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Letendre A, Khan M, Bartel R, Chiang B, James A, Shewchuk B, Kima J, Macphail M, Vaska M, Schwann M, Yang H, Kopciuk KA. Creation of a Métis-Specific Instrument for Cancer Screening: A Scoping Review of Cancer-Screening Programs and Instruments. Curr Oncol 2023; 30:9849-9859. [PMID: 37999135 PMCID: PMC10670396 DOI: 10.3390/curroncol30110715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
Understanding the barriers to and facilitators of cancer screening programs among Indigenous populations remains limited. In the spirit of mutual respect, this co-led, collaborative project was carried out between the Métis Nation of Alberta and Screening Programs from Alberta Health Services (AHS). This scoping review assessed the cancer screening literature for available questionnaires and then identified themes and suitable questions for a Métis-specific cancer screening questionnaire. Literature searches on cervical, breast, and colorectal cancer screening programs and related concepts were conducted in electronic databases, including the Native Health Database, MEDLINE (Ovid), PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences Collection, and Web of Science. Grey literature was collected from AHS Insite, Open Archives Initiative repository, American Society of Clinical Oncology, European Society of Medical Oncology, Google, and Google Scholar. 135 articles were screened based on the eligibility criteria with 114 articles selected, including 14 Indigenous-specific ones. Knowledge, attitude, belief, behaviour, barrier, and facilitator themes emerged from the review, but no Métis-specific cancer screening instruments were found. Thus, one was developed using existing cancer screening instruments, with additional questions created by the project team. A survey of the Métis population in Alberta will use this questionnaire and provide data to address the burden of cancer among Métis people.
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Affiliation(s)
- Angeline Letendre
- Cancer Prevention & Screening Innovation, Provincial, Population and Public Health, Alberta Health Services, Edmonton, AB T5J 3E4, Canada;
| | - Momtafin Khan
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
| | - Reagan Bartel
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Bonnie Chiang
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
| | - Ashton James
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Brittany Shewchuk
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
| | - June Kima
- Métis Nation of Alberta, Edmonton, AB T5G 0X5, Canada; (R.B. & A.J. & J.K.)
| | - Meghan Macphail
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Marcus Vaska
- Knowledge Resource Service, Alberta Health Services, Calgary, AB T2N 4N2, Canada;
| | - Monica Schwann
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
| | - Huiming Yang
- Screening Programs, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (B.C.); (M.S.); (H.Y.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Karen A. Kopciuk
- Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada; (M.K.)
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
- Departments of Oncology and Mathematics and Statistics, University of Calgary, Calgary, AB T2N 1N4, Canada
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Cotes C, Morozova A, Pourhassan S, Aran S, Singh H. Community Outreach in Breast Imaging: What Radiologists Can Do to Close the Gap for the Uninsured Population. Radiographics 2023; 43:e230011. [PMID: 37792594 DOI: 10.1148/rg.230011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
After implementation of the Affordable Care Act in 2010, the uninsured population of the United States decreased significantly. As of 2022, there were approximately 26.4 million uninsured individuals in the United States. The lack of coverage and access to services disproportionally affect minority groups in the country, reflecting the influence of the social determinants of health in their uninsured status. Use of screening mammography, an effective modality that results in early detection of and decreased mortality from breast cancer, was delayed or postponed by women of all races due to lockdowns and fear during the COVID-19 pandemic. Since then, the return to mammographic screening has lagged among minorities, further increasing their disproportionate screening gap. Radiologists-and more specifically breast imagers-must recognize these issues, as people who are uninsured and part of minority groups are diagnosed with breast cancer at later stages and have higher mortality rates, less continuity of care, and overall lower survival. The purpose of this article is to familiarize radiologists with the uninsured population, explain how they are disproportionally affected by breast cancer, and propose strategies that breast imagers can pursue to improve screening access and decrease compliance gaps for this patient population. ©RSNA, 2023 See the invited commentary by Nguyen in this issue. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Claudia Cotes
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Anastasiia Morozova
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Sara Pourhassan
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Shima Aran
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Harnoor Singh
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
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Hu J, Clark L, Shi P, Staggs VS, Daley C, Gajewski B. Bayesian Hierarchical Factor Analysis for Efficient Estimation across Race/Ethnicity. REVISTA COLOMBIANA DE ESTADÍSTICA 2021; 44:313-329. [PMID: 34393301 PMCID: PMC8356675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Patient reported outcomes are gaining more attention in patient-centered health outcomes research and quality of life studies as important indicators of clinical outcomes, especially for patients with chronic diseases. Factor analysis is ideal for measuring patient reported outcomes. If there is heterogeneity in the patient population and when sample size is small, differential item functioning and convergence issues are challenges for applying factor models. Bayesian hierarchical factor analysis can assess health disparity by assessing for differential item functioning, while avoiding convergence problems. We conducted a simulation study and used an empirical example with American Indian minorities to show that fitting a Bayesian hierarchical factor model is an optimal solution regardless of heterogeneity of population and sample size.
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Affiliation(s)
- Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center
| | - Lauren Clark
- Department of Biostatistics & Data Science, University of Kansas Medical Center
| | - Peng Shi
- Department of Biostatistics & Data Science, University of Kansas Medical Center
| | - Vincent S. Staggs
- Biostatistics & Epidemiology Core, Health Services & Outcomes Research, Children’s Mercy Kansas City, and University of Missouri-Kansas City School of Medicine
| | - Christine Daley
- Department of Family Medicine, University of Kansas Medical Center
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center
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What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators. Public Health 2021; 190:152-159. [PMID: 33419526 DOI: 10.1016/j.puhe.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.
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Kara B. Development and psychometric evaluation of the Beliefs about Home Hemodialysis Scale for patients on in-center hemodialysis<span style="font-size: 12px">Running title: Health beliefs and home hemodialysis</span>. AIMS MEDICAL SCIENCE 2020. [DOI: 10.3934/medsci.2020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Daley CM, Daley SM, Pacheco CM, Smith TE, Talawyma M, McCloskey C, Choi WS, Nazir N, Filippi MK, McKinney D, Gunville J, Greiner KA. Feasibility of Implementing the All Nations Breath of Life Culturally Tailored Smoking Cessation Program for American Indians in Multi-Tribal Urban Communities. Nicotine Tob Res 2018; 20:552-560. [PMID: 28177511 DOI: 10.1093/ntr/ntx030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022]
Abstract
Introduction Prevalence of cigarette smoking is highest among American Indians, yet few culturally appropriate smoking cessation programs have yet been developed and tested for multi-tribal American Indian adult populations. This study examined implementation of the All Nations Breath of Life culturally tailored smoking cessation program in multi-tribal urban and suburban American Indian communities in seven locations across five states (N = 312). Methods This single-arm study used community-based participatory research to conduct a 12-week intervention whose primary purpose was to curb commercial tobacco use among American Indians. Participants were followed through month 6 in person and month 12 via telephone. The primary outcome was continuous abstinence from recreational cigarette smoking at 6 months post-baseline, verified through voluntary provision of salivary cotinine levels. Results At program completion (12 weeks post-baseline), 53.3% of program completers remained abstinent; labeling those lost to follow-up as smokers resulted in a 41.4% quit rate. At 6 months post-baseline (primary endpoint), 31.1% of retained participants quit smoking (p < .0001 compared to the highest quit rates among multi-tribal populations reported in the literature, 7%); final quit rate was 22.1% labeling those lost to follow-up as smokers (p = .002). Retention rate at endpoint was 71.2%. 12-month follow-up was attempted with all participants and had a retention rate of 49.0%. Of those participants reached, 34.0% were smoke-free. Conclusions All Nations Breath of Life shows promise as a smoking cessation program for multi-tribal urban American Indian communities. It can be successfully implemented in a variety of urban settings. Implications This is the first large feasibility study of a culturally tailored smoking cessation program for American Indians with good cessation and retention rates in a multi-tribal urban American Indian population. It shows that All Nations Breath of Life can be implemented in multiple urban settings across five states. To our knowledge, this is the first program of its kind to be implemented across multiple heterogeneous urban locations and to include salivary cotinine testing for verification of self-report data across these locations.
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Affiliation(s)
- Christine Makosky Daley
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Sean M Daley
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Christina M Pacheco
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - T Edward Smith
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - Myrietta Talawyma
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | | | - Won S Choi
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Niaman Nazir
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS
| | - Melissa K Filippi
- Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Dona McKinney
- Department of Defense Programs Office, Lincoln University, Jefferson City, MO
| | - Jordyn Gunville
- Department of Anthropology, Center for American Indian Studies, Johnson County Community College, Overland Park, KS
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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Bott M, Karanevich AG, Garrard L, Price LR, Mudaranthakam DP, Gajewski B. Confirmatory Factor Analysis Alternative: Free, Accessible CBID Software. West J Nurs Res 2018; 40:257-269. [PMID: 27920348 PMCID: PMC5453854 DOI: 10.1177/0193945916681564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
New software that performs Classical and Bayesian Instrument Development (CBID) is reported that seamlessly integrates expert (content validity) and participant data (construct validity) to produce entire reliability estimates with smaller sample requirements. The free CBID software can be accessed through a website and used by clinical investigators in new instrument development. Demonstrations are presented of the three approaches using the CBID software: (a) traditional confirmatory factor analysis (CFA), (b) Bayesian CFA using flat uninformative prior, and (c) Bayesian CFA using content expert data (informative prior). Outcomes of usability testing demonstrate the need to make the user-friendly, free CBID software available to interdisciplinary researchers. CBID has the potential to be a new and expeditious method for instrument development, adding to our current measurement toolbox. This allows for the development of new instruments for measuring determinants of health in smaller diverse populations or populations of rare diseases.
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Affiliation(s)
- Marjorie Bott
- 1 The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Lili Garrard
- 2 U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Byron Gajewski
- 1 The University of Kansas Medical Center, Kansas City, KS, USA
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Garrard L, Price LR, Bott MJ, Gajewski BJ. A novel method for expediting the development of patient-reported outcome measures and an evaluation across several populations. APPLIED PSYCHOLOGICAL MEASUREMENT 2016; 40:455-468. [PMID: 27667878 PMCID: PMC5029789 DOI: 10.1177/0146621616652634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Item response theory (IRT) models provide an appropriate alternative to the classical ordinal confirmatory factor analysis (CFA) during the development of patient-reported outcome measures (PROMs). Current literature has identified the assessment of IRT model fit as both challenging and underdeveloped (Sinharay & Johnson, 2003; Sinharay, Johnson, & Stern, 2006). This study evaluates the performance of Ordinal Bayesian Instrument Development (OBID), a Bayesian IRT model with a probit link function approach, through applications in two breast cancer-related instrument development studies. The primary focus is to investigate an appropriate method for comparing Bayesian IRT models in PROMs development. An exact Bayesian leave-one-out cross-validation (LOO-CV) approach (Vehtari & Lampinen, 2002) is implemented to assess prior selection for the item discrimination parameter in the IRT model and subject content experts' bias (in a statistical sense and not to be confused with psychometric bias as in differential item functioning) toward the estimation of item-to-domain correlations. Results support the utilization of content subject experts' information in establishing evidence for construct validity when sample size is small. However, the incorporation of subject experts' content information in the OBID approach can be sensitive to the level of expertise of the recruited experts. More stringent efforts need to be invested in the appropriate selection of subject experts to efficiently use the OBID approach and reduce potential bias during PROMs development.
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Affiliation(s)
- Lili Garrard
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Byron J. Gajewski
- University of Kansas School of Nursing, Kansas City, USA
- University of Kansas Medical Center, Kansas City, USA
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Khodayarian M, Mazloomi-Mahmoodabad SS, Lamyian M, Morowatisharifabad MA, Tavangar H. Response costs of mammography adherence: Iranian women's perceptions. Health Promot Perspect 2016; 6:85-91. [PMID: 27386423 PMCID: PMC4932227 DOI: 10.15171/hpp.2016.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Mammography as the most common secondary prevention method has known to be helpful in detecting breast cancer at the early stages. Low level of participation among women toward mammography uptake due to cultural beliefs is a great concern. This study aimed at exploring the perceptions of women about response costs of mammography adherence (MA) in Yazd, Iran. Methods: A qualitative study using semi-structured interviews was performed. Fourteen women,one oncology nurse, and a breast cancer survivor were purposefully interviewed. Interviews were transcribed verbatim and analyzed by directed content analysis method based on protection motivation theory (PMT). Results: One main theme was emerged from the analysis namely called "response costs".Two main categories were also emerged from the data; (1) psychological barriers with six subcategories including "embarrassment," "worry about being diagnosed with cancer," "preoccupation with underlying disease," "misconception about mammography," "need for an accompanying person," and "internalizing the experiences of the others," and (2) maladaptive coping modes which encompassed three subcategories: "religious faith," "fatalism," and"avoidance and denial." Conclusion: Useful information was provided about the response costs of mammography utilization based on the perceptions of women. Cognitive barriers may be decreased by conducting modifications in women’s awareness and attitude toward MA as well as changing the national health system infrastructures. Incorporating religious and cultural belief systems into MA educational programs through motivational messages is recommended.
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Affiliation(s)
- Mahsa Khodayarian
- Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences (International Campus), Yazd, Iran
| | | | - Minoor Lamyian
- Department of Midwifery and Reproductive Health, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Ali Morowatisharifabad
- Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences (International Campus), Yazd, Iran
| | - Hossein Tavangar
- Department of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Garrard L, Price LR, Bott MJ, Gajewski BJ. A novel method for expediting the development of patient-reported outcome measures and an evaluation of its performance via simulation. BMC Med Res Methodol 2015; 15:77. [PMID: 26419748 PMCID: PMC4589027 DOI: 10.1186/s12874-015-0071-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Developing valid and reliable patient-reported outcome measures (PROMs) is a critical step in promoting patient-centered health care, a national priority in the U.S. Small populations or rare diseases often pose difficulties in developing PROMs using traditional methods due to small samples. METHODS To overcome the small sample size challenge while maintaining psychometric soundness, we propose an innovative Ordinal Bayesian Instrument Development (OBID) method that seamlessly integrates expert and participant data in a Bayesian item response theory (IRT) with a probit link model framework. Prior distributions obtained from expert data are imposed on the IRT model parameters and are updated with participants' data. The efficiency of OBID is evaluated by comparing its performance to classical instrument development performance using actual and simulation data. RESULTS AND DISCUSSION : The overall performance of OBID (i.e., more reliable parameter estimates, smaller mean squared errors (MSEs) and higher predictive validity) is superior to that of classical approaches when the sample size is small (e.g. less than 100 subjects). Although OBID may exhibit larger bias, it reduces the MSEs by decreasing variances. Results also closely align with recommendations in the current literature that six subject experts will be sufficient for establishing content validity evidence. However, in the presence of highly biased experts, three experts will be adequate. CONCLUSIONS This study successfully demonstrated that the OBID approach is more efficient than the classical approach when the sample size is small. OBID promises an efficient and reliable method for researchers and clinicians in future PROMs development for small populations or rare diseases.
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Affiliation(s)
- Lili Garrard
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Larry R Price
- College of Education, Texas State University, San Marcos, TX, 78666, USA.
| | - Marjorie J Bott
- University of Kansas School of Nursing, Mail Stop 4043, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
- University of Kansas School of Nursing, Mail Stop 4043, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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Trinh QD, Nguyen PL, Leow JJ, Dalela D, Chao GF, Mahal BA, Nayak M, Schmid M, Choueiri TK, Aizer AA. Cancer-specific mortality of Asian Americans diagnosed with cancer: a nationwide population-based assessment. J Natl Cancer Inst 2015; 107:djv054. [PMID: 25794888 DOI: 10.1093/jnci/djv054] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Racial disparities in cancer survival outcomes have been primarily attributed to underlying biologic mechanisms and the quality of cancer care received. Because prior literature shows little difference exists in the socioeconomic status of non-Hispanic whites and Asian Americans, any difference in cancer survival is less likely to be attributable to inequalities of care. We sought to examine differences in cancer-specific survival between whites and Asian Americans. METHODS The Surveillance, Epidemiology, and End Results Program was used to identify patients with lung (n = 130 852 [16.9%]), breast (n = 313 977 [40.4%]), prostate (n = 166 529 [21.4%]), or colorectal (n = 165 140 [21.3%]) cancer (the three leading causes of cancer-related mortality within each sex) diagnosed between 1991 and 2007. Fine and Gray's competing risks regression compared the cancer-specific mortality (CSM) of eight Asian American groups (Chinese, Filipino, Hawaiian/Pacific Islander, Japanese, Korean, other Asian, South Asian [Indian/Pakistani], and Vietnamese) to non-Hispanic white patients. All P values were two-sided. RESULTS In competing risks regression, the receipt of definitive treatment was an independent predictor of CSM (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.35 to 0.40; HR = 0.55, 95% CI = 0.53 to 0.58; HR = 0.61, 95% CI = 0.60 to 0.62; and HR = 0.27, 95% CI = 0.25 to 0.29) for prostate, breast, lung, and colorectal cancers respectively, all P < .001). In adjusted analyses, most Asian subgroups (except Hawaiians and Koreans) had lower CSM relative to white patients, with hazard ratios ranging from 0.54 (95% CI = 0.38 to 0.78) to 0.88 (95% CI = 0.84 to 0.93) for Japanese patients with prostate and Chinese patients with lung cancer, respectively. CONCLUSIONS Despite adjustment for potential confounders, including the receipt of definitive treatment and tumor characteristics, most Asian subgroups had better CSM than non-Hispanic white patients. These findings suggest that underlying genetic/biological differences, along with potential cultural variations, may impact survival in Asian American cancer patients.
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Affiliation(s)
- Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Paul L Nguyen
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Jeffrey J Leow
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Deepansh Dalela
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Grace F Chao
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Brandon A Mahal
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Manan Nayak
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Toni K Choueiri
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
| | - Ayal A Aizer
- Division of Urologic Surgery and Center for Surgery and Public Health (QDT, JJL, GFC, MS), Department of Radiation Oncology (PLN, BAM, MN, AAA), and Department of Medical Oncology (TKC), Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI (DD)
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Kara B. Health Beliefs Related to Salt-Restricted Diet in Patients on Hemodialysis: Psychometric Evaluation of the Turkish Version of the Beliefs About Dietary Compliance Scale. J Transcult Nurs 2014; 25:256-64. [PMID: 24381119 DOI: 10.1177/1043659613514114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the reliability and validity of the Turkish version of the Beliefs about Dietary Compliance Scale (BDCS-T). METHODS This methodological study enrolled a sample of 140 patients. Data were collected by using a questionnaire form, the BDCS-T, and the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire. Descriptive statistics, the one-sample Kolmogorov-Smirnov test, Mann-Whitney U test, correlation coefficients, and psychometric tests were used for the analysis of data. RESULTS The factor analysis confirmed that the BDCS-T had a two-factor structure (perceived benefits and perceived barriers) explaining 58.7% of the total variance. The BDCS-T had acceptable internal consistency (Cronbach's alpha coefficients: perceived benefits = .91; perceived barriers = .66), test-retest reliability (intraclass correlation coefficients: perceived benefits = .93; perceived barriers = .79), concurrent validity with the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire scores, and known group validity with intensity of diet nonadherence. CONCLUSIONS The BDCS-T was found to be a reliable and valid tool for assessing the beliefs related to salt-restricted diet in patients on hemodialysis. IMPLICATIONS FOR PRACTICE Nurses are recommended to make tailored interventions by taking the benefits and barriers that the patients perceive toward low-salt dietary adherence into account.
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Gajewski BJ, Jiang Y, Yeh HW, Engelman K, Teel C, Choi WS, Greiner KA, Daley CM. Teaching Confirmatory Factor Analysis to Non-Statisticians: A Case Study for Estimating Composite Reliability of Psychometric Instruments. CASE STUDIES IN BUSINESS, INDUSTRY AND GOVERNMENT STATISTICS : CSBIGS 2014; 5:88-101. [PMID: 24772373 PMCID: PMC3996839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Texts and software that we are currently using for teaching multivariate analysis to non-statisticians lack in the delivery of confirmatory factor analysis (CFA). The purpose of this paper is to provide educators with a complement to these resources that includes CFA and its computation. We focus on how to use CFA to estimate a "composite reliability" of a psychometric instrument. This paper provides guidance for introducing, via a case-study, the non-statistician to CFA. As a complement to our instruction about the more traditional SPSS, we successfully piloted the software R for estimating CFA on nine non-statisticians. This approach can be used with healthcare graduate students taking a multivariate course, as well as modified for community stakeholders of our Center for American Indian Community Health (e.g. community advisory boards, summer interns, & research team members). The placement of CFA at the end of the class is strategic and gives us an opportunity to do some innovative teaching: (1) build ideas for understanding the case study using previous course work (such as ANOVA); (2) incorporate multi-dimensional scaling (that students already learned) into the selection of a factor structure (new concept); (3) use interactive data from the students (active learning); (4) review matrix algebra and its importance to psychometric evaluation; (5) show students how to do the calculation on their own; and (6) give students access to an actual recent research project.
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Filippi MK, Ndikum-Moffor F, Braiuca SL, Goodman T, Hammer TL, James AS, Choi WS, Greiner KA, Daley CM. Breast cancer screening perceptions among American Indian women under age 40. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:535-540. [PMID: 23813490 PMCID: PMC3780408 DOI: 10.1007/s13187-013-0499-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Breast cancer mortality rates are the second leading cause of cancer death in American Indian (AI) women. AI breast cancer screening rates have been decreasing, and AI women have some of the lowest screening rates compared to other racial/ethnic groups. Our research team investigated breast cancer and breast cancer screening education prior to recommended age for screening. It is imperative to examine the perspectives of young AI women toward breast cancer screening to better understand screening perceptions among AI women. Following a community-based participatory research approach, we conducted five focus groups and four interviews with AI women aged 25-39 (N = 48) in Kansas and Missouri. Nine themes emerged from the focus groups and relate to topics such as the following: knowledge of breast cancer and breast cancer screening, barriers to screening and treatment, suggestions to improve access, and perceptions and use of health-care systems. Specifically, we found that AI women lacked knowledge of details about screenings and their risks for getting breast cancer, cost was cited as a primary barrier to screening, additional education was needed (particularly materials that were AI focused), breast health was generally not discussed with others, and more instruction was requested for techniques used to identify bodily changes or abnormalities. Understanding attitudes of AI women not of recommended screening age may provide an insight into low screening rates among AI women. Furthermore, the results may inform outreach strategies to improve current and future screening rates.
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Affiliation(s)
- Melissa K Filippi
- Department of Family Medicine, Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Daley CM, Kraemer-Diaz A, James AS, Monteau D, Joseph S, Pacheco J, Bull JW, Cully A, Choi WS, Greiner KA. Breast cancer screening beliefs and behaviors among American Indian women in Kansas and Missouri: a qualitative inquiry. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:S32-S40. [PMID: 22351375 DOI: 10.1007/s13187-012-0334-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
American Indian women have rising incidence and disproportionate mortality rates due to breast cancer. Using a community-based participatory research approach, we conducted ten focus groups with American Indian women in Kansas and Missouri to understand their barriers to mammography and identify ways to intervene to improve screening rates. Focus groups were stratified by screening status, including women who were up to date with current screening mammography recommendations (mammogram within the last 2 years, N = 7 groups, 66 participants) and women who were not (N = 3 groups, 18 participants). While many similarities were identified across strata, some differences emerged, particularly descriptions of prior negative experiences with the health care system among women who were not up to date with screening recommendations. Primary areas identified by participants for intervention included culturally appropriate educational materials and interventions directed specifically at improving American Indian women's trust in Western medicine and alleviating feelings of discrimination.
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Affiliation(s)
- Christine Makosky Daley
- Department of Family Medicine, Center for American Indian Community Health, University of Kansas Medical Center, MS 1030, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
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