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Young A, Findlay S, Cole M, Cranford JA, Daniel M, Alter H, Chisolm-Straker M, Macias-Konstantopoulos WL, Wendt WJ, Stoklosa H. A Teach-the-Teacher Module for Human Trafficking Bedside Instruction. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11422. [PMID: 39044803 PMCID: PMC11263469 DOI: 10.15766/mep_2374-8265.11422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/20/2024] [Indexed: 07/25/2024]
Abstract
Introduction Human trafficking (HT) is a public health issue that adversely affects patients' well-being. Despite the prevalence of trafficked persons in health care settings, a lack of educational modules exists for use in clinical contexts. We developed a 50-minute train-the-trainer module on HT. Methods After piloting the workshop for faculty, fellows, and residents (n = 19) at the Society for Academic Emergency Medicine (SAEM) national conference, we implemented it in medical students' curricula during their emergency medicine clerkship at the University of Iowa (n = 162). We evaluated the worskhop by (a) a retrospective pre-post survey of self-reported ability to (1) define HT, (2) recognize high-risk signs, (3) manage situations with trafficked persons, and (4) teach others about HT, and (b) a 3-month follow-up survey to assess longitudinal behavior change. Results In both contexts, results demonstrated improvement across all learning outcomes (pre-post differences of 1.5, 1.3, 1.9, and 1.7 on a 4-point Likert-type scale for each learning objective above, respectively, at the SAEM conference and 1.2, 1.0, 1.3, and 1.3 at the University of Iowa; p < .001 for all). In the 3-month follow-up, we observed statistically significant changes in self-reported consideration of and teaching about HT during clinical encounters among learners who had previously never done either (p < .001 and p = .006, respectively). Discussion This train-the-trainer module is a brief and effective clinical tool for bedside teaching about HT, especially among people who have never previously considered HT in a clinical context.
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Affiliation(s)
- Anthony Young
- Fourth-Year Medical Student, University of Iowa Roy J. and Lucille A. Carver College of Medicine
- Co-primary authors
| | - Shannon Findlay
- Assistant Professor, Department of Emergency Medicine, University of Iowa Hospitals and Clinics
- Co-primary authors
| | - Michael Cole
- Associate Professor, Department of Emergency Medicine, University of Michigan Medical School
| | - James A. Cranford
- Associate Research Scientist, Department of Emergency Medicine, University of Michigan
| | - Michelle Daniel
- Professor of Clinical Emergency Medicine, Department of Emergency Medicine, and Vice Dean for Medical Education, University of California, San Diego, School of Medicine
| | - Harrison Alter
- Founding Director and Director of Research, Andrew Levitt Center for Social Emergency Medicine, Berkeley
| | - Makini Chisolm-Straker
- Associate Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai
| | - Wendy L. Macias-Konstantopoulos
- Associate Professor, Department of Emergency Medicine, Harvard Medical School; Director, Center for Social Justice and Health Equity, Department of Emergency Medicine, Massachusetts General Hospital
| | - Wendi-Jo Wendt
- Assistant Professor, Department of Pediatric Emergency Medicine, Medical College of Wisconsin
| | - Hanni Stoklosa
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School; Chief Medical Officer, HEAL Trafficking
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Stevens ER, Cleland CM, Shunk A, El Shahawy O. Evaluating strategies to recruit health researchers to participate in online survey research. BMC Med Res Methodol 2024; 24:153. [PMID: 39026149 PMCID: PMC11256559 DOI: 10.1186/s12874-024-02275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/05/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Engaging researchers as research subjects is key to informing the development of effective and relevant research practices. It is important to understand how best to engage researchers as research subjects. METHODS A 24 factorial experiment, as part of a Multiphase Optimization Strategy, was performed to evaluate effects of four recruitment strategy components on participant opening of an emailed survey link and survey completion. Participants were members of three US-based national health research consortia. A stratified simple random sample was used to assign potential survey participants to one of 16 recruitment scenarios. Recruitment strategy components were intended to address both intrinsic and extrinsic sources of motivation, including: $50 gift, $1,000 raffle, altruistic messaging, and egoistic messaging. Multivariable generalized linear regression analyses adjusting for consortium estimated component effects on outcomes. Potential interactions among components were tested. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). RESULTS Surveys were collected from June to December 2023. A total of 418 participants were included from the consortia, with final analytical sample of 400 eligible participants. Out of the final sample, 82% (341) opened the survey link and 35% (147) completed the survey. Altruistic messaging increased the odds of opening the survey (aOR 2.02, 95% CI: 1.35-2.69, p = 0.033), while egoistic messaging significantly reduced the odds of opening the survey (aOR 0.56, 95%CI 0.38-0.75, p = 0.08). The receipt of egoistic messaging increased the odds of completing the survey once opened (aOR 1.81, 95%CI: 1.39-2.23, p < 0.05). There was a significant negative interaction effect between the altruistic appeal and egoistic messaging strategies for survey completion outcome. Monetary incentives did not a have a significant impact on survey completion. CONCLUSION Intrinsic motivation is likely to be a greater driver of health researcher participation in survey research than extrinsic motivation. Altruistic and egoistic messaging may differentially impact initial interest and survey completion and when combined may lead to improved rates of recruitment, but not survey completion. Further research is needed to determine how to best optimize message content and whether the effects observed are modified by survey burden.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Charles M Cleland
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amelia Shunk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Omar El Shahawy
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- School of Global Public Health, New York University, New York, NY, USA
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Yabroff KR, Sylvia Shi K, Zhao J, Freedman AN, Zheng Z, Nogueira L, Han X, Klabunde CN, de Moor JS. Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions. JCO Oncol Pract 2024; 20:429-437. [PMID: 38194620 DOI: 10.1200/op.23.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/14/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Use of genomic testing, especially multimarker panels, is increasing in the United States. Not all tests and related treatments are covered by health insurance, which can result in substantial patient out-of-pocket (OOP) costs. Little is known about oncologists' treatment decisions with respect to patient insurance coverage and OOP costs for genomic testing. METHODS We identified 1,049 oncologists who used multimarker tumor panels from the 2017 National Survey of Precision Medicine in Cancer Treatment. Separate multivariable ordinal logistic regressions examined associations of oncologist-, practice-, and area-level characteristics and oncologists' ratings of importance (very, somewhat, or a little/not important) of insurance coverage and OOP costs for genomic testing in treatment decisions, adjusting for oncologist years of experience, sex, race and ethnicity, specialty, use of next-generation sequencing (NGS) tests, region, tumor boards, patient insurance mix, and area-level socioeconomic characteristics. RESULTS Among oncologists, 47.3%, 32.7%, and 20.0% reported that patient insurance coverage for genomic testing was very, somewhat, or a little/not important, respectively, in treatment decisions. In addition, 56.9%, 28.0%, and 15.2% reported that OOP costs for testing were very, somewhat, or a little/not important, respectively. In adjusted analyses, oncologists who used NGS tests were more likely to report patient insurance and OOP costs as important (odds ratio [OR], 2.00 [95% CI, 1.16 to 3.45] and OR, 2.12 [95% CI, 1.22 to 3.68], respectively) in treatment decisions compared with oncologists who did not use these tests, as were oncologists who treated solid tumors, rather than only hematological cancers. More years of experience and higher percentages of Medicaid or self-paid/uninsured patients in the practice were associated with reporting insurance coverage (OR, 1.43 [95% CI, 1.09 to 1.89]) and OOP costs (OR, 1.51 [95% CI, 1.13 to 2.01]) as important. Oncologists in practices with molecular tumor boards for genomic tests were less likely to report coverage (OR, 0.63 [95% CI, 0.47 to 0.85]) and OOP costs (OR, 0.72 [95% CI, 0.53 to 0.97]) as important than their counterparts in practices without these tumor boards. CONCLUSION Most oncologists rate patient health insurance and OOP costs for genomic tests as important considerations in subsequent treatment recommendations. Modifiable factors associated with these ratings can inform interventions to support patient-physician decision making about care.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Rockville, MD
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Edwards PJ, Roberts I, Clarke MJ, DiGuiseppi C, Woolf B, Perkins C. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev 2023; 11:MR000008. [PMID: 38032037 PMCID: PMC10687884 DOI: 10.1002/14651858.mr000008.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Self-administered questionnaires are widely used to collect data in epidemiological research, but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research. OBJECTIVES To identify effective strategies to increase response to postal and electronic questionnaires. SEARCH METHODS We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented. SELECTION CRITERIA Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre-defined criteria. DATA COLLECTION AND ANALYSIS We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi2 test and quantified the degree of inconsistency between trial results using the I2 statistic. MAIN RESULTS Postal We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I2 = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24). The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I2 = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I2 = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow-up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non-monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I2 = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non-monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I2 = 57%); using a single-sided rather than a double-sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I2 = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first-class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54). The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00). Electronic We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I2 = 19%). The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I2 = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non-monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e-questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I2 = 94%); and using a more interesting e-questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I2 = 41%). The odds of response also increased with: personalised e-questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I2 = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64). The odds of response were reduced when: "Survey" was mentioned in the e-mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e-questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01). The odds of response using a postal questionnaire were over twice those using an e-questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I2 = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I2 = 97%); and when administering the e-questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94). AUTHORS' CONCLUSIONS Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.
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Affiliation(s)
- Philip James Edwards
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ian Roberts
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mike J Clarke
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin Woolf
- School of Psychological Science, University of Bristol, Bristol, UK
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Parish CL, Feaster DJ, Pollack HA, Horigian VE, Wang X, Jacobs P, Pereyra MR, Drymon C, Allen E, Gooden LK, Del Rio C, Metsch LR. Health Care Provider Stigma Toward Patients With Substance Use Disorders: Protocol for a Nationally Representative Survey. JMIR Res Protoc 2023; 12:e47548. [PMID: 37751236 PMCID: PMC10565625 DOI: 10.2196/47548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The US overdose epidemic is an escalating public health emergency, accounting for over 100,000 deaths annually. Despite the availability of medications for opioid use disorders, provider-level barriers, such as negative attitudes, exacerbate the treatment gap in clinical care settings. Assessing the prevalence and intensity of provider stigma, defined as the negative perceptions and behaviors that providers embody and enact toward patients with substance use disorders, across providers with different specialties, is critical to expanding the delivery of substance use treatment. OBJECTIVE To thoroughly understand provider stigma toward patients with substance use disorders, we conducted a nationwide survey of emergency medicine and primary care physicians and dentists using a questionnaire designed to reveal how widely and intensely provider attitudes and stigma can impact these providers' clinical practices in caring for their patients. The survey also queried providers' stigma and clinical practices toward other chronic conditions, which can then be compared with their stigma and practices related to substance use disorders. METHODS Our cross-sectional survey was mailed to a nationally representative sample of primary care physicians, emergency medicine physicians, and dentists (N=3011), obtained by American Medical Association and American Dental Association licensees based on specified selection criteria. We oversampled nonmetropolitan practice areas, given the potential differences in provider stigma and available resources in these regions compared with metropolitan areas. Data collection followed a recommended series of contacts with participants per the Dillman Total Design Method, with mixed-modality options offered (email, mail, fax, and phone). A gradually increasing compensation scale (maximum US$250) was implemented to recruit chronic nonresponders and assess the association between requiring higher incentives to participate and providers stigma. The primary outcome, provider stigma, was measured using the Medical Condition Regard Scale, which inquired about participants' views on substance use and other chronic conditions. Additional survey measures included familiarity and social engagement with people with substance use disorders; clinical practices (screening, treating, and referring for a range of chronic conditions); subjective norms and social desirability; knowledge and prior education; and descriptions of their patient populations. RESULTS Data collection was facilitated through collaboration with the National Opinion Research Center between October 2020 and October 2022. The overall Council of American Survey Research Organizations completion rate was 53.62% (1240/2312.7; physicians overall: 855/1681.9, 50.83% [primary care physicians: 506/1081.3, 46.79%; emergency medicine physicians: 349/599.8, 58.2%]; dentists: 385/627.1, 61.4%). The ineligibility rate among those screened is applied to those not screened, causing denominators to include fractional numbers. CONCLUSIONS Using systematically quantified data on the prevalence and intensity of provider stigma toward substance use disorders in health care, we can provide evidence-based improvement strategies and policies to inform the development and implementation of stigma-reduction interventions for providers to address their perceptions and treatment of substance use. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47548.
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Affiliation(s)
- Carrigan Leigh Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Daniel J Feaster
- Department of Biostatistics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Viviana E Horigian
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Xiaoming Wang
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Petra Jacobs
- Office of Behavioral and Social Clinical Trials, Division of Behavioral and Social Research, National Institute on Aging/National Institute of Health, Bethesda, MD, United States
| | - Margaret R Pereyra
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | | | - Elizabeth Allen
- National Opinion Research Center, Chicago, IL, United States
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Miami, FL, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
- School of General Studies, Columbia University, New York, NY, United States
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Girolamo ND, Caron M, Brandão J, Reynders RM. Most veterinarians treating exotic animals use formularies to select drug dosages without consistently checking their sources. J Am Vet Med Assoc 2022; 260:1-11. [PMID: 35201996 DOI: 10.2460/javma.21.03.0116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess what information sources veterinarians use to select drug dosages for treating exotic animals and how they implement this information. SAMPLE 936 veterinarians from Europe, Asia, Australia, Africa, and the Americas. PROCEDURES An anonymous, online survey was used to collect data on information sources used for dosage decisions by veterinarians treating exotic species. Logistic regression models were built to identify associations between individual characteristics and primary outcomes. RESULTS Respondents reported their single most common source for establishing drug dosages as formularies (682/936 [72.9%]), followed by scientific journals (96 [10.3%]), other textbooks (68 [7.3%]), colleagues (47 [5.0%]), or continuing education notes (38 [4.1%]). Over two-thirds of the respondents (645, 68.9%) consulted a specific exotic animal formulary for establishing drug dosages in most situations. Of the 936 respondents, 407 (43.5%) reported that they sometimes (318 [34.0%]) or never (89 [9.5%]) checked the source of a dosage in a textbook or a formulary, 503 (55.3%) reported that they sometimes (399 [42.6%]) or never (104 [11.1%]) searched the original publication on a dosage, and 486 (51.9%) reported that they would base their dosage decision on the abstract of an article if they had no access to the full-text. Several respondents' reported characteristics were significant predictors of primary outcomes. CLINICAL RELEVANCE Considering our findings, we recommend authors of formularies and textbooks should focus on evidence-based information and state clearly when information is anecdotal. Tailored strategies to educate veterinarians treating exotic animals on the importance of primary sources are also recommended.
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Affiliation(s)
- Nicola Di Girolamo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK
| | - Marianne Caron
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK
| | - João Brandão
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK
| | - Reint Meursinge Reynders
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC) Location AMC, Meibergdreef 9, Amsterdam, Netherlands
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Kumar AD, Durham DD, Lane L, Perera P, Rivera MP, Henderson LM. Randomized control trial of unconditional versus conditional incentives to increase study enrollment rates in participants at increased risk of lung cancer. J Clin Epidemiol 2022; 141:11-17. [PMID: 34469801 PMCID: PMC8903037 DOI: 10.1016/j.jclinepi.2021.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/05/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Understanding how incentives and their timing influence study enrollment rates is important to efficient study design and increasing the generalizability of findings. This 2-arm, parallel randomized trial evaluated how conditional vs. unconditional mailed incentives of a $20 gift card affected study enrollment in a sample of participants screened for lung cancer screening. METHODS Eligible participants included Black and White adults who underwent lung cancer screening with low-dose CT and had negative screening results at two North Carolina imaging facilities in 2018. We used a stratified randomization scheme, by sex and race, to assign incentive type (conditional vs. unconditional). We used the Tailored Design Method with six points of mailed contact to engage participants. We compared study enrollment rates using chi-square tests and logistic regression analyses. RESULTS After adjusting for sex, race, age, smoking status, participant residence, and screening site, participants who received unconditional incentives were 74% more likely to enroll than those who received conditional incentives (adjusted OR = 1.74 (95% CI: 1.01, 3.00). CONCLUSIONS Type of incentive can play a role in increasing study enrollment, especially mailed surveys that target individuals who currently or previously smoked. Unconditional incentives may be worth the initial cost to engage study participants.
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Affiliation(s)
- Anjali D. Kumar
- Department of Epidemiology, University of North Carolina, Chapel Hill,Corresponding author.
| | | | - Lindsay Lane
- Department of Radiology, University of North Carolina, Chapel Hill
| | - Pasangi Perera
- Department of Radiology, University of North Carolina, Chapel Hill
| | - M. Patricia Rivera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill,Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill
| | - Louise M. Henderson
- Department of Epidemiology, University of North Carolina, Chapel Hill,Department of Radiology, University of North Carolina, Chapel Hill,Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill
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Millar MM, Olson LM, VanBuren JM, Richards R, Pollack MM, Holubkov R, Berg RA, Carcillo JA, McQuillen PS, Meert KL, Mourani PM, Burd RS. Incentive delivery timing and follow-up survey completion in a prospective cohort study of injured children: a randomized experiment comparing prepaid and postpaid incentives. BMC Med Res Methodol 2021; 21:233. [PMID: 34706653 PMCID: PMC8549144 DOI: 10.1186/s12874-021-01421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Retaining participants over time is a frequent challenge in research studies evaluating long-term health outcomes. This study’s objective was to compare the impact of prepaid and postpaid incentives on response to a six-month follow-up survey. Methods We conducted an experiment to compare response between participants randomized to receive either prepaid or postpaid cash card incentives within a multisite study of children under 15 years in age who were hospitalized for a serious, severe, or critical injury. Participants were parents or guardians of enrolled children. The primary outcome was survey response. We also examined whether demographic characteristics were associated with response and if incentive timing influenced the relationship between demographic characteristics and response. We evaluated whether incentive timing was associated with the number of calls needed for contact. Results The study enrolled 427 children, and parents of 420 children were included in this analysis. Follow-up survey response did not differ according to the assigned treatment arm, with the percentage of parents responding to the survey being 68.1% for the prepaid incentive and 66.7% with the postpaid incentive. Likelihood of response varied by demographics. Spanish-speaking parents and parents with lower income and lower educational attainment were less likely to respond. Parents of Hispanic/Latino children and children with Medicaid insurance were also less likely to respond. We found no relationship between the assigned incentive treatment and the demographics of respondents compared to non-respondents. Conclusions Prepaid and postpaid incentives can obtain similar participation in longitudinal pediatric critical care outcomes research. Incentives alone do not ensure retention of all demographic subgroups. Strategies for improving representation of hard-to-reach populations are needed to address health disparities and ensure the generalizability of studies using these results. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01421-8.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
| | - Lenora M Olson
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph A Carcillo
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI 48201 and, Central Michigan University, Mt. Pleasant, MI, USA.,Central Michigan University, Mt. Pleasant, MI, USA
| | - Peter M Mourani
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, 20010, USA
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9
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Buckenmaier SS, Mollica MA, Freedman A, Kent EE, de Moor JS. Information Sources Used by Oncologists to Understand Multi-marker Tumor Panel Tests for Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1105-1114. [PMID: 32415436 DOI: 10.1007/s13187-020-01742-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Precision medicine using multi-marker tumor panel (MMTP) testing can help inform cancer treatment decisions. Oncologists' knowledge of these tests and their ability to find up-to-date information about their application in clinical care is essential. This study aimed to (1) describe information sources used by oncologists to learn about new genomic tests and (2) examine characteristics associated with the use of each information source. The National Cancer Institute's National Survey of Precision Medicine in Cancer Treatment surveyed a nationally representative sample of oncologists about MMTP testing. We examined the use of 11 information sources among oncologists that reported using MMTP tests (n = 1222). Bivariate analyses were used to examine whether information sources differed by oncologist- and practice-level characteristics and type of MMTP test. Most oncologists reported using peer-reviewed medical literature (88.8%), scientific conferences (87.9%), and medical professional societies (83.8%) to learn about MMTPs. In contrast, government websites, FDA inserts, and foundation resources were each used by < 36% of oncologists. The use of information sources differed by oncologist and practice characteristics. For example, a greater percentage of oncologists with an academic affiliation used peer-reviewed medical literature and scientific conferences, as compared to those without an academic affiliation (p = 0.006). As the number and type of MMTP tests increase, providing oncologists with current information about their appropriate application is essential. Further understanding of how oncologists use specific information sources may improve the dissemination and effective implementation of new MMTPs and help tailor educational interventions based on provider characteristics.
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Affiliation(s)
- Susan S Buckenmaier
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA.
| | - Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
| | - Andrew Freedman
- Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program, Clinical and Translational Epidemiology Branch, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, 9609 Medical Center Drive, Bethesda, MD, 20892-9762, USA
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10
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Roberts MC, Spees LP, Freedman AN, Klein WMP, Prabhu Das I, Butler EN, de Moor JS. Oncologist-Reported Reasons for Not Ordering Multimarker Tumor Panels: Results From a Nationally Representative Survey. JCO Precis Oncol 2021; 5:PO.20.00431. [PMID: 34250411 PMCID: PMC8232803 DOI: 10.1200/po.20.00431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
This study examines oncologist-reported reasons for not using multimarker tumor panel testing and the association between these reasons and oncologist-level, facility-level, and patient-mix characteristics. METHODS We used data collected from a nationally representative sample (N = 1,281) of medical oncologists participating in the National Cancer Institute's National Survey of Precision Medicine in Cancer Treatment. RESULTS In addition to testing not being seen as relevant (87%) and no evidence of test utility (77%), the most frequently reported reasons for not ordering a multimarker tumor panel test was difficulty in obtaining sufficient tissue (57%) and using individual gene tests (72%). These reasons were more likely to be reported by oncologists practicing in rural clinics and less likely to be reported by oncologists with an academic affiliation or with access to genetic services such as on-site genetic counselors and internal genetic testing policies. CONCLUSION Modifiable, organizational factors were associated with ordering multimarker tumor panels. Receipt of genomics training and organizational policies related to the use of genomics were associated with lower reporting of barriers to ordering multimarker tumor panels, pointing to potential targets for future studies aimed at increasing appropriate multimarker tumor panel testing in cancer treatment management.
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Affiliation(s)
- Megan C. Roberts
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa P. Spees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew N. Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - William M. P. Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Irene Prabhu Das
- Office of the Director, National Institutes of Health, Bethesda, MD
| | - Eboneé N. Butler
- Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, MD
| | - Janet S. de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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11
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Spees LP, Roberts MC, Freedman AN, Butler EN, Klein WMP, Prabhu Das I, de Moor JS. Involving patients and their families in deciding to use next generation sequencing: Results from a nationally representative survey of U.S. oncologists. PATIENT EDUCATION AND COUNSELING 2021; 104:33-39. [PMID: 32197930 PMCID: PMC7484216 DOI: 10.1016/j.pec.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Next generation sequencing (NGS) may aid in tumor classification and treatment. Barriers to shared decision-making may influence use of NGS. We examined, from oncologists' perspectives, whether barriers to involving patients/families in decision-making were associated with NGS use. METHODS Using data from the first national survey of medical oncologists' perspectives on precision medicine (N = 1281), we approached our analyses in two phases. Bivariate analyses initially evaluated associations between barriers to involving patients/families in deciding to use NGS and provider- and organizational-level characteristics. Modified Poisson regressions then examined associations between patient/family barriers and NGS use. RESULTS Approximately 59 % of oncologists reported at least one barrier to involving patients/families in decision-making regarding NGS use. Those reporting patient/family barriers tended to have fewer genomic resources at their practices, to be in rural or suburban areas, and to have a higher proportion of Medicaid patients. However, these barriers were not associated with NGS use. CONCLUSIONS Oncologists encounter barriers to involving patients/families in NGS testing decisions. Organizational barriers may also potentially play a role in testing decisions. PRACTICE IMPLICATIONS To foster patient-centered care, strategies to support patient involvement in genomic testing decisions are needed, particularly among practices in low-resource settings.
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Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Megan C Roberts
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Eboneé N Butler
- Division of Cancer Prevention, National Cancer Institute, Rockville, USA
| | - William M P Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Irene Prabhu Das
- Office of the Director, National Institutes of Health, Bethesda, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
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12
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Pace LE, Lee YS, Tung N, Hamilton JG, Gabriel C, Raja SC, Jenkins C, Braswell A, Domchek SM, Symecko H, Spielman K, Karlan BY, Lester J, Kamara D, Levin J, Morgan K, Offit K, Garber J, Keating NL. Comparison of up-front cash cards and checks as incentives for participation in a clinician survey: a study within a trial. BMC Med Res Methodol 2020; 20:210. [PMID: 32807084 PMCID: PMC7430023 DOI: 10.1186/s12874-020-01086-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background Evidence is needed regarding effective incentive strategies to increase clinician survey response rates. Cash cards are increasingly used as survey incentives; they are appealing because of their convenience and because in some cases their value can be reclaimed by investigators if not used. However, their effectiveness in clinician surveys is not known. In this study within the BRCA Founder OutReach (BFOR) study, a clinical trial of population-based BRCA1/2 mutation screening, we compared the use of upfront cash cards requiring email activation versus checks as clinician survey incentives. Methods Participants receiving BRCA1/2 testing in the BFOR study could elect to receive their results from their primary care provider (PCP, named by the patient) or from a geneticist associated with the study. In order to understand PCPs’ knowledge, attitudes, experiences and willingness to disclose results we mailed paper surveys to the first 501 primary care providers (PCPs) in New York, Boston, Los Angeles and Philadelphia who were nominated by study participants to disclose their BRCA1/2 mutation results obtained through the study. We used alternating assignment stratified by city to assign the first 303 clinicians to receive a $50 up-front incentive as a cash card (N = 155) or check (N = 148). The cash card required PCPs to send an activation email in order to be used. We compared response rates by incentive type, adjusting for PCP characteristics and study site. Results In unadjusted analyses, PCPs who received checks were more likely to respond to the survey than those who received cash cards (54.1% versus 41.9%, p = 0.046); this remained true when we adjusted for provider characteristics (OR for checks 1.61, 95% CI 1.01, 2.59). No other clinician characteristics had a statistically significant association with response rates in adjusted analyses. When we included an interaction term for incentive type and city, the favorable impact of checks on response rates was evident only in Los Angeles and Philadelphia. Conclusions An up-front cash card incentive requiring email activation may be less effective in eliciting clinician responses than up-front checks. However, the benefit of checks for clinician response rates may depend on clinicians’ geographic location. Trial registration ClinicalTrials.gov (NCT03351803), November 24, 2017.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Yeonsoo S Lee
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Nadine Tung
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jada G Hamilton
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Camila Gabriel
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Sahitya C Raja
- Rush Medical College at Rush University, 600 S Paulina St Suite 202, Chicago, IL, 60612, USA
| | - Colby Jenkins
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.,Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Anthony Braswell
- David Geffen School of Medicine at the University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Susan M Domchek
- Basser Center for BRCA, University of Pennsylvania, West Tower, Centre Square, 1500 Market St, Philadelphia, PA, 19102, USA
| | - Heather Symecko
- Basser Center for BRCA, University of Pennsylvania, West Tower, Centre Square, 1500 Market St, Philadelphia, PA, 19102, USA
| | - Kelsey Spielman
- Basser Center for BRCA, University of Pennsylvania, West Tower, Centre Square, 1500 Market St, Philadelphia, PA, 19102, USA
| | - Beth Y Karlan
- David Geffen School of Medicine at the University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jenny Lester
- David Geffen School of Medicine at the University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Daniella Kamara
- David Geffen School of Medicine at the University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jeffrey Levin
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Kelly Morgan
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Kenneth Offit
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Judy Garber
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Nancy L Keating
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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13
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Palmer NR, Shim JK, Kaplan CP, Schillinger D, Blaschko SD, Breyer BN, Pasick RJ. Ethnographic investigation of patient-provider communication among African American men newly diagnosed with prostate cancer: a study protocol. BMJ Open 2020; 10:e035032. [PMID: 32759241 PMCID: PMC7409964 DOI: 10.1136/bmjopen-2019-035032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient-provider communication contributes to suboptimal care, which can be exacerbated by patients' limited health literacy, providers' lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making. METHODS AND ANALYSIS Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients' understanding of their diagnoses and treatment options, sources of support in decision-making, patient-provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients' experiences and providers' perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data. ETHICS AND DISSEMINATION To our knowledge, this is the first study to examine in-depth patient-provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.
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Affiliation(s)
- Nynikka R Palmer
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Janet K Shim
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Celia P Kaplan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Sarah D Blaschko
- Division of Urology, Highland Hospital, Oakland, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Rena J Pasick
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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14
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Yabroff KR, Zhao J, de Moor JS, Sineshaw HM, Freedman AN, Zheng Z, Han X, Rai A, Klabunde CN. Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments. J Natl Cancer Inst 2020; 112:498-506. [PMID: 31675070 PMCID: PMC7225678 DOI: 10.1093/jnci/djz173] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/31/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. METHODS We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. RESULTS Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. CONCLUSIONS Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Helmneh M Sineshaw
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ashish Rai
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- National Cancer Institute, and Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
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15
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Just the fax, please: Updating electronic/hybrid methods for surveying pharmacists. Res Social Adm Pharm 2019; 15:226-227. [DOI: 10.1016/j.sapharm.2018.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022]
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