surveillance, allowing for elective repair of thoracic aortic aneurysms.
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Affiliation(s)
- Priya B Patel
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Livia E V M de Guerre
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Grace Wang
- Division of Vascular and Endovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Kristina Giles
- Division of Vascular and Endovascular Surgery, Maine Medical Center, Portland, Me
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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4
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Conley CC, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Burgos C, Ricker C, Kim J, Graves KD, Ashing KT, Quinn GP, Soliman H, Vadaparampil ST. A pilot randomized trial of an educational intervention to increase genetic counseling and genetic testing among Latina breast cancer survivors. J Genet Couns 2021; 30:394-405. [PMID: 32936981 PMCID: PMC7960565 DOI: 10.1002/jgc4.1324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/27/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023]
Abstract
Latinas are less likely to participate in genetic counseling (GC) and genetic testing (GT) than non-Hispanic Whites. A multisite, randomized pilot study tested a culturally targeted educational intervention to increase uptake of GC/GT among Latina breast cancer (BC) survivors (N = 52). Participants were recruited in Tampa, FL and Ponce, PR and randomized to: (a) fact sheet about BC survivorship (control) or (b) a culturally targeted educational booklet about GC/GT (intervention). Participants in the intervention condition were also offered no-cost telephone GC followed by free GT with mail-based saliva sample collection. Participants self-reported hereditary breast and ovarian cancer (HBOC) knowledge and emotional distress at baseline and 1- and 3-month follow-ups. We used logistic regression to examine differences in GC/GT uptake by study arm (primary outcome) and repeated measures ANOVA to examine the effects of study arm and time on HBOC knowledge and emotional distress (secondary outcomes). Compared to the control arm, intervention participants were more likely to complete GC (ORIntervention = 13.92, 95% CI = 3.06-63.25, p < .01) and GT (ORIntervention = 12.93, 95% CI = 2.82-59.20, p < .01). Study site did not predict uptake of GC (p = .08) but Ponce participants were more likely to complete GT (ORPonce = 4.53, 95% CI = 1.04-19.72, p = .04). ANOVAs demonstrated an increase in HBOC knowledge over time across both groups (F(2,88) = 12.24, p < .01, ηp2 = 0.22). We also found a significant interaction of study arm and time, such that intervention participants demonstrated a greater and sustained (to the 3-month follow-up) increase in knowledge than control participants (F(2,88) = 3.66, p = .03, ηp2 = 0.08). No other main or interaction effects were significant (all p's> .15). Study findings demonstrate the potential of our culturally targeted print intervention. Lessons learned from this multisite pilot study for enhancing GC/GT in Latinas include the need to attend to both access to GC/GT and individual factors such as attitudes and knowledge.
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Affiliation(s)
- Claire C. Conley
- Moffitt Cancer Center, Tampa, FL
- Georgetown Lombardi Cancer Center, Washington, DC
| | | | | | | | | | | | - Charité Ricker
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
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5
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Rodríguez Espinosa P, Sussman A, Pearson CR, Oetzel JG, Wallerstein N. Personal Outcomes in Community-based Participatory Research Partnerships: A Cross-site Mixed Methods Study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:439-449. [PMID: 32706125 PMCID: PMC7772261 DOI: 10.1002/ajcp.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Community-based participatory research (CBPR) has been embraced by diverse populations to address health inequities within their communities. CBPR has been shown to produce favorable health outcomes, but little is known about personal outcomes (e.g., individual growth and capacities) resulting from the direct involvement in a CBPR partnership. We empirically examine which CBPR partnerships' processes and practices are associated with personal outcomes. We hypothesize that higher levels of collaborative approaches and adherence to CBPR principles and practices would be associated with personal outcomes. Based on a national cross-site CBPR study, Research for Improved Health, we utilized mixed-method data from a comprehensive community-engagement survey (N = 450) and seven in-depth case studies to explore the hypothesized relationships. Our multivariate mixed-effects model revealed the importance of various partnering practices. Relationship dynamics emerged as key predictors including the following: respect in the partnership, voice and influence in decision-making among partners, and stewardship. Qualitative findings highlighted individual, partnership, and community-level impacts, within and beyond the partnership. Our findings have implications for CBPR best practices and highlight the potential role of personal outcomes for partnerships' sustainability, long-term outcomes, and health equity research.
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Affiliation(s)
| | - Andrew Sussman
- Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
| | - John G Oetzel
- School of Management and Marketing, University of Waikato, Hamilton, New Zealand
| | - Nina Wallerstein
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, NM, USA
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Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M, Fish LJ, Randolph S, Zhang P, Le P, Harvey D, Godbee RL, Patierno SR. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Adv Cancer Res 2020; 146:167-188. [PMID: 32241388 DOI: 10.1016/bs.acr.2020.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States; Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, United States; Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States.
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kenisha Bethea
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, United States
| | - Pao Hwa-Lin
- Chinese Christian Church, Raleigh, NC, United States; Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | | | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | | | - Ping Zhang
- Chinese American Friendly Association, Raleigh, NC, United States
| | - Peter Le
- St. Joseph's Primary Care, Raleigh, NC, United States
| | - Demetrius Harvey
- Black Men's Health Initiative, Wilson, NC, United States; Alumni Chapter of Kappa Alpha Psi Fraternity, Inc., Smithfield, NC, United States
| | | | - Steven R Patierno
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, United States
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7
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Barrett NJ, Rodriguez EM, Iachan R, Hyslop T, Ingraham KL, Le GM, Martin K, Haring RC, Rivadeneira NA, Erwin DO, Fish LJ, Middleton D, Hiatt RA, Patierno SR, Sarkar U, Gage-Bouchard EA. Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers. Cancer 2020; 126:1077-1089. [PMID: 31909824 DOI: 10.1002/cncr.32487] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Engaging diverse populations in biomedical research, including biospecimen donation, remains a national challenge. This study examined factors associated with an invitation to participate in biomedical research, intent to participate in biomedical research in the future, and participation in biomedical research and biospecimen donation among a diverse, multilingual, community-based sample across 3 distinct geographic areas. METHODS Three National Cancer Institute-designated cancer centers engaged in community partnerships to develop and implement population health assessments, reaching a convenience sample of 4343 participants spanning their respective catchment areas. Data harmonization, multiple imputation, and multivariable logistic modeling were used. RESULTS African Americans, Hispanic/Latinos, and other racial minority groups were more likely to be offered opportunities to participate in biomedical research compared to whites. Access to care, history of cancer, educational level, survey language, nativity, and rural residence also influenced opportunity, intent, and actual participation in biomedical research. CONCLUSIONS Traditionally underserved racial and ethnic groups reported heightened opportunity and interest in participating in biomedical research. Well-established community partnerships and long-standing community engagement around biomedical research led to a diverse sample being reached at each site and may in part explain the current study findings. However, this study illustrates an ongoing need to establish trust and diversify biomedical research participation through innovative and tailored approaches. National Cancer Institute-designated cancer centers have the potential to increase opportunities for diverse participation in biomedical research through community partnerships and engagement. Additional work remains to identify and address system-level and individual-level barriers to participation in both clinical trials and biospecimen donation for research.
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Affiliation(s)
- Nadine J Barrett
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Community and Family Medicine, Duke School of Medicine, Durham, North Carolina.,Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Terry Hyslop
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Kearston L Ingraham
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Gem M Le
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | | | - Rodney C Haring
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Natalie A Rivadeneira
- Center for Vulnerable Populations, Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California.,Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Laura J Fish
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | | | - Robert A Hiatt
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, San Francisco, California
| | - Steven R Patierno
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Urmimala Sarkar
- Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California
| | - Elizabeth A Gage-Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Castro-Figueroa EM, Torres-Blasco N, Rosal MC, Castro WP, González-Lorenzo ME, Vélez H, Costas-Muñiz R, Jiménez JC. Preferences, use of and satisfaction with mental health services among a sample of Puerto Rican cancer patients. PLoS One 2019; 14:e0216127. [PMID: 31318876 PMCID: PMC6638843 DOI: 10.1371/journal.pone.0216127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the preferences, the use, satisfaction of mental health services (MHS) among a sample of Puerto Rican patients with cancer undergoing oncology treatment. METHODS A convenience sample of 120 patients diagnosed with cancer was recruited. Self-report questionnaires assessed socio-demographic and background questions, and the Mental Health Service Preference, Utilization and Satisfaction Questionnaire (MHSPUS). The Socio-demographic and Background Questionnaire inquired about participants' demographic and socioeconomic characteristics, and included questions such as history of psychiatric diagnosis and spiritual practices. Univariate and Chi square analyses were used for descriptive purposes. Logistic regressions were used to explore associations between sociodemographic factors and MHS preferences and use. RESULTS The majority of the sample were females (53.8%), 61 and older (53.8%), and married or living with partner (57.1%), and reported an income equal to or less than $12,000 per year (44.4%), which places them under the US federal poverty line. Most of the participants (66.7%) reported being receptive to seeking services. Findings showed a significant association between living situation and past (p < .05) and lifetime use (p < .05) of MHS and past use of MHS. Participants living alone were more like to have used MHS in the past and during their lifetime. Adjusted logistic regression analyses revealed that living with someone was a protective factor for not using MHS in their lifetime (OR = 0.28; C1 = 0.08-0.95). Participants preferred to receive MHS at the oncology clinic, preferably on the date of their oncology appointments and during morning hours. CONCLUSION Findings support the integration of mental health services within the oncology practice setting.
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Affiliation(s)
- Eida M. Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
- Department of Psychiatry, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United Sates of America
| | - Wallesca P. Castro
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Marilis E. González-Lorenzo
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Héctor Vélez
- School of Medicine, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
- Ponce Hematology Oncology, Ponce, Puerto Rico
| | - Rosario Costas-Muñiz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, United Sates of America
| | - Julio C. Jiménez
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
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9
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McIntyre J, Jiménez J, Rivera YM, Sutton SK, Asencio G, Castro-Figueroa EM, Gwede CK, Brandon TH, Vadaparampil ST, Simmons VN, Corchado J, Moreno L, Wells KJ, Quinn GP. Comparison of Health Communication Channels for Reaching Hispanics About Biobanking: a Pilot Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:833-841. [PMID: 28378199 PMCID: PMC5628139 DOI: 10.1007/s13187-017-1214-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cancer education is essential for improving cancer prevention and biobanking knowledge among racial-ethnic minorities, with the goal of increasing diversity and representativeness of biospecimen collections. However, little is known about the communication modalities for optimal delivery of information. We examined feasibility of recruitment and compared communication modalities for delivering cancer prevention and biobanking education to Hispanics. Communication modalities were evaluated using participation rates and change in knowledge, attitudes, self-efficacy, intention, receptivity, and trust. Enrollment in a biobanking registry was a behavioral outcome. Community members in Ponce, Puerto Rico and Tampa, Florida were recruited. Participants (N = 254) were randomized to one of three communication modalities: standard dissemination (mailed materials); enhanced dissemination (mailed materials plus follow-up call); and 'charla' (face-to-face group discussion). Participants completed questionnaires about their knowledge, attitudes, self-efficacy, intentions, receptivity, and trust regarding biobanking and cancer prevention pre- and post-intervention. Knowledge, attitudes, and self-efficacy were improved among all three modalities. Although the greatest increases in knowledge were observed when the information was delivered via charla, the charla had the lowest participation rate. The standard and enhanced dissemination modalities were more feasible for delivering cancer prevention and biobanking education to Hispanics. Lack of differences among the three modalities suggests culturally tailored education may be sufficient to capture the community's intention to participate in biobanking research, regardless of the delivery method for the education. Results from this study contribute to the limited knowledge regarding Hispanics knowledge and intentions for biospecimen collection, and in the future may improve participation in this underrepresented group.
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Affiliation(s)
- Jessica McIntyre
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
| | - Julio Jiménez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
- Department of Psychiatry and Human Behavior, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Yonaira M Rivera
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Gloria Asencio
- Department of Psychiatry and Human Behavior, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Eida M Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
- Department of Psychiatry and Human Behavior, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Clement K Gwede
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Thomas H Brandon
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Vani N Simmons
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Johanna Corchado
- Department of Psychiatry and Human Behavior, Ponce Health Sciences University, Ponce Research Institute, Ponce, Puerto Rico
| | - Laura Moreno
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, USA
- San Diego Moores Cancer Center, University of California, San Diego, CA, USA
| | - Gwendolyn P Quinn
- Health Outcomes and Behavior Department, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
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Simon MA, Malin EL, Hitsman BL, Ciecierski CC, Victorson DE, Banas JR, Stuart M, Luedke T, Nu-Neighbors Advisory Committees, Cella D. Institutional Alliances to Reduce Cancer Disparities in Chicago. J Health Care Poor Underserved 2018; 27:97-113. [PMID: 27763461 DOI: 10.1353/hpu.2016.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A partnership formed between Northeastern Illinois University (NEIU) and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University sought to address well-documented cancer health disparities in Chicago by developing a collaborative research, training, and educational infrastructure between a minority-serving institution and a National Cancer Institute designated comprehensive cancer center. With a critical examination of partnership documentation and outputs, we describe the partnership's community-engaged approaches, challenges, and lessons learned. Northeastern Illinois University and the Lurie Cancer Center engaged in a yearlong partnership-building phase, identified interdisciplinary research teams, formed a governance structure, and identified collective aims. Partnership outcomes included funded inter-institutional research projects, new curriculum, and an annual research trainee program. Significant challenges faced included uncertain fiscal climate, widespread turnover, and dissimilar institutional demands. Lessons learned from this minority serving institution and comprehensive cancer center partnership may be useful for bridging distinct academic communities in the pursuit of ameliorating health disparities.
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Rivera YM, Moreno L, Briant KJ, Vélez H, Jiménez JC, Torres J, Vadaparampil ST, Muñoz-Antonia T, Quinn GP. Developing Sustainable Cancer Education Programs: Training Public Health Students to Deliver Cancer 101 in Puerto Rico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:128-133. [PMID: 27424481 PMCID: PMC5243927 DOI: 10.1007/s13187-016-1076-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of promotores to educate Hispanic communities about different health topics has been proven successful, albeit with limitations in program sustainability. The goal of this study was to develop a sustainable train-the-trainer model to train graduate public health (PH) students to disseminate cancer education among communities in Puerto Rico (PR). Graduate students (n = 32) from Ponce Health Sciences University's (PHSU) PH program participated in a 2-day Cáncer 101 training, where they learned how to deliver nine cancer modules to the community. Cancer knowledge was assessed before and after the training via 54 items measuring discussed concepts. Participants also assessed the training's effectiveness by completing a training evaluation informed by social cognitive theory (SCT) constructs of self-efficacy, outcome expectations, facilitation, and observational learning. Participants were mainly female (78.1 %), 26.7 ± 3.9 years old, and enrolled in a Masters-level program (81.3 %). Participants reported an average 11.38-point increase in cancer knowledge after attending the training [t(31) = 14.88, p < .001]. Participants also evaluated the training favorably upon completion, reporting satisfactory comments in the open-ended responses and high scores on measured SCT constructs. The Cáncer 101 training program effectively prepared students to deliver cancer education to local communities. Training graduate PH students to educate communities about health issues is an innovative, and potentially sustainable, way to reach underserved populations.
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Affiliation(s)
- Y M Rivera
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - L Moreno
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - K J Briant
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - H Vélez
- Public Health Program, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - J C Jiménez
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - J Torres
- Department of Academic Affairs, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - S T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA
| | - T Muñoz-Antonia
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - G P Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA.
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Rivera YM, Vélez H, Canales J, Jiménez JC, Moreno L, Torres J, Vadaparampil ST, Muñoz-Antonia T, Quinn GP. When a Common Language Is Not Enough: Transcreating Cancer 101 for Communities in Puerto Rico. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:776-783. [PMID: 26365291 PMCID: PMC4791206 DOI: 10.1007/s13187-015-0912-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In Puerto Rico (PR), cancer is the leading cause of death. Previous research has identified the need for cancer education in PR. Using culturally adapted cancer curricula to train local health educators may effectively increase cancer education and reduce health disparities. This article describes the three-phase process used to transcreate the Cancer 101 curriculum to train Master of Public Health (MPH) students to educate PR communities. First, an expert panel collaboratively reviewed the curriculum for content, legibility, utility, and colloquialisms. Recommendations included incorporating local references and resources, replacing words and examples with culturally relevant topics, and updating objectives and evaluation items. Subsequent focus groups with 10 MPH students assessed the adaptation's strengths, weaknesses, and utility for future trainees. Participants were satisfied with the curriculum's overall adaptation, ease of use, and listed resources; further improvements were suggested for all modules. Final expert panel revisions highlighted minor feedback, with the final curriculum containing nine transcreated modules. The transcreation process identified the need for changes to content and cultural translation. Changes were culturally and literacy-level appropriate, represented PR's social context, and were tailored for future trainees to successfully deliver cancer education. Findings highlight the importance of adapting Spanish educational materials across Hispanic sub-groups.
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Affiliation(s)
- Y M Rivera
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - H Vélez
- Public Health Program, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - J Canales
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - J C Jiménez
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - L Moreno
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - J Torres
- Biochemistry Department, Ponce Health Sciences University, Ponce, PR, 00732, USA
| | - S T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA
| | - T Muñoz-Antonia
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - G P Quinn
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA.
- Department of Oncologic Science, University of South Florida, Tampa, FL, 33612, USA.
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Appleyard CB, Antonia SJ, Sullivan DM, Santiago-Cardona PG, Cáceres W, Velez H, Torres-Ruiz JA, Wright KL. Building a long distance training program to enhance clinical cancer research capacity in Puerto Rico. Rev Recent Clin Trials 2015; 9:254-62. [PMID: 25626061 DOI: 10.2174/1574887110666150127110721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/02/2014] [Accepted: 12/08/2014] [Indexed: 01/20/2023]
Abstract
Barriers persist in the development and delivery of effective cancer therapies to under-represented minority populations. In Puerto Rico, cancer is the second leading cause of death, yet cancer research awareness and training opportunities remain somewhat limited on the island. These limitations hinder progress toward decreasing the cancer health disparities that exist within the Puerto Rican population. The predominantly Hispanic population of Puerto Rico is the focus of a partnership between the Ponce Health Sciences University-Medical School and Ponce Research Institute (PHSU) in Ponce, Puerto Rico and the H. Lee Moffitt Cancer Center in Tampa, Florida. The Partnership goals are to reduce these barriers through an integrated, multipronged approach of training and education alongside outreach and research components. This report describes the approaches, successes and challenges of enhancing clinical cancer research capacity on the island and the unique challenges of a partnership between two institutes physically separated by long distances. Once fully developed this model may be exportable to other Latin American countries where the need is even greater.
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Castro EM, Jiménez JC, Quinn G, García M, Colón Y, Ramos A, Brandon T, Simmons V, Gwede C, Vadaparampil S, Nazario CM. Identifying clinical and support service resources and network practices for cancer patients and survivors in southern Puerto Rico. Support Care Cancer 2015; 23:967-75. [PMID: 25249352 PMCID: PMC4346447 DOI: 10.1007/s00520-014-2451-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. METHODS From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. RESULTS The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24 % of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61 % of the responses were for medical specialists, 43 % were for mental health services, and 37 % were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both a referral and information. CONCLUSION Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization.
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Affiliation(s)
- Eida M Castro
- Department of Psychology, Ponce School of Medicine and Health Sciences, #388 Zona Industrial Reparada 11, Ponce, 00716, Puerto Rico,
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Hébert JR, Braun KL, Meade CD, Bloom J, Kobetz E. Community-Based Participatory Research Adds Value to the National Cancer Institute's Research Portfolio. Prog Community Health Partnersh 2015; 9 Suppl:1-4. [PMID: 26213397 PMCID: PMC4703947 DOI: 10.1353/cpr.2015.0022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wells KJ, Lima DS, Meade CD, Muñoz-Antonia T, Scarinci I, McGuire A, Gwede CK, Pledger WJ, Partridge E, Lipscomb J, Matthews R, Matta J, Flores I, Weiner R, Turner T, Miele L, Wiese TE, Fouad M, Moreno CS, Lacey M, Christie DW, Price-Haywood EG, Quinn GP, Coppola D, Sodeke SO, Green BL, Lichtveld MY. Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities. EVALUATION AND PROGRAM PLANNING 2014; 44:14-25. [PMID: 24486917 PMCID: PMC4360072 DOI: 10.1016/j.evalprogplan.2013.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 10/12/2013] [Accepted: 12/19/2013] [Indexed: 05/09/2023]
Abstract
Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals.
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Affiliation(s)
- Kristen J Wells
- University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA
| | - Diana S Lima
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Teresita Muñoz-Antonia
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Isabel Scarinci
- University of Alabama at Birmingham Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL 35210, USA
| | - Allison McGuire
- University of Alabama at Birmingham Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL 35210, USA
| | - Clement K Gwede
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - W Jack Pledger
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Edward Partridge
- University of Alabama at Birmingham Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL 35210, USA
| | - Joseph Lipscomb
- Emory University, 615 Michael Street, Atlanta, GA 30322, USA
| | - Roland Matthews
- Morehouse School of Medicine, 720 Westview Drive Southwest, Atlanta, GA 30310, USA
| | - Jaime Matta
- Ponce School of Medicine, 388 Zona Ind Reparada 2, Ponce, PR 00716-2347, USA
| | - Idhaliz Flores
- Ponce School of Medicine, 388 Zona Ind Reparada 2, Ponce, PR 00716-2347, USA
| | - Roy Weiner
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Timothy Turner
- Tuskegee University, 1200 West Montgomery Road, Tuskegee Institute, AL 36088, USA
| | - Lucio Miele
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Thomas E Wiese
- Xavier University of Louisiana College of Pharmacy, 1 Drexel Drive, New Orleans, LA 70125, USA
| | - Mona Fouad
- University of Alabama at Birmingham Comprehensive Cancer Center, 1824 6th Avenue South, Birmingham, AL 35210, USA
| | - Carlos S Moreno
- Emory University, 615 Michael Street, Atlanta, GA 30322, USA
| | - Michelle Lacey
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Debra W Christie
- University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Eboni G Price-Haywood
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Gwendolyn P Quinn
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Domenico Coppola
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Stephen O Sodeke
- Tuskegee University, 1200 West Montgomery Road, Tuskegee Institute, AL 36088, USA
| | - B Lee Green
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Maureen Y Lichtveld
- Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
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