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Allen CG, Bouchie G, Judge DP, Coen E, English S, Norman S, Kirchoff K, Ramos PS, Hirschhorn J, Lenert L, McMahon LL. Establishing an infrastructure to optimize the integration of genomics into research: Results from a precision health needs assessment. Transl Behav Med 2024:ibae008. [PMID: 38470971 DOI: 10.1093/tbm/ibae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Researchers across the translational research continuum have emphasized the importance of integrating genomics into their research program. To date capacity and resources for genomics research have been limited; however, a recent population-wide genomic screening initiative launched at the Medical University of South Carolina in partnership with Helix has rapidly advanced the need to develop appropriate infrastructure for genomics research at our institution. We conducted a survey with researchers from across our institution (n = 36) to assess current knowledge about genomics health, barriers, and facilitators to uptake, and next steps to support translational research using genomics. We also completed 30-minute qualitative interviews with providers and researchers from diverse specialties (n = 8). Quantitative data were analyzed using descriptive analyses. A rapid assessment process was used to develop a preliminary understanding of each interviewee's perspective. These interviews were transcribed and coded to extract themes. The codes included types of research, alignment with precision health, opportunities to incorporate precision health, examples of researchers in the field, barriers, and facilitators to uptake, educational activity suggestions, questions to be answered, and other observations. Themes from the surveys and interviews inform implementation strategies that are applicable not only to our institution, but also to other organizations interested in making genomic data available to researchers to support genomics-informed translational research.
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Affiliation(s)
| | | | | | - Emma Coen
- Medical University of South Carolina, Charleston, SC
| | - Sarah English
- Medical University of South Carolina, Charleston, SC
| | | | | | - Paula S Ramos
- Medical University of South Carolina, Charleston, SC
| | | | - Leslie Lenert
- Medical University of South Carolina, Charleston, SC
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Allen CG, Hunt KJ, McMahon LL, Thornhill C, Jackson A, Clark JT, Kirchoff K, Garrison KL, Foil K, Malphrus L, Norman S, Ramos PS, Perritt K, Brown C, Lenert L, Judge DP. Using implementation science to evaluate a population-wide genomic screening program: Findings from the first 20,000 In Our DNA SC participants. Am J Hum Genet 2024; 111:433-444. [PMID: 38307026 PMCID: PMC10940017 DOI: 10.1016/j.ajhg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/04/2024] Open
Abstract
We use the implementation science framework RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) to describe outcomes of In Our DNA SC, a population-wide genomic screening (PWGS) program. In Our DNA SC involves participation through clinical appointments, community events, or at home collection. Participants provide a saliva sample that is sequenced by Helix, and those with a pathogenic variant or likely pathogenic variant for CDC Tier 1 conditions are offered free genetic counseling. We assessed key outcomes among the first cohort of individuals recruited. Over 14 months, 20,478 participants enrolled, and 14,053 samples were collected. The majority selected at-home sample collection followed by clinical sample collection and collection at community events. Participants were predominately female, White (self-identified), non-Hispanic, and between the ages of 40-49. Participants enrolled through community events were the most racially diverse and the youngest. Half of those enrolled completed the program. We identified 137 individuals with pathogenic or likely pathogenic variants for CDC Tier 1 conditions. The majority (77.4%) agreed to genetic counseling, and of those that agreed, 80.2% completed counseling. Twelve clinics participated, and we conducted 108 collection events. Participants enrolled at home were most likely to return their sample for sequencing. Through this evaluation, we identified facilitators and barriers to implementation of our state-wide PWGS program. Standardized reporting using implementation science frameworks can help generalize strategies and improve the impact of PWGS.
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Affiliation(s)
| | - Kelly J Hunt
- Medical University of South Carolina, Charleston, SC, USA
| | - Lori L McMahon
- Medical University of South Carolina, Charleston, SC, USA
| | - Clay Thornhill
- Medical University of South Carolina, Charleston, SC, USA
| | - Amy Jackson
- Medical University of South Carolina, Charleston, SC, USA
| | - John T Clark
- Medical University of South Carolina, Charleston, SC, USA
| | - Katie Kirchoff
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Kimberly Foil
- Medical University of South Carolina, Charleston, SC, USA
| | - Libby Malphrus
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Paula S Ramos
- Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Perritt
- Medical University of South Carolina, Charleston, SC, USA
| | - Caroline Brown
- Medical University of South Carolina, Charleston, SC, USA
| | - Leslie Lenert
- Medical University of South Carolina, Charleston, SC, USA
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, SC, USA
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Allen CG, Donahue C, Coen E, Meeder K, Wallace K, Melvin C, Neelon B, Hughes K. Implementation Mapping for Managing Patients at High Risk for Hereditary Cancer. Am J Prev Med 2024; 66:503-515. [PMID: 37806365 PMCID: PMC10922485 DOI: 10.1016/j.amepre.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Currently, no standard workflow exists for managing patients with pathogenic variants that put them at higher risk for hereditary cancers. Therefore, follow-up care for individuals with pathogenic variants is logistically challenging and results in poor guideline adherence. To address this challenge, authors created clinical management strategies for individuals identified at high risk for hereditary cancers. METHODS An implementation mapping approach was used to develop and evaluate the establishment of a Hereditary Cancer Clinic at the Medical University of South Carolina throughout in 2022. This approach consisted of 5 steps: conduct a needs assessment, identify objectives, select implementation strategies, produce implementation protocols, and develop an evaluation plan. The needs assessment consisted of qualitative interviews with patients (n=11), specialists (n=9), and members of the implementation team (n=4). Interviews were coded using the Consolidated Framework for Implementation Research to identify barriers and facilitators to establishment of the Hereditary Cancer Clinic. Objectives were identified, and then the team selected implementation strategies and produced implementation protocols to address concerns identified during the needs assessment. Authors conducted a second round of patient interviews to assess patient education materials. RESULTS The research team developed a long-term evaluation plan to guide future assessment of implementation, service, and clinical/patient outcomes. CONCLUSIONS This approach provides the opportunity for real-time enhancements and impact, with strategies for care specialists, patients, and implementation teams. Findings support ongoing efforts to improve patient management and outcomes while providing an opportunity for long-term evaluation of implementation strategies and guidelines for patients at high risk for hereditary cancers.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Colleen Donahue
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Emma Coen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kiersten Meeder
- Division of Oncologic and Endocrine Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin Hughes
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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Allen CG, Neil G, Halbert CH, Sterba KR, Nietert PJ, Welch B, Lenert L. Barriers and facilitators to the implementation of family cancer history collection tools in oncology clinical practices. J Am Med Inform Assoc 2024; 31:631-639. [PMID: 38164994 PMCID: PMC10873828 DOI: 10.1093/jamia/ocad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION This study aimed to identify barriers and facilitators to the implementation of family cancer history (FCH) collection tools in clinical practices and community settings by assessing clinicians' perceptions of implementing a chatbot interface to collect FCH information and provide personalized results to patients and providers. OBJECTIVES By identifying design and implementation features that facilitate tool adoption and integration into clinical workflows, this study can inform future FCH tool development and adoption in healthcare settings. MATERIALS AND METHODS Quantitative data were collected using survey to evaluate the implementation outcomes of acceptability, adoption, appropriateness, feasibility, and sustainability of the chatbot tool for collecting FCH. Semistructured interviews were conducted to gather qualitative data on respondents' experiences using the tool and recommendations for enhancements. RESULTS We completed data collection with 19 providers (n = 9, 47%), clinical staff (n = 5, 26%), administrators (n = 4, 21%), and other staff (n = 1, 5%) affiliated with the NCI Community Oncology Research Program. FCH was systematically collected using a wide range of tools at sites, with information being inserted into the patient's medical record. Participants found the chatbot tool to be highly acceptable, with the tool aligning with existing workflows, and were open to adopting the tool into their practice. DISCUSSION AND CONCLUSIONS We further the evidence base about the appropriateness of scripted chatbots to support FCH collection. Although the tool had strong support, the varying clinical workflows across clinic sites necessitate that future FCH tool development accommodates customizable implementation strategies. Implementation support is necessary to overcome technical and logistical barriers to enhance the uptake of FCH tools in clinical practices and community settings.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Grace Neil
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Leslie Lenert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Allen CG, Hatch A, Qanungo S, Ford M, Marrison ST, Umemba Q. Development of a Hereditary Breast and Ovarian Cancer and Genetics Curriculum for Community Health Workers: KEEP IT (Keeping Each other Engaged Program via IT) Community Health Worker Training. J Cancer Educ 2024; 39:70-77. [PMID: 37919623 DOI: 10.1007/s13187-023-02377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
We developed a curriculum for community health workers (CHWs) using an innovative, community-engaged focus group and Delphi process approach. Equipping CHWs with knowledge of hereditary breast and ovarian cancer syndrome (HBOC) and genetics could help enhance identification of women at risk for HBOC, referral, and navigation through genetic services. We conducted focus groups with five CHWs and a three-round Delphi process with eight experts. In the first round of the Delphi process, participants rated and commented on draft curriculum modules. The second round involved live video discussion to highlight points of confusion and concern in the modules. The curriculum was revised and refined based on quantitative and qualitative data and reassessed by the experts in Round 3. Ultimately, agreement was achieved on eight of 10 modules when assessing for clarity of learning objectives, seven out of 10 when assessing for adult learning theory, and nine out of 10 when assessing for participants' ability to learn desired knowledge. We plan to virtually deliver this curriculum to CHWs to enhance their HBOC and genomic competencies. By equipping CHWs to understand and participate in genomics education, we can enable more equitable participation in genomics-informed clinical care and research. Beyond this curriculum, the Delphi methodology can further be used to design content for new CHW curriculums.
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Affiliation(s)
| | - Ashley Hatch
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Marvella Ford
- Medical University of South Carolina, Charleston, SC, USA
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Roberts MC, Allen CG. Next-Generation Public Health Genomics: A Call to Assess the Equitable Implementation, Population Health Impact, and Sustainability of Precision Public Health Applications. Public Health Genomics 2023; 27:30-34. [PMID: 38128494 DOI: 10.1159/000535579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Allen CG, McBride CM, Escoffery C, Guan Y, Hood C, Zaho J, Brody G, An W. Developing and assessing a kin keeping scale with application to identifying central influencers in African American family networks. J Community Genet 2023; 14:593-603. [PMID: 37648941 PMCID: PMC10725405 DOI: 10.1007/s12687-023-00665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
Promoting family communication about inherited disease risk is an arena in which family systems theory is highly relevant. One family systems' construct that can support promotion of family communication regarding inherited disease risk is the notion of "kin keeping." However, kin keeping and whether it might be capitalized on to encourage family communication about inherited risk has been understudied. The goal of this report was to propose a broadened conceptualization of kin keeping that distinguishes between a structural functional perspective (role conceptualization) and transitional behaviors (skill conceptualization), and to develop and evaluate a scale that would enable this assertion to be tested among a sample of African American community health workers. We developed a scale using four steps: item development using concept analysis and content validity, scale development among a national sample (n = 312), scale evaluation using exploratory factor analysis (n = 52), and scale reduction. We then posed suppositions of associations that would indicate whether the developed kin keeping measure was assessing a specific family role or set of behaviors. Our results included the development of the first quantitative measure of kin keeping (9- and 15-item scales). Model fit for 9-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.09, SMRM = 0.06) and model fit for 15-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.06, SMRM = 0.05). These findings allow us to move toward more rigorous research about the role of kin keeping on information sharing and health decision making. Results also suggest that, contrary to the historical structural functional conceptualization of kin keeping as a role, kin keeping might also be conceptualized as a behavior or set of modifiable behaviors. Ultimately, the kin keeping scale could be used to operationalize kin keeping in various theoretical models and frameworks, guide intervention development to encourage or train for kin keeping behaviors, and test assumptions of whether families vary in the density of kin keeping.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, Charleston, SC, USA.
- Emory University, Atlanta, GA, USA.
| | | | | | - Yue Guan
- Emory University, Atlanta, GA, USA
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Allen CG, Olstad DL, Kahkoska AR, Guan Y, Ramos PS, Steinberg J, Staras SAS, Lumpkins CY, Milko LV, Turbitt E, Rahm AK, Saylor KW, Best S, Hatch A, Santangelo I, Roberts MC. Extending an Antiracism Lens to the Implementation of Precision Public Health Interventions. Am J Public Health 2023; 113:1210-1218. [PMID: 37651661 PMCID: PMC10568499 DOI: 10.2105/ajph.2023.307386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/02/2023]
Abstract
Precision public health holds promise to improve disease prevention and health promotion strategies, allowing the right intervention to be delivered to the right population at the right time. Growing concerns underscore the potential for precision-based approaches to exacerbate health disparities by relying on biased data inputs and recapitulating existing access inequities. To achieve its full potential, precision public health must focus on addressing social and structural drivers of health and prominently incorporate equity-related concerns, particularly with respect to race and ethnicity. In this article, we discuss how an antiracism lens could be applied to reduce health disparities and health inequities through equity-informed research, implementation, and evaluation of precision public health interventions. (Am J Public Health. 2023;113(11):1210-1218. https://doi.org/10.2105/AJPH.2023.307386).
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Affiliation(s)
- Caitlin G Allen
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dana Lee Olstad
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Anna R Kahkoska
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Yue Guan
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Paula S Ramos
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Julia Steinberg
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephanie A S Staras
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Crystal Y Lumpkins
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Laura V Milko
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Erin Turbitt
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alanna K Rahm
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Katherine W Saylor
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephanie Best
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ashley Hatch
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Isabella Santangelo
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Megan C Roberts
- Caitlin G. Allen and Ashley Hatch are with the Department of Public Health Sciences, College of Medicine, and Paula S. Ramos is with the Departments of Medicine and Public Health Sciences, Medical University of South Carolina, Charleston. Dana Lee Olstad is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Anna R. Kahkoska is with the Department of Nutrition, Laura V. Milko is with the Department of Genetics, and Megan C. Roberts is with the Eshelman School of Pharmacy, University of North Carolina, Chapel Hill. Yue Guan and Isabella Santangelo are with the Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA. Julia Steinberg is with The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia. Stephanie A. S. Staras is with the Department of Health Outcome and Biomedical Informatics, College of Medicine, and Institute for Child Health Policy, University of Florida, Gainesville. Crystal Y. Lumpkins is with the Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Alanna K. Rahm is with the Department of Genomic Health, Geisinger Medical Center, Danville, PA. Katherine W. Saylor is with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Stephanie Best is with the Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Allen CG, Sterba K, Norman S, Jackson A, Hunt KJ, McMahon L, Judge DP. Use of a multi-phased approach to identify and address facilitators and barriers to the implementation of a population-wide genomic screening program. Implement Sci Commun 2023; 4:122. [PMID: 37821977 PMCID: PMC10566189 DOI: 10.1186/s43058-023-00500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Population-wide genomic screening for CDC Tier-1 conditions offers the ability to identify the 1-2% of the US population at increased risk for Hereditary Breast and Ovarian Cancer, Lynch Syndrome, and Familial Hypercholesterolemia. Implementation of population-wide screening programs is highly complex, requiring engagement of diverse collaborators and implementation teams. Implementation science offers tools to promote integration of these programs through the identification of determinants of success and strategies to address potential barriers. METHODS Prior to launching the program, we conducted a pre-implementation survey to assess anticipated barriers and facilitators to reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), among 51 work group members (phase 1). During the first year of program implementation, we completed coding of 40 work group meetings guided by the Consolidated Framework for Implementation Research (CFIR) (phase 2). We matched the top barriers to implementation strategies identified during phase 2 using the CFIR-ERIC (Expert Recommendation for Implementing Change) matching tool. RESULTS Staffing and workload concerns were listed as the top barrier in the pre-implementation phase of the program. Top barriers during implementation included adaptability (n = 8, 20%), complexity (n = 14, 35%), patient needs and resources (n = 9, 22.5%), compatibility (n = 11, 27.5%), and self-efficacy (n = 9, 22.5%). We identified 16 potential implementation strategies across six ERIC clusters to address these barriers and operationalized these strategies for our specific setting and program needs. CONCLUSION Our findings provide an example of successful use of the CFIR-ERIC tool to guide implementation of a population-wide genomic screening program.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Katherine Sterba
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Samantha Norman
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
| | - Amy Jackson
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Hunt
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lori McMahon
- Research Office, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel P Judge
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
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10
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Abstract
PROBLEM ADDRESSED To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models. RESULTS Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < .0001) and more likely to have discussed FCH with family members (B = 0.07, p < .0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < .0001) and seek other health information (B = 0.24, p < .0001). Stratified models showed differences in this process by age, race/ethnicity, and family history of cancer. IMPLICATIONS FOR PUBLIC HEALTH RESEARCH AND PRACTICE Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.
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Affiliation(s)
| | | | | | | | - Muin J. Khoury
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Allen CG, Hunt K, Jackson A, Baierl J, McMahon L, Judge D. Applying the R = MC 2 implementation science heuristic to assess the impact of readiness on reach and implementation of a population-wide genomic screening program. J Genet Couns 2023:10.1002/jgc4.1775. [PMID: 37732417 PMCID: PMC10954584 DOI: 10.1002/jgc4.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
Population-wide genomic screening for genes that have high penetrance and clinical actionability enhances the opportunity to identify individuals at risk for developing hereditary conditions. Organizational readiness has been shown to influence the likelihood of successful implementation of complex initiatives such as the integration of population-wide genomic screening in clinical settings. We use the organizational readiness heuristic R = MC2 to better understand three factors that influence readiness for implementation of In Our DNA SC, a population-wide genomic screening program: motivation to implement, general capacity of an organization, and innovation-specific capacities. We then assessed the influence of these readiness factors on implementation outcomes of reach (measured through enrollment rate) and implementation (measured through the number of DNA samples collected). Data were collected pre-implementation and captured during the three-month pilot phase of the In Our DNA SC program. We collected administrative data from the electronic health record and quantitatively captured elements of readiness through surveys distributed to provider champions and clinical administrative champions at the 10 sites implementing the population-wide genomic screening program. We facilitated innovation-specific capacity through training offered at each site, as well as technical assistance through weekly meetings with other implementing sites, and resources available to all staff. Forty percent of provider champions attended training and 80% of administrative champions attended training. An average of 3.7 additional staff were trained at each implementing site. Satisfaction with training positively influenced reach (β = 0.0121, p = 0.0271) but did not impact implementation. Provider engagement (innovation capabilities) was associated with reach (β = 0.0020, p = 0.0251) and clinical administrator engagement was associated with sample collection rate (β = 0.2599, β = 0.038). Readiness to change is considered one of the most important factors in understanding the potential opportunity for implementation. We found that motivation to adopt a population-wide genomic screening program positively impacted the program's reach. The type of champion influenced discrete outcomes, with provider champions positively impacting reach and administrative champions influencing implementation (assessed through sample collection rate). As genomics continues to be integrated into clinical practice, it will be important to understand the contextual factors that influence readiness for implementation and design support throughout the life-course of implementation to ensure the success of large-scale, complex initiatives.
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Affiliation(s)
- Caitlin G. Allen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelly Hunt
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amy Jackson
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph Baierl
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lori McMahon
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Judge
- Medical University of South Carolina, Charleston, South Carolina, USA
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Allen CG, Judge DP, Nietert PJ, Hunt KJ, Jackson A, Gallegos S, Sterba KR, Ramos PS, Melvin CL, Wager K, Catchpole K, Ford M, McMahon L, Lenert L. Anticipating adaptation: tracking the impact of planned and unplanned adaptations during the implementation of a complex population-based genomic screening program. Transl Behav Med 2023; 13:381-387. [PMID: 37084411 PMCID: PMC10255754 DOI: 10.1093/tbm/ibad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
In 2021, the Medical University of South Carolina (MUSC) launched In Our DNA SC. This large-scale initiative will screen 100,000 individuals in South Carolina for three preventable hereditary conditions that impact approximately two million people in the USA but often go undetected. In anticipation of inevitable changes to the delivery of this complex initiative, we developed an approach to track and assess the impact of evaluate adaptations made during the pilot phase of program implementation. We used a modified version of the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) and Adaptations to code adaptations made during the 3-month pilot phase of In Our DNA SC. Adaptations were documented in real-time using a REDCap database. We used segmented linear regression models to independently test three hypotheses about the impact of adaptations on program reach (rate of enrollment in the program, rate of messages viewed) and implementation (rate of samples collected) 7 days pre- and post-adaptation. Effectiveness was assessed using qualitative observations. Ten adaptations occurred during the pilot phase of program implementation. Most adaptations (60%) were designed to increase the number and type of patient contacted (reach). Adaptations were primarily made based on knowledge and experience (40%) or from quality improvement data (30%). Of the three adaptations designed to increase reach, shortening the recruitment message potential patients received significantly increased the average rate of invitations viewed by 7.3% (p = 0.0106). There was no effect of adaptations on implementation (number of DNA samples collected). Qualitative findings support improvement in effectiveness of the intervention after shortening the consent form and short-term positive impact on uptake of the intervention as measured by team member's participation. Our approach to tracking adaptations of In Our DNA SC allowed our team to quantify the utility of modifications, make decisions about pursuing the adaptation, and understand consequences of the change. Streamlining tools for tracking and responding to adaptations can help monitor the incremental impact of interventions to support continued learning and problem solving for complex interventions being delivered in health systems based on real-time data.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Daniel P Judge
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paul J Nietert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Kelly J Hunt
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Amy Jackson
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Sam Gallegos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Katherine R Sterba
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paula S Ramos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Cathy L Melvin
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Karen Wager
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Ken Catchpole
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Marvella Ford
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Lori McMahon
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Leslie Lenert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
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Allen CG, Jefferson M, Magwood G, Melvin C, Babatunde OA, Halbert CH. Understanding men's beliefs and concerns about linking health data in the context of precision medicine. J Clin Transl Sci 2023; 7:e150. [PMID: 37456269 PMCID: PMC10346034 DOI: 10.1017/cts.2023.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023] Open
Abstract
Background/Objective Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers' and clinicians' ability to deliver care. We have limited understanding of how individuals perceive linking data as it relates to precision medicine. The aim of this study was to identify how sociodemographics, comorbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among men. Methods We recruited 124 adult men from primary care practices at a large clinical research university to complete a cross-sectional survey that included questions about sociodemographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptive statistics, bivariate associations, and multivariable regression were conducted. Results Participants had positive beliefs about linking data for precision medicine (M = 4.05/5) and average concern about linking data (M = 2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (β = 0.41, p = 0.027). Races other than African American (β = -0.64, p = 0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (β = -0.75, p = 0.0006). Conclusion Our results advance the literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
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Affiliation(s)
- Caitlin G. Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Escoffery C, Sekar S, Allen CG, Madrigal L, Haardoerfer R, Mertens A. A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks. Transl Behav Med 2023; 13:327-337. [PMID: 36694938 PMCID: PMC10182421 DOI: 10.1093/tbm/ibac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Swathi Sekar
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Caitlin G Allen
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lillian Madrigal
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Regine Haardoerfer
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Ann Mertens
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
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15
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Nielsen VM, Ursprung WWS, Song G, Hirsch G, Mason T, Santarelli C, Guimaraes E, Marshall E, Allen CG, Lei PP, Brown D, Behl-Chadha B. Evaluating the impact of community health worker certification in Massachusetts: Design, methods, and anticipated results of the Massachusetts community health worker workforce survey. Front Public Health 2023; 10:1043668. [PMID: 36711392 PMCID: PMC9877511 DOI: 10.3389/fpubh.2022.1043668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background Professional certification of community health workers (CHWs) is a debated topic. Although intended to promote CHWs, certification may have unintended impacts given the grassroots nature of the workforce. As such, both intended effects and unintended adverse effects should be carefully evaluated. However, there is a lack of published literature describing such effective evaluations with a robust methodology. In this methods paper, we describe a key component of evaluating CHW certification in Massachusetts-the Massachusetts CHW Workforce Survey. Methods Design of the surveys was informed by a program theory framework that delineated both positive and negative potential impacts of Massachusetts CHW certification on CHWs and CHW employers. Using this framework, we developed measures of interest and preliminary CHW and CHW employer surveys. To validate and refine the surveys, we conducted cognitive interviews with CHWs and CHW employers. We then finalized survey tools with input from state and national stakeholders, CHWs, and CHW employers. Our sample consisted of three frames based on where CHWs are most likely to be employed in Massachusetts: acute care hospitals, community-based organizations, and ambulatory care health centers, primarily community health centers and federally qualified health centers. We then undertook extensive outreach efforts to determine whether each organization employed CHWs and to obtain CHW and CHW employer contact information. Our statistical analysis of the data utilized inverse probability score weighting accounting for organizational, site, and individual response. Anticipated results Wave one of the survey was administered in 2016 prior to launch of Massachusetts CHW certification and wave two in 2021. We report descriptive statistics of the three sample frames and response rates of each survey for each wave. Further, we describe select anticipated results related to certification, including outcomes of the program theory framework. Conclusions The Massachusetts CHW Workforce Survey is the culmination of 5 years of effort to evaluate the impact of CHW certification in Massachusetts. Our comprehensive description of our methodology addresses an important gap in CHW research literature. The rigorous design, administration, and analysis of our surveys ensure our findings are robust, valid, and replicable, which can be leveraged by others evaluating the CHW workforce.
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Affiliation(s)
- Victoria M. Nielsen
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Boston, MA, United States,*Correspondence: Victoria M. Nielsen ✉
| | - W. W. Sanouri Ursprung
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Boston, MA, United States
| | - Glory Song
- Massachusetts Department of Public Health, Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Boston, MA, United States
| | - Gail Hirsch
- Massachusetts Department of Public Health, Office of Community Health Workers, Bureau of Community Health and Prevention, Boston, MA, United States
| | - Theresa Mason
- Massachusetts Department of Public Health, Office of Community Health Workers, Bureau of Community Health and Prevention, Boston, MA, United States
| | - Claire Santarelli
- Division of Health Protection and Promotion, Massachusetts Department of Public Health, Bureau of Community Health and Prevention, Boston, MA, United States
| | | | - Erica Marshall
- Division of Community-Based Prevention and Care, Massachusetts Department of Public Health, Bureau of Community Health and Prevention, Boston, MA, United States
| | - Caitlin G. Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Pei-Pei Lei
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, United States
| | - Diane Brown
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, United States
| | - Bittie Behl-Chadha
- Office of Survey Research, University of Massachusetts Chan Medical School, Shrewsbury, MA, United States
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16
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Allen CG, Turbitt E, Smit AK, Passero LE, Olstad DL, Hatch A, Landry L, Roberts MC. Precision Public Health Initiatives in Cancer: Proceedings from the Transdisciplinary Conference for Future Leaders in Precision Public Health. BMC Proc 2022; 16:4. [PMID: 35799197 PMCID: PMC9261247 DOI: 10.1186/s12919-022-00234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Precision public health is an emergent field that requires transdisciplinary collaborations and leverages innovative approaches to improve population health. These opportunities have inspired a new generation of precision public health researchers. Despite burgeoning interest in precision public health, there are limited opportunities for researchers to convene and continue the momentum of this field. METHODS The Transdisciplinary Conference for Future Leaders in Precision Public Health was the among the first events to bring together international researchers and practitioners to learn, network, and agenda set for the future of the field. The conference took place virtually on October 14 and 15, 2021. RESULTS The conference spanned two days and featured a keynote address, speakers from public health disciplines who are international leaders in precision-based research, networking opportunities, a poster session, and research agenda setting activities. CONCLUSION The conference was a critical first step to creating a shared international conversation about precision public health, especially among early-stage investigators. This allowed attendees to continue building their individual skills and international collaborations to support the growth of the field of precision public health.
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Affiliation(s)
| | - Erin Turbitt
- University of Technology Sydney, Sydney, Australia
| | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney, Australia
| | | | | | - Ashley Hatch
- Medical University of South Carolina, Charleston, USA
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17
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Allen CG, Judge DP, Levin E, Sterba K, Hunt K, Ramos PS, Melvin C, Wager K, Catchpole K, Clinton C, Ford M, McMahon LL, Lenert L. A pragmatic implementation research study for In Our DNA SC: a protocol to identify multi-level factors that support the implementation of a population-wide genomic screening initiative in diverse populations. Implement Sci Commun 2022; 3:48. [PMID: 35484601 PMCID: PMC9052691 DOI: 10.1186/s43058-022-00286-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/20/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In 2021, the Medical University of South Carolina (MUSC) partnered with Helix, a population genetic testing company, to offer population-wide genomic screening for Centers for Disease Control and Preventions' Tier 1 conditions of hereditary breast and ovarian cancer, Lynch syndrome, and familial hypercholesterolemia to 100,000 individuals in South Carolina. We developed an implementation science protocol to study the multi-level factors that influence the successful implementation of the In Our DNA SC initiative. METHODS We will use a convergent parallel mixed-methods study design to evaluate the implementation of planned strategies and associated outcomes for In Our DNA SC. Aims focus on monitoring participation to ensure engagement of diverse populations, assessing contextual factors that influence implementation in community and clinical settings, describing the implementation team's facilitators and barriers, and tracking program adaptations. We report details about each data collection tool and analyses planned, including surveys, interview guides, and tracking logs to capture and code work group meetings, adaptations, and technical assistance needs. DISCUSSION The goal of In Our DNA SC is to provide population-level screening for actionable genetic conditions and to foster ongoing translational research. The use of implementation science can help better understand how to support the success of In Our DNA SC, identify barriers and facilitators to program implementation, and can ensure the sustainability of population-level genetic testing. The model-based components of our implementation science protocol can support the identification of best practices to streamline the expansion of similar population genomics programs at other institutions.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Daniel P Judge
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Katherine Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Paula S Ramos
- Department of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Karen Wager
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth Catchpole
- Anesthesia & Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Marvella Ford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Lori L McMahon
- Office of Vice President for Research, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
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18
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Roberts MC, Mader JM, Turbitt E, Smit AK, Landry L, Olstad DL, Passero LE, Allen CG. Using a Participatory Approach to Develop Research Priorities for Future Leaders in Cancer-Related Precision Public Health. Front Genet 2022; 13:881527. [PMID: 35754808 PMCID: PMC9218810 DOI: 10.3389/fgene.2022.881527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
Precision public health is an emerging discipline combining principles and frameworks of precision health with the goal of improving population health. The development of research priorities drawing on the strengths of precision and public health is critical to facilitate the growth of the discipline to improve health outcomes. We held an interactive workshop during a virtual conference bringing together early-career researchers across public health disciplines to identify research priorities in precision public health. The workshop participants discussed and voted to identify three priority areas for future research and capacity building including 1) enhancing equity and access to precision public health research and resources, 2) improving tools and metrics for evaluation and 3) applying principles of implementation science to support sustainable practices. Participants also developed future objectives for achieving each priority. Future efforts by working groups will continue the process of identifying, revising, and advancing critical research priorities to grow the impact of precision public health.
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Affiliation(s)
- Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC, United States
| | | | - Erin Turbitt
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Amelia K Smit
- Daffodil Centre, A Joint Venture with Cancer Council NSW, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Latrice Landry
- Program for Cancer Care Equity, Dana Farber Cancer Institute, Boston, MA, United States
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauren E Passero
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Chapel Hill, NC, United States
| | - Caitlin G Allen
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
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19
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Shen EC, Srinivasan S, Passero LE, Allen CG, Dixon M, Foss K, Halliburton B, Milko LV, Smit AK, Carlson R, Roberts MC. Barriers and Facilitators for Population Genetic Screening in Healthy Populations: A Systematic Review. Front Genet 2022; 13:865384. [PMID: 35860476 PMCID: PMC9289280 DOI: 10.3389/fgene.2022.865384] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022] Open
Abstract
Studies suggest that 1-3% of the general population in the United States unknowingly carry a genetic risk factor for a common hereditary disease. Population genetic screening is the process of offering otherwise healthy patients in the general population testing for genomic variants that predispose them to diseases that are clinically actionable, meaning that they can be prevented or mitigated if they are detected early. Population genetic screening may significantly reduce morbidity and mortality from these diseases by informing risk-specific prevention or treatment strategies and facilitating appropriate participation in early detection. To better understand current barriers, facilitators, perceptions, and outcomes related to the implementation of population genetic screening, we conducted a systematic review and searched PubMed, Embase, and Scopus for articles published from date of database inception to May 2020. We included articles that 1) detailed the perspectives of participants in population genetic screening programs and 2) described the barriers, facilitators, perceptions, and outcomes related to population genetic screening programs among patients, healthcare providers, and the public. We excluded articles that 1) focused on direct-to-consumer or risk-based genetic testing and 2) were published before January 2000. Thirty articles met these criteria. Barriers and facilitators to population genetic screening were organized by the Social Ecological Model and further categorized by themes. We found that research in population genetic screening has focused on stakeholder attitudes with all included studies designed to elucidate individuals' perceptions. Additionally, inadequate knowledge and perceived limited clinical utility presented a barrier for healthcare provider uptake. There were very few studies that conducted long-term follow-up and evaluation of population genetic screening. Our findings suggest that these and other factors, such as prescreen counseling and education, may play a role in the adoption and implementation of population genetic screening. Future studies to investigate macro-level determinants, strategies to increase provider buy-in and knowledge, delivery models for prescreen counseling, and long-term outcomes of population genetic screening are needed for the effective design and implementation of such programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020198198.
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Affiliation(s)
- Emily C Shen
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,UNC Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Swetha Srinivasan
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Lauren E Passero
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
| | - Caitlin G Allen
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Madison Dixon
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Kimberly Foss
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Brianna Halliburton
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura V Milko
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Amelia K Smit
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.,Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Carlson
- Health Sciences Library, University of North Carolina, Chapel Hill, NC, United States
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States
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20
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Ritchie JB, Welch BM, Allen CG, Frey LJ, Morrison H, Schiffman JD, Alekseyenko AV, Dean B, Hughes Halbert C, Bellcross C. Comparison of a Cancer Family History Collection and Risk Assessment Tool - ItRunsInMyFamily - with Risk Assessment by Health-Care Professionals. Public Health Genomics 2021; 25:1-9. [PMID: 34872100 PMCID: PMC9167897 DOI: 10.1159/000520001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Primary care providers (PCPs) and oncologists lack time and training to appropriately identify patients at increased risk for hereditary cancer using family health history (FHx) and clinical practice guideline (CPG) criteria. We built a tool, "ItRunsInMyFamily" (ItRuns) that automates FHx collection and risk assessment using CPGs. The purpose of this study was to evaluate ItRuns by measuring the level of concordance in referral patterns for genetic counseling/testing (GC/GT) between the CPGs as applied by the tool and genetic counselors (GCs), in comparison to oncologists and PCPs. The extent to which non-GCs are discordant with CPGs is a gap that health information technology, such as ItRuns, can help close to facilitate the identification of individuals at risk for hereditary cancer. METHODS We curated 18 FHx cases and surveyed GCs and non-GCs (oncologists and PCPs) to assess concordance with ItRuns CPG criteria for referring patients for GC/GT. Percent agreement was used to describe concordance, and logistic regression to compare providers and the tool's concordance with CPG criteria. RESULTS GCs had the best overall concordance with the CPGs used in ItRuns at 82.2%, followed by oncologists with 66.0% and PCPs with 60.6%. GCs were significantly more likely to concur with CPGs (OR = 4.04, 95% CI = 3.35-4.89) than non-GCs. All providers had higher concordance with CPGs for FHx cases that met the criteria for genetic counseling/testing than for cases that did not. DISCUSSION/CONCLUSION The risk assessment provided by ItRuns was highly concordant with that of GC's, particularly for at-risk individuals. The use of such technology-based tools improves efficiency and can lead to greater numbers of at-risk individuals accessing genetic counseling, testing, and mutation-based interventions to improve health.
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Affiliation(s)
- Jordon B. Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Brandon M. Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC US
| | - Caitlin G. Allen
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Rollins School of Public Health, Atlanta, Georgia, U.S
| | - Lewis J. Frey
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Heath Morrison
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
| | - Joshua D. Schiffman
- Oncological Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, U.S
| | | | - Brian Dean
- Computer Science, Clemson University, Clemson, SC, U.S
| | - Chanita Hughes Halbert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, U.S
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC US
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC US
| | - Cecelia Bellcross
- Department of Human Genetics, Emory University, Atlanta, Georgia, U.S
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21
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Allen CG, Todem D, Williams KP. Adherence to Mammography and Pap Screening Guidelines Among Medically Underserved Women: the Role of Family Structures and Network-Level Behaviors. J Cancer Educ 2021; 36:1155-1162. [PMID: 33107009 PMCID: PMC8076331 DOI: 10.1007/s13187-020-01879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Poor adherence to screening recommendations is an important contributing factor to disparities in breast and cervical cancer outcomes among women in the USA. Screening behaviors are multifactorial, but there has been limited focus on how family network beliefs and behaviors influence individual's likelihood to complete screening. This research aims to fill this gap by evaluating the role of family network composition and screening behaviors on women's likelihood to adhere to mammogram and pap screening recommendations. We used an ego network approach to analyze data from 137 families and their networks. Primary outcomes were whether an individual had received a mammogram in the past year and whether she had received a pap screening in the past 3 years. Network-level predictors included network composition (size of network, average age of network members, satisfaction with family communication) and network screening behaviors. We conducted multivariable logistic regressions to assess the influence of network-level variables on both mammogram and pap smears, adjusting for potential individual-level confounders. Each network had an average age of 47.9 years, and an average size of 3.05 women, with the majority of members being sisters (57.7%). We found differences in network screening behaviors by race, with Arab networks being less likely to have completed self-breast exams (OR = 0.21, 95%CI = 0.05-0.76, p = 0.02), ever a gotten pap screen (OR = 0.11, 95%CI = 0.01-0.85, p = 0.04), and gotten pap screening in the last 3 years (OR = 0.31, 95%CI = 0.10-0.99, p = 0.04) compared with African American networks. Network screening behaviors also strongly influenced the likelihood of an individual completing a similar screening behavior. This analysis sheds light on family network characteristics that influence screening behaviors among medically underserved women. These findings support the development and dissemination of screening interventions among female's family networks.
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Affiliation(s)
- Caitlin G Allen
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - David Todem
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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22
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Abstract
Achieving health equity among disparity populations has been a national, regional, and local priority for several years. Health promotion and disease prevention behaviors play an important role in achieving health equity; the first generation of behavioral science studies in minority health and health disparities have provided important insights about the nature and distribution of risk exposure behaviors in disparity populations. Interventions have also been developed to enhance health promotion and disease prevention behaviors using behavioral counseling, tailored health communications, and interventions that are developed collaboratively with community stakeholders. Although intervention development and evaluation are components of transdisciplinary translational behavior research, discovery science is a critical first step in translational research. Consistent with this, conceptual models and frameworks of minority health and health disparities have evolved to include multilevel determinants that include basic behavioral mechanisms such as stress responses and stress reactivity that have physiological, psychological, and behavioral components that are relevant to minority health and health disparities. This report describes priorities, opportunities, and barriers to conducting transdisciplinary translational behavioral research during the next generation of minority health and health disparities research.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Caitlin G Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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23
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Allen CG. Choosing to Be Both: Perspectives From a Researcher About Early Motherhood. Am J Public Health 2021; 111:1903. [PMID: 34788118 DOI: 10.2105/ajph.2021.306528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Caitlin G Allen
- Postdoctoral Fellow, Medical University of South Carolina, Charleston
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24
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Babatunde OA, Zahnd WE, Eberth JM, Lawson AB, Adams SA, Boakye EA, Jefferson MS, Allen CG, Pearce JL, Li H, Halbert CH. Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina. Int J Environ Res Public Health 2021; 18:ijerph182211824. [PMID: 34831579 PMCID: PMC8625868 DOI: 10.3390/ijerph182211824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions-the social deprivation index (SDI). Data were analyzed using chi-square tests, Student's t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02-1.10), African American race (OR = 1.35, 95% CI: 1.29-1.41), and being unmarried (OR = 1.17, 95% CI: 1.13-1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Department of Psychiatry, Prisma Health, 109 Physicians Drive, Greer, SC 29650, USA
- Correspondence: ; Tel.: +1-803-477-1675
| | - Whitney E. Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
| | - Jan M. Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL 62794, USA;
| | - Melanie S. Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
| | - Caitlin G. Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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25
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Welch BM, Allen CG, Ritchie JB, Morrison H, Hughes-Halbert C, Schiffman JD. Using a Chatbot to Assess Hereditary Cancer Risk. JCO Clin Cancer Inform 2021; 4:787-793. [PMID: 32897737 DOI: 10.1200/cci.20.00014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We developed a Web-based chatbot (ItRunsInMyFamily.com) to help individuals collect their family health history (FHx) and determine their risk for hereditary cancer. The purpose of the current study was to assess the characteristics of users and identify opportunities to improve the FHx collection tool. METHODS During Family Health History Month (November 2019) we launched an FHx campaign using social media advertisements to raise awareness about hereditary cancers and encourage individuals in the general population to use ItRunsInMyFamily to collect their FHx. Through this campaign, we were able to gather information about users and identify opportunities to improve the tool. RESULTS We reached 14,140 users in November 2019 through online marketing campaigns-Facebook, Google, previous ItRuns users, and Web site marketing. Of those, 3,204 completed the full FHx assessment and received risk recommendations. The campaign targeted women between age 40 and 60 years. Users came from 3,783 counties around the United States, 48 unique cancers were reported among probands, and 79 unique cancers were reported among family members, an average of two and a half cancers per family. CONCLUSION Our results demonstrate that it is possible to gather FHx information at the population level, with high levels of engagement and interest in the topic. There is room for future enhancements and improvements to ItRunsInMyFamily to broaden its reach and encourage individuals to learn about and record their health information.
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Affiliation(s)
- Brandon M Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jordon B Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | | | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Actkins KV, Srinivasan S, Spees LP, Turbitt E, Allen CG, Roberts MC. Uptake of Genetic Testing Among Patients with Cancer At Risk for Lynch Syndrome in the National Health Interview Survey. Cancer Prev Res (Phila) 2021; 14:927-932. [PMID: 34341014 DOI: 10.1158/1940-6207.capr-21-0073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/14/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Lynch syndrome is the most common inherited cancer syndrome that increases the risk of developing colorectal and endometrial cancer. Universal screening guidelines were first recommended by the Centers for Disease Control and Prevention (CDC) in 2009 and are updated annually by multiple societies. Therefore, one would expect genetic testing rates to increase over time. But testing remains underutilized among those with colorectal or endometrial cancer, even though early detection can improve prognosis and survival rates. In this study, we aimed to understand differences in genetic testing uptake among those with colorectal cancer or endometrial cancer from 2005, 2010, 2015, using data from the National Health Interview Survey (NHIS). We examined genetic testing uptake across cancer-type, age (≤50 or ≥51), sex, race, insurance, and education using a χ2 statistical analysis. Despite an upward genetic testing trend in 2010, we found no significant differences in genetic testing uptake over time. In 2010, non-White individuals experienced the highest increase from 2005 in comparison with White individuals. However, genetic testing rates declined for both groups by 2015. Our findings show that genetic testing for colorectal cancer and endometrial cancer did not increase over a 10-year period in spite of guidelines that recommend testing. PREVENTION RELEVANCE: Genetic testing uptake for colorectal cancer and endometrial cancer has not increased over a 10-year period in spite of universal screening guidelines. More genetic testing education is needed at the provider and patient level to improve screening strategies for cancer patients who are most at risk for Lynch syndrome.
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Affiliation(s)
- Ky'Era V Actkins
- Department of Microbiology, Immunology, and Physiology, Meharry Medical College, Nashville, Tennessee
| | - Swetha Srinivasan
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa P Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin Turbitt
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,UNC Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Modell SM, Allen CG, Ponte A, Marcus G. Cancer genetic testing in marginalized groups during an era of evolving healthcare reform. J Cancer Policy 2021; 28:100275. [PMID: 35559905 PMCID: PMC8224823 DOI: 10.1016/j.jcpo.2021.100275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Affordable Care Act and subsequent reforms pose tradeoffs for racial-ethnic, rural, and sex-related groups in the United States experiencing disparities in BRCA1/2 genetic counseling and testing and colorectal cancer screening, calling for policy changes. METHODS A working group of the American Public Health Association Genomics Forum Policy Committee engaged in monthly meetings to examine ongoing literature and identify policy alternatives in the coverage of cancer genetic services for marginalized groups. 589 items were collected; 408 examined. Efforts continued from February 2015 through September 2020. RESULTS African Americans and Latinos have shown 7-8 % drops in uninsured rates since the Exchanges opened. The ACA has increased BRCA1/2 test availability while several disparities remain, including by sex. Rural testing and screening utilization rates have improved. Medicaid expansion and the inclusion of Medicare in the ACA have resulted in mixed improvements in colorectal cancer screening rates in marginalized groups. CONCLUSION Cancer genetic testing and screening to date have only partially benefited from healthcare reforms. Sensitivity to cost concerns and further monitoring of emerging data are needed. A reduction in disparities depends on the availability of private insurance, Medicaid and Medicare to the marginalized. Attention to value-based design and the way cancer benefits are translated into actual testing and screening are crucial. POLICY SUMMARY The findings suggest the need for further benefits-related health agency interpretation of and amendments to the ACA, continued Medicaid and innovative Medicare expansion, and incorporation of cancer services values-based considerations at several levels, aimed at reducing group disparities.
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Affiliation(s)
- Stephen M Modell
- Epidemiology, University of Michigan School of Public Health, M5409 SPH II, 1415 Washington Hts., Ann Arbor, MI, 48109, United States.
| | - Caitlin G Allen
- Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, United States
| | - Amy Ponte
- Genedu Health Solutions, 47 Petigru Dr., Beaufort, SC, 29902, United States
| | - Gail Marcus
- Genetics and Newborn Screening Unit, North Carolina Department of Health and Human Services, C/O CDSA of the Cape Fear, 3311 Burnt Mill Dr., Wilmington, NC, 28403, United States
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Halbert CH, Jefferson M, Allen CG, Babatunde OA, Drake R, Angel P, Savage SJ, Frey L, Lilly M, Obi T, Obeid J. Racial Differences in Patient Portal Activation and Research Enrollment Among Patients With Prostate Cancer. JCO Clin Cancer Inform 2021; 5:768-774. [PMID: 34328797 PMCID: PMC8812608 DOI: 10.1200/cci.20.00131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study was to examine racial differences in patient portal activation and research participation among patients with prostate cancer. MATERIALS AND METHODS Participants were African American and White patients with prostate cancer who were treated with radical prostatectomy (n = 218). Patient portal activation was determined using electronic health records, and research participation was measured based on completion of a social determinants survey. RESULTS Thirty-one percent of patients completed the social determinants survey and enrolled in the study and 66% activated a patient portal. The likelihood of enrolling in the study was reduced with greater levels of social deprivation (odds ratio [OR], 0.70; 95% CI, 0.50 to 0.98; P = .04). Social deprivation also had a signification independent association with patient portal activation along with racial background. African American patients (OR, 0.48; 95% CI, 0.23 to 0.91; P = .02) and those with greater social deprivation (OR, 0.58; 95% CI, 0.42 to 0.82; P = .002) had a lower likelihood of activating a patient portal compared with White patients and those with lower social deprivation. CONCLUSION Although the majority of patients with prostate cancer activated their patient portal, rates of patient portal activation were lower among African American patients and those who lived in areas with greater social deprivation. Greater efforts are needed to promote patient portal activation among African American patients with prostate cancer and address access to health information technology among those who live in socially disadvantaged geographic areas.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Oluwole A Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Richard Drake
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Peggi Angel
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Stephen J Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Lewis Frey
- Department of Public Health Sciences, Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Division of Hematology-Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Ted Obi
- Ichan School of Medicine at Mount Sinai, New York, NY
| | - Jihad Obeid
- Department of Public Health Sciences, Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC
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Roberts MC, Fohner AE, Landry L, Olstad DL, Smit AK, Turbitt E, Allen CG. Advancing precision public health using human genomics: examples from the field and future research opportunities. Genome Med 2021; 13:97. [PMID: 34074326 PMCID: PMC8168000 DOI: 10.1186/s13073-021-00911-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/17/2021] [Indexed: 01/21/2023] Open
Abstract
Precision public health is a relatively new field that integrates components of precision medicine, such as human genomics research, with public health concepts to help improve population health. Despite interest in advancing precision public health initiatives using human genomics research, current and future opportunities in this emerging field remain largely undescribed. To that end, we provide examples of promising opportunities and current applications of genomics research within precision public health and outline future directions within five major domains of public health: biostatistics, environmental health, epidemiology, health policy and health services, and social and behavioral science. To further extend applications of genomics within precision public health research, three key cross-cutting challenges will need to be addressed: developing policies that implement precision public health initiatives at multiple levels, improving data integration and developing more rigorous methodologies, and incorporating initiatives that address health equity. Realizing the potential to better integrate human genomics within precision public health will require transdisciplinary efforts that leverage the strengths of both precision medicine and public health.
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Affiliation(s)
- Megan C. Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599 USA
| | - Alison E. Fohner
- Department of Epidemiology and Institute of Public Health Genetics, University of Washington, 1959 NE Pacific Ave, Seattle, WA 98195 USA
| | - Latrice Landry
- Harvard Medical School, Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital &The Division of Population Sciences in Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215-5450 USA
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Amelia K. Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 119-143 Missenden Road, Camperdown, NSW 2050 Australia
| | - Erin Turbitt
- Discipline of Genetic Counselling, The University of Technology Sydney, 100 Broadway, Ultimo, NSW 2008 Australia
| | - Caitlin G. Allen
- Department of Behavioral Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
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Allen CG, Bethea BJ, McKinney LP, Escoffery C, Akintobi TH, McCray GG, McBride CM. Exploring the Role of Community Health Workers in Improving the Collection of Family Health History: A Pilot Study. Health Promot Pract 2021; 23:504-517. [PMID: 34049463 DOI: 10.1177/15248399211019980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community health workers (CHWs) have been successful partners in addressing public health and health care challenges but have yet to be engaged in efforts to promote family health history (FHH) collection. FHH information is a key factor in determining disease risk and supporting screening and prevention across multiple diseases. The collection of FHH information could be facilitated by the existing cadre of CHWs already working alongside clients and families. In this qualitative study, we interviewed 30 CHWs from Georgia to better understand the current level of knowledge about FHH, perceptions of how FHH collection aligns with their role, and barriers and facilitators in order to support more active involvement of CHWs in FHH collection. Interviews were completed, transcribed, and double coded by three study team members. More than half of CHWs reported knowing their own FHH information. CHWs showed a strong interest and support for collecting FHH in their job, despite limited current engagement in this role. CHWs acknowledged the collection of FHH as being an opportunity to empower clients to have conversations with their providers. To better support this work, CHWs requested training in using and integrating FHH tools into their workflow and support in communicating about FHH with their clients. Our findings suggest that with support and training, CHWs are uniquely positioned to improve FHH collection among their client base. Ultimately, improving FHH collection skills among the population could allow for better integration of risk-stratified approaches that are informed by FHH information for the prevention, management, and treatment of disease.
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Allen CG, Cotter MM, Smith RA, Watson L. Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research. Transl Behav Med 2021; 11:1088-1098. [PMID: 33289828 PMCID: PMC8248958 DOI: 10.1093/tbm/ibaa121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site's project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Science and Health Education,
Rollins School of Public Health, Emory University, Atlanta, GA,
USA
| | - Megan M Cotter
- Population Sciences Department, American Cancer Society,
Inc., Atlanta, GA, USA
| | - Robert A Smith
- Prevention and Early Detection Team, American Cancer
Society, Inc., Atlanta, GA, USA
| | - Lesley Watson
- Strategy and Analytics Team, American Cancer Society
Cancer Action Network, Inc., Washington, DC, USA
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Allen CG, Peterson S, Khoury MJ, Brody LC, McBride CM. A scoping review of social and behavioral science research to translate genomic discoveries into population health impact. Transl Behav Med 2021; 11:901-911. [PMID: 32902617 PMCID: PMC8240657 DOI: 10.1093/tbm/ibaa076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the completion of the Human Genome Project, progress toward translating genomic research discoveries to address population health issues has been limited. Several meetings of social and behavioral scientists have outlined priority research areas where advancement of translational research could increase population health benefits of genomic discoveries. In this review, we track the pace of progress, study size and design, and focus of genomics translational research from 2012 to 2018 and its concordance with five social and behavioral science recommended priorities. We conducted a review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines for Scoping Reviews. Steps involved completing a search in five databases and a hand search of bibliographies of relevant literature. Our search (from 2012 to 2018) yielded 4,538 unique studies; 117 were included in the final analyses. Two coders extracted data including items from the PICOTS framework. Analysis included descriptive statistics to help identify trends in pace, study size and design, and translational priority area. Among the 117 studies included in our final sample, nearly half focused on genomics applications that have evidence to support translation or implementation into practice (Centers for Disease Control and Prevention Tier 1 applications). Common study designs were cross-sectional (40.2%) and qualitative (24.8%), with average sample sizes of 716 across all studies. Most often, studies addressed public understanding of genetics and genomics (33.3%), risk communication (29.1%), and intervention development and testing of interventions to promote behavior change (19.7%). The number of studies that address social and behavioral science priority areas is extremely limited and the pace of this research continues to lag behind basic science advances. Much of the research identified in this review is descriptive and related to public understanding, risk communication, and intervention development and testing of interventions to promote behavior change. The field has been slow to develop and evaluate public health-friendly interventions and test implementation approaches that could enable health benefits and equitable access to genomic discoveries. As the completion of the human genome approaches its 20th anniversary, full engagement of transdisciplinary efforts to address translation challenges will be required to close this gap.
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Affiliation(s)
- Caitlin G Allen
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
| | - Shenita Peterson
- Woodruff Health Science Center Library, Emory University, Atlanta, GA, USA
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lawrence C Brody
- Gene and Environment Interaction Section, National Human Genome Research Institute, Bethesda, MD, USA
| | - Colleen M McBride
- Behavioral, Social and Health Education Sciences Department, Emory University, Atlanta, GA, USA
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Guan Y, McBride CM, Rogers H, Zhao J, Allen CG, Escoffery C. Initiatives to Scale Up and Expand Reach of Cancer Genomic Services Outside of Specialty Clinical Settings: A Systematic Review. Am J Prev Med 2021; 60:e85-e94. [PMID: 33168338 PMCID: PMC7855907 DOI: 10.1016/j.amepre.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT This systematic review aims to (1) characterize strategies used to identify individuals at increased risk for hereditary breast and ovarian cancer syndrome and Lynch syndrome outside of oncology and clinical genetic settings, (2) describe the extent to which these strategies have extended the reach of genetic services to underserved target populations, and (3) summarize indicators of the potential scalability of these strategies. EVIDENCE ACQUISITION Investigators searched PubMed, EMBASE, and PsycINFO for manuscripts published from October 2005 to August 2019. Eligible manuscripts were those published in English, those that described strategies to identify those at risk for hereditary breast and ovarian cancer syndrome or Lynch syndrome, those implemented outside of an oncology or genetic specialty clinic, and those that included measures of cancer genetic services uptake. This study assessed strategies used to increase the reach of genetic risk screening and counseling services. Each study was evaluated using the 16-item quality assessment tool, and results were reported according to the PRISMA guidelines. EVIDENCE SYNTHESIS Of the 16 eligible studies, 11 were conducted in clinical settings and 5 in public health settings. Regardless of setting, most (63%, 10/16) used brief screening tools to identify people with a family history suggestive of hereditary breast and ovarian cancer syndrome or Lynch syndrome. When reported, genetic risk screening reach (range =11%-100%) and genetic counseling reach (range =11%-100%) varied widely across studies. Strategies implemented in public health settings appeared to be more successful (median counseling reach=65%) than those implemented in clinical settings (median counseling reach=26%). Most studies did not describe fundamental components relevant for broad scalability. CONCLUSIONS Efforts to expand cancer genomic services are limited outside of traditional oncology and genetic clinics. This is a missed opportunity because evidence thus far suggests that these efforts can be successful in expanding the reach of genetic services with the potential to reduce health inequities in access. This review highlights the need for accelerating research that applies evidence-based implementation strategies and frameworks along with process evaluation to understand barriers and facilitators to scalability of strategies with high reach.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hannah Rogers
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Jingsong Zhao
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Allen CG, Green RF, Bowen S, Dotson WD, Yu W, Khoury MJ. Challenges and Opportunities for Communication about the Role of Genomics in Public Health. Public Health Genomics 2021; 24:67-74. [PMID: 33445172 DOI: 10.1159/000512485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/22/2020] [Indexed: 11/19/2022] Open
Abstract
Despite growing awareness about the potential for genomic information to improve population health, lingering communication challenges remain in describing the role of genomics in public health programs. Identifying and addressing these challenges provide an important opportunity for appropriate communication to ensure the translation of genomic discoveries for public health benefits. In this commentary, we describe 5 common communication challenges encountered by the Centers for Disease Control and Prevention's Office of Genomics and Precision Public Health based on over 20 years of experience in the field. These include (1) communicating that using genomics to assess rare diseases can have an impact on public health; (2) providing evidence that genetic factors can add important information to environmental, behavioral, and social determinants of health; (3) communicating that although genetic factors are nonmodifiable, they can increase the impact of public health programs and communication strategies; (4) addressing the concern that genomics is not ready for clinical practice; and (5) communicating that genomics is valuable beyond the domain of health care and can be integrated as part of public health programs. We discuss opportunities for addressing these communication challenges and provide examples of ongoing approaches to communication about the role of genomics in public health to the public, researchers, and practitioners.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ridgely Fisk Green
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Bowen
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W David Dotson
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Yu
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Muin J Khoury
- Office of Genomics and Precision Public Health, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,
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Allen CG, Escoffery C, An W, Brody G, Hood C, McBride CM. Abstract PO-239: Improving family cancer history collection among African American families: A mixed-methods assessment of qualities of a family health history collection tool. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Importance: Family cancer history (FCH) is a critical cancer risk factor. Gathering this information using a FCH collection tool is considered the front-line method for assessing cancer risk. High-quality FCH collection tools are essential to recording health information and allowing providers to tailor prevention and early detection. Unfortunately, most FCH tools do not consider end-users’ perspectives resulting in fewer than 3% of the population having ever used a tool to record health information. African American (AA) families are among the least likely to use a FCH tool to complete health history. Objective: To evaluate AA perceptions of FCH tools using the diffusion of innovations (DOI) constructs and assess whether these tool characteristics influence subjective (belief about how well they completed the tool) or objective (percent of tool complete) FCH completeness. Methods: 52 AA individuals used a publically available FCH collection tool (ItRunsInMyFamily) to complete their family history of cancer. Individuals answered survey questions (10 point scale) and were interviewed about their experience using the tool based on the DOI innovation constructs. Basic descriptive and bivariate analyses were conducted for the quantitative results using SAS 9.4 and qualitative results were analyzed using MaxQDA. Results: We found overall positive experiences for individuals who used the FCH tools (means: complexity=8.8, compatibility=8.8, observability=7.9, trialability=8.9, and relative advantages=8.0). Lower levels of perceived complexity of the tool was associated with higher levels of subjective FCH completeness (B=0.06, p=0.004). There were no associations between DOI tool characteristics and objective FCH completeness. Qualitative findings suggested that interviewees felt the tool was easy to understand and use; however, the tool did not account for unique family dynamics (e.g., step siblings) or extended kin beyond three generations. Many reported using the networking feature of the tool to invite their family members to complete relevant information, but few reported that their family members ever engaged with the tool. Conclusion and Relevance: AA individuals who were part of this study had positive perceptions about FCH tool characteristics. Of the DOI constructs assessed, only complexity was associated with how well individuals perceived they completed their FCH (not how well they actually completed their FCH). Reducing tool complexity could help improve overall impressions of the tool and self-efficacy about ability to complete FCH. Improving the networking capabilities of the tool and providing education to family members who are invited to contribute health information may improve engagement of family members in completing relevant aspects of the FCH tools and improve completeness of FCH.
Better tailoring of tools for AA families could reduce known disparities in FCH tool use and enhance opportunities for risk-stratified screening and early cancer detection among AAs.
Citation Format: Caitlin G. Allen, Cam Escoffery, Weihua An, Gene Brody, Clarissa Hood, Colleen M. McBride. Improving family cancer history collection among African American families: A mixed-methods assessment of qualities of a family health history collection tool [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-239.
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Jefferson M, Magwood G, Melvin C, Babatunde O, Halbert CH, Allen CG. Abstract PO-074: Understanding men’s concerns about linking health data in the context of precision medicine. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background and Importance: Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers’ and clinicians’ ability to deliver care. To date, we have limited understanding of how racial and ethnic minorities perceive linking data as it relates to precision medicine. Objective: The aim of this study was to identify how demographics, co-morbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among minority men. Methods: Adult individuals were recruited from primary care practices at a large clinical research university. 375 individuals were invited to participate and 124 completed a cross-sectional survey that included questions about demographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptives, bivariate, and multivariable regression were conducted in SAS version 9.4. Results: Participants had positive perceptions about beliefs about linking data for precision medicine (M=4.05/5) and average concern about linking data (M=2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (B=0.41, p=0.027). Races other than Black or African American (B=-0.64, p=0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (B=-0.75, p=-.0006).
Conclusion and Relevance: Our results contribute to the lack of literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants.
Citation Format: Melanie Jefferson, Gayenell Magwood, Cathy Melvin, Oluwole Babatunde, Chanita Hughes Halbert, Caitlin G. Allen. Understanding men’s concerns about linking health data in the context of precision medicine [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-074.
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Affiliation(s)
| | | | - Cathy Melvin
- 1Medical University of South Carolina, Charleston, SC,
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Halbert CH, Allen CG, Jefferson M, Magwood GS, Melvin C, Babatunde OA, Baquet C, Delmoor E, Johnson J, Mathews D, Leach RJ, Ricks-Santi L. Lessons Learned from the Medical University of South Carolina Transdisciplinary Collaborative Center (TCC) in Precision Medicine and Minority Men's Health. Am J Mens Health 2020; 14:1557988320979236. [PMID: 33319609 PMCID: PMC7745579 DOI: 10.1177/1557988320979236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
The Transdisciplinary Collaborative Center (TCC) in Precision Medicine for Minority Men's Health was established at the Medical University of South Carolina (MUSC) in 2015 to address disparities in the translation of precision medicine approaches among racial minority groups. This regional consortium focuses on three primary areas: (1) the development of a consortium of regional and national partners, (2) conducting transdisciplinary research examining synergistic effects of biological, social, physiological, and clinical determinants of chronic disease risks and outcomes, and (3) dissemination and implementation of precision medicine approaches, with an emphasis on reducing disparities in health care and outcomes among minority men. Given consistent calls to better translate precision medicine approaches and the focus of this consortium on addressing disparities among minority men, we provide an overview of our experience in developing the MUSC TCC, including barriers and facilitators to conducting translational research on minority men's health issues in the context of precision medicine. Lessons learned and areas for improvement include providing enough time to create consistent partnerships and community engagement to improve recruitment and retention, identifying unique ways to engage diverse partners from across the region and nation, and better approaches to dissemination and communication for large partnerships focusing on precision medicine.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin G. Allen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melanie Jefferson
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell S. Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Cathy Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Oluwole Adeyami Babatunde
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Claudia Baquet
- Hope Institute LLC and UMB School of Pharmacy Pharmaceutical HSR, Baltimore, USA
| | - Ernestine Delmoor
- Philadelphia Chapter, National Black Leadership Initiative on Cancer, Philadelphia, PA, USA
| | - Jerry Johnson
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Robin J. Leach
- Department of Cell Systems and Anatomy, Mays Cancer Center, UT Health San Antonio, San Antonio, TX, USA
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McBride CM, Graves KD, Kaphingst KA, Allen CG, Wang C, Arredondo E, Klein WMP. Behavioral and social scientists' reflections on genomics: a systematic evaluation within the Society of Behavioral Medicine. Transl Behav Med 2020; 9:1012-1019. [PMID: 30950497 DOI: 10.1093/tbm/ibz044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clinical and public health translation of genomics could be facilitated by expertise from behavioral medicine, yet genomics has not been a significant focus of the Society of Behavioral Medicine (SBM). SBM convened a working group (WG) to lead a systematic exploration of members' views on: (a) whether SBM should give a higher priority to genomic translation and (b) what efforts, if any, should be made to support this increased engagement. The WG used a stepped process over 2 years that began by gaining input from SBM leadership regarding key issues and suggestions for approach, engaging a cross section of membership to expand and record these discussions, followed by systematic qualitative analyses to inform priority action steps. Discussions with SBM leaders and members suggested that genomics was relevant to SBM, particularly for junior members. SBM members' expertise in social and behavioral theory, and implementation study designs, were viewed as highly relevant to genomic translation. Participants expressed that behavioral and social scientists should be engaged in translational genomics work, giving special attention to health disparities. Proposed action steps are aligned with a "push-pull" framework of innovation dissemination. "Push" strategies aim to reach potential adopters and included linking members with genomics expertise to those wanting to become involved and raising awareness of evidence-based genomic applications ready for implementation. "Pull" strategies aim to expand demand and included developing partnerships with genomics societies and advocating for funding, study section modifications, and training programs.
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Affiliation(s)
- Colleen M McBride
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristi D Graves
- Fisher Center for Hereditary Cancer, Georgetown University, Washington, DC, USA
| | | | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Catharine Wang
- Community Sciences Department, Boston University School of Public Health, Boston, MA, USA
| | - Elva Arredondo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA, USA
| | - William M P Klein
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, USA
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Allen CG, Roberts M, Andersen B, Khoury MJ. Correction to: Communication about Hereditary Cancers on Social Media: a Content Analysis of Tweets about Hereditary Breast and Ovarian Cancer and Lynch Syndrome. J Cancer Educ 2020; 35:827-831. [PMID: 32415435 DOI: 10.1007/s13187-020-01754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The original version of this article unfortunately contained mistakes.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Megan Roberts
- The National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | | | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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Allen CG, Ritchie JB, Morrison H, Lauzon SD, Nichols M, Schiffman JD, Hughes Halbert C, Welch BM. A thematic analysis of health information technology use among cancer genetic counselors. J Genet Couns 2020; 30:170-179. [PMID: 32643297 DOI: 10.1002/jgc4.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
As precision medicine becomes a mainstay in health care, the use of health information technology (IT) platforms will play an important role in the delivery of services across the cancer care continuum. Currently, there is both limited understanding about perceptions of health IT tools and barriers to their use among cancer genetic counselors. We assessed open-ended responses from a survey conducted among 128 board-certified cancer genetic counselors in the United States. We evaluated the utility of ten health IT tools and perceived barriers to adoption. Responses about characteristics of health IT tools that influence current use (i.e., technology-specific challenges) were deductively analyzed using the diffusion of innovations (DOI) characteristics. Responses about cancer genetic counselors' perceived challenges to adopting health IT tools (i.e., discipline-specific challenges) were inductively coded using a thematic approach. DOI innovation characteristics included mixed perceptions about the relative advantage, complexity, compatibility, trialability, and observability of tools based on the type of tool and perceived end-user. One-third of participants indicated that they were considering adopting or switching health IT tools. Common barriers to adoption included no perceived need for change, lack of organizational infrastructure, cost, and lack of decision-making power. Our findings indicate that addressing barriers to use and adoption of health IT may allow for expansion of these tools among cancer genetic counselors. Integrating health IT is critical for enhancing cancer genetic counselors' capacity to address patient needs and realizing the potential of precision medicine.
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Affiliation(s)
- Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jordon B Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brandon M Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
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Allen CG, Barbero C, Shantharam S, Moeti R. Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settings. J Public Health Manag Pract 2020; 25:571-580. [PMID: 30180116 PMCID: PMC6395551 DOI: 10.1097/phh.0000000000000846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Community health workers (CHWs) are becoming a well-recognized workforce to help reduce health disparities and improve health equity. Although evidence demonstrates the value of engaging CHWs in health care teams, there is a need to describe best practices for integrating CHWs into US health care settings. The use of existing health promotion and implementation theories could guide the research and implementation of health interventions conducted by CHWs. We conducted a standard 5-step scoping review plus stakeholder engagement to provide insight into this topic. Using PubMed, EMBASE, and Web of Science, we identified CHW intervention studies in health care settings published between 2000 and 2017. Studies were abstracted by 2 researchers for characteristics and reported use of theory. Our final review included 50 articles published between January 2000 and April 2017. Few studies used implementation theories to understand the facilitators and barriers to CHW integration. Those studies that incorporated implementation theories used RE-AIM, intervention mapping, cultural tailoring, PRECEDE-PROCEED, and the diffusion of innovation. Although most studies did not report using implementation theories, some constructs of implementation such as fidelity or perceived benefits were assessed. In addition, studies that reported intervention development often cited specific theories, such as the transtheoretical or health belief model, that helped facilitate the development of their program. Our results are consistent with other literature describing poor uptake and use of implementation theory. Further translation of implementation theories for CHW integration is recommended.
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Affiliation(s)
- Caitlin G Allen
- Emory University School of Public Health, Atlanta, Georgia (Ms Allen); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Barbero and Ms Moeti; and IHRC, Inc, Atlanta, Georgia (Ms Shantharam)
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Allen CG, McKinney L, Bethea B, Escoffery C, McCray G, McBride C, Akintobi T. Abstract B090: Exploring the roles of CHWs in improving uptake of family health history assessment among patients and providers: Implications for cancer risk reduction and prevention among minority populations. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-b090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The collection of family health history (FHH) is integral to the implementation of population screening that could identify those at high cancer risk who could benefit most from life-saving interventions. Although most individuals believe FHH is important to their health, few actually collect or know their FHH. Recent findings have identified a reduced likelihood of FHH collection among minority populations who may already be at an increased risk for familial cancers such as kidney, cervical, prostate, ovarian, and triple-negative breast cancer. The community health worker (CHW) workforce is especially well positioned to address these challenges in FHH collection, as they are trusted members of their community and well recognized for their work in creating community-clinical linkages. Engaging CHWs in promoting FHH collection could help improve cancer risk assessment utilization among minority populations. We conducted 30 semistructured interviews with CHWs in Georgia to understand their current roles and opportunities to expand their roles to include the gathering and sharing FHH information. Interview questions were guided by the Consolidated Framework for Implementation Research and also included current engagement in FHH collection, beliefs and understanding of FHH collection, and perceived training needs to complete an FHH record using an FHH collection tool. All interviews were double coded in MAXQDA using a codebook developed, adapted, and agreed upon by the research team. Findings demonstrate that most CHWs believe that there is value in collecting FHH and that they are well suited to gather basic FHH information, but the majority had no experience collecting FHH, either formally as part of their jobs or from their own family members. Some concerns raised about this role include the potential for community members to be resistant to providing the information, CHWs' lack of medical knowledge required to address questions from clients about genetics, and the potential complexity of information needed to complete FHH tools. CHWs also provided recommendations for reducing the burden of FHH collection such as tutorials about how to gather accurate and complete information. They also suggested providing resources to clients that focus on the importance of knowing FHH and how it can be used to improve health and become knowledgeable about cancer risk-reduction resources and prevention strategies. Understanding opportunities for CHWs to extend their role in this way could help improve health care delivery and access by enhancing patient-provider communication about FHH in order to tailor recommendations, prevention, and treatment of diseases. Results from this study may inform efforts to strengthen the utility of existing FHH collection tools and accompanying materials to promote the uptake of FHH assessment among patients and providers.
Citation Format: Caitlin G. Allen, Lawrence McKinney, Brittaney Bethea, Cam Escoffery, Gail McCray, Colleen McBride, Tabia Akintobi. Exploring the roles of CHWs in improving uptake of family health history assessment among patients and providers: Implications for cancer risk reduction and prevention among minority populations [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B090.
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Ritchie JB, Allen CG, Morrison H, Nichols M, Lauzon SD, Schiffman JD, Hughes Halbert C, Welch BM. Utilization of health information technology among cancer genetic counselors. Mol Genet Genomic Med 2020; 8:e1315. [PMID: 32468681 PMCID: PMC7434745 DOI: 10.1002/mgg3.1315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background Health information technology (IT) is becoming increasingly utilized by cancer genetic counselors (CGCs). We sought to understand the current engagement, satisfaction, and opportunities to adopt new health IT tools among CGCs. Methods We conducted a mixed‐mode survey among 128 board‐certified CGCs using both closed‐ and open‐ended questions. We then evaluated the utilization and satisfaction among 10 types of health IT tools, including the following: cancer screening tool, family health history (FHx) collection tools, electronic health records (EHRs), telegenetics software, pedigree drawing software, genetic risk assessment tools, gene test panel ordering tools, electronic patient education tools, patient communication tools, and family communication tools. Results Seven of 10 health IT tools were used by a minority of CGCs. The vast majority of respondents reported using EHRs (95.2%) and genetic risk assessment tools (88.6%). Genetic test panel ordering software had the highest satisfaction rate (very satisfied and satisfied) at 80.0%, followed by genetic risk assessment tools (77.1%). EHRs had the highest dissatisfaction rate among CGCs at 18.3%. Dissatisfaction with a health IT tool was associated with desire to change: EHRs (p < .001), cancer screening tools (p = .010), genetic risk assessment tools (p = .024), and family history collection tools (p = .026). We found that nearly half of CGCs were considering adopting or changing their FHx tool (49.2%), cancer screening tool (44.9%), and pedigree drawing tool (41.8%). Conclusion Overall, CGCs reported high levels of satisfaction among commonly used health IT tools. Tools that enable the collection of FHx, cancer screening tools, and pedigree drawing software represent the greatest opportunities for research and development.
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Affiliation(s)
- Jordon B Ritchie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Heath Morrison
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Steven D Lauzon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua D Schiffman
- University of Utah, Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Medical University of South Carolina, Hollings Cancer Center, Charleston, SC, USA
| | - Brandon M Welch
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.,Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
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Allen CG, Duquette D, Guan Y, McBride CM. Applying theory to characterize impediments to dissemination of community-facing family health history tools: a review of the literature. J Community Genet 2020; 11:147-159. [PMID: 31267271 PMCID: PMC7062972 DOI: 10.1007/s12687-019-00424-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/30/2019] [Indexed: 10/26/2022] Open
Abstract
Uptake of community-facing family health history (FHH) tools to identify those at highest risk of disease and target prevention efforts has been consistently low. This review uses the diffusion of innovations (DOI) as a framework to organize the FHH evidence base and identify potential strategies to improve uptake of community-facing FHH tools. Methods for this literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We completed systematic searches in PubMed, Embase, and Web of Science databases for studies from 2009 to 2017 and hand searched bibliographies of relevant literature to identify additional articles. We abstracted and synthesized results, which were then organized by the DOI including the innovation-decision making process and characteristics of the innovation likely to influence diffusion (e.g., compatibility, relative advantage, complexity, trialability, observa/bility). Of the 290 unique articles identified, 65 were eligible for full-text review after title and abstract screening; a total of 27 were included in the final abstraction. Eleven unique tools were identified. The most commonly used tool was the Surgeon General's My Family Health Portrait (n =9/27). Only six studies directly evaluated participant perceptions shown to be associated with tool uptake. Studies tended to focus on improving compatibility by customizing tools to the target population's needs and use of educational interventions. Results from this review suggest the need to evaluate strategies to increase the pace of uptake of community-facing FHH tools. These include pragmatic trials that compare different approaches to engage and evaluate participant perceptions of the relative advantage and complexity of tools. Ancillary support strategies may include collaborations with community networks to facilitate use and implementation study designs for rigorous evaluation.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30308, USA.
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, 420 East Superior Street, Chicago, IL, 60611, USA
| | - Yue Guan
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30308, USA
| | - Colleen M McBride
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30308, USA
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Allen CG, Roberts M, Andersen B, Khoury MJ. Communication About Hereditary Cancers on Social Media: A Content Analysis of Tweets About Hereditary Breast and Ovarian Cancer and Lynch Syndrome. J Cancer Educ 2020; 35:131-137. [PMID: 30506398 DOI: 10.1007/s13187-018-1451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Social media is increasingly being used as an information source and tool for individuals and organizations to share resources and engage in conversations about health topics. Because the public tends to learn about health topics and genetics from online social media sources, it is imperative to understand the amount, type, and quality of information being shared. We performed a retrospective analysis of tweets related to hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS) between January 1, 2017 and December 31, 2017. A total of 63,770 tweets were included in our dataset. The majority were retweets (59.9%) and users came from 744 different cities. Most tweets were considered "informational" (51.4%) and were designed to provide resources to the public. Online communities (25%), organizations (20%), and providers or researchers (15%) were among the most common contributors. Our results demonstrated that conversations were primarily focused on information and resource sharing, along with individuals discussing their personal stories and testimonials about their experiences with these HBOC and LS. Future studies could consider ways to harness Twitter to help tailor and deliver health communication campaigns and education interventions to improve the public's understanding of these complex topics.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Megan Roberts
- The National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | | | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA
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Allen CG, McBride CM, Haardörfer R, Roberts MC. Associations Between Objective Television Exposure and Cancer Perceptions in a National Sample of Adults. Cancer Control 2019; 26:1073274819846603. [PMID: 31131620 PMCID: PMC6537258 DOI: 10.1177/1073274819846603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The expanding sources of media coverage of cancer may have a powerful impact on
emotions, cancer knowledge, information seeking, and other health behaviors. We
explored whether television advertisements were associated with cancer worry,
perceived risk, and perceived ability to prevent cancer using cross-sectional
data from the Health Information National Trends Survey (HINTS) linked to
television advertisement data from Kantar Media. We conducted hierarchical
linear modeling assessing 2-level models for each of the 3 outcomes of interest.
The most common content included advertisements for cancer clinics (54.4%),
public service announcements about cancer (22.0%), and advertisements about
cancer organizations (9.1%). Most variance in cancer perceptions was due to
individual-level characteristics and not exposure to television advertisements,
which aligns with previous literature suggesting a small, but significant,
association of television exposure with health beliefs. Higher levels of
exposures to cancer-specific television advertisements were associated with
higher levels of risk perceptions. Additionally, older adults’ levels of
perceived worry and risk were more likely to be associated with television
exposure than younger adults. Given the substantial investments being made in
cancer advertisements on television, the differences in exposure are important
to consider in future efforts to understand predictors of beliefs about cancer
and in the development of interventions designed to target risk-reducing
behaviors.
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Affiliation(s)
- Caitlin G Allen
- 1 Behavioral Sciences and Health Education Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colleen M McBride
- 1 Behavioral Sciences and Health Education Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- 1 Behavioral Sciences and Health Education Department, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Megan C Roberts
- 2 Division of Cancer Control and Population Sciences, The National Cancer Institute, Bethesda, MD, USA
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Roberts MC, Allen CG, Andersen BL. The FDA authorization of direct-to-consumer genetic testing for three BRCA1/2 pathogenic variants: a twitter analysis of the public's response. JAMIA Open 2019; 2:411-415. [PMID: 32025636 PMCID: PMC6993995 DOI: 10.1093/jamiaopen/ooz037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/30/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives In March 2018, the Food and Drug Administration (FDA) announced its authorization of a direct-to-consumer (DTC) genetic test for three pathogenic BRCA1/2 variants. We sought to determine to whether social media discussion increased following the authorization, who was driving social media conversations, and what topics were discussed. Methods Using Crimson Hexagon, we described tweets before, during, and after the FDA announcement authorizing 23andMe to return BRCA1/2 results (3/4/18–3/10/18). We conducted qualitative coding of a subset of 605 tweets to better understand Twitter communication. Results We identified 11 055 twitter posts across the week of FDA’s announcement. Twitter discourse about 23andMe and the FDA authorization peaked the day following the FDA’s press release. Most tweets (48.6%) were informational and 26.3% were either expressing opinions (about 23andMe and/or FDA authorization, 14.9%) or testimonials (personal experiences with genetic testing, 11.4%). The types of tweets varied over the week-long period (P < .001). Discussion Twitter discussion about the FDA’s authorization of DTC for three pathogenic BRCA1/2 variants increased immediately following the announcement. As more genetic technologies are brought to the DTC market, social media sites, like Twitter, will play a role in disseminating this information, providing a platform for information exchange, consumer testimonials, opinion pieces, and research.
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Affiliation(s)
- Megan C Roberts
- The National Cancer Institute, Division of Cancer Control and Population Sciences, Rockville, Maryland, USA
| | - Caitlin G Allen
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Brittany L Andersen
- Boston University College of Communication, Division of Emerging Media Studies, Boston, Massachusetts, USA
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Allen CG, Fohner AE, Landry L, Paul JL, Smith SG, Turbitt E, Roberts MC. Perspectives From Early Career Investigators Who Are "Staying in the Game" of Precision Public Health Research. Am J Public Health 2019; 109:1186-1187. [PMID: 31390241 PMCID: PMC6687233 DOI: 10.2105/ajph.2019.305199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Caitlin G Allen
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Alison E Fohner
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Latrice Landry
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Jean L Paul
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Samuel G Smith
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Erin Turbitt
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | - Megan C Roberts
- Caitlin G. Allen is with the Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA. Alison E. Fohner is with the Department of Epidemiology, University of Washington, Seattle. Latrice Landry is with Harvard School of Public Health, Cambridge, MA. Jean L. Paul is with the Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria. Samuel G. Smith is with Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom. Erin Turbitt is with the Graduate School of Health, University of Technology Sydney, Ultimo, Australia. Megan C. Roberts is with the Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill
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Allen CG, Fohner AE, Landry L, Paul J, Smith SG, Turbitt E, Roberts MC. Early career investigators and precision public health. Lancet 2019; 394:382-383. [PMID: 31379330 DOI: 10.1016/s0140-6736(19)30498-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/26/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Caitlin G Allen
- Behavioral Sciences and Health Education Department, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | - Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Latrice Landry
- Laboratory for Molecular Medicine, Partners Medicine, Boston, MA, USA
| | - Jean Paul
- The Village Research Project, Mental Health Research Program, Ludwig Boltzmann Gesellschaft/Medical University of Innsbruck, Innsbruck, Austria
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Erin Turbitt
- Discipline of Genetic Counselling, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Allen CG, Roberts M, Guan Y. Exploring Predictors of Genetic Counseling and Testing for Hereditary Breast and Ovarian Cancer: Findings from the 2015 U.S. National Health Interview Survey. J Pers Med 2019; 9:E26. [PMID: 31083288 PMCID: PMC6616387 DOI: 10.3390/jpm9020026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
Despite efforts to increase the availability of clinical genetic testing and counseling for Hereditary Breast and Ovarian (HBOC)-related cancers, these services remain underutilized in clinical settings. There have been few efforts to understand the public's use of cancer genetic services, particularly for HBOC-related cancers. This analysis is based on data from the 2015 National Health Interview Survey (NHIS), a U.S.-based nationwide probability sample, to better understand the public's use of HBOC-related clinical cancer genetic services. Bivariate analyses were used to compute percentages and examine the associations of familial cancer risk for three genetic services outcomes (ever had genetic counseling for cancer risk, ever discussed genetic testing for cancer risk with a provider, and ever had genetic testing for cancer risk). Multivariable logistic regression models were used to estimate the association of familial cancer risk and other demographic and health variables with genetic services. Most women (87.67%) in this study were at low risk based on self-reported family history of breast and ovarian cancer, 10.65% were at medium risk, and 1.68% were at high risk. Overall, very small numbers of individuals had ever had genetic counseling (2.78%), discussed genetic testing with their physician (4.55%) or had genetic testing (1.64%). Across all genetic services outcomes, individuals who were at higher familial risk were more likely to have had genetic counseling than those at lower risk (high risk: aOR = 5.869, 95% CI = 2.911-11.835; medium risk: aOR = 4.121, 95% CI = 2.934-5.789), discussed genetic testing (high risk: aOR = 5.133, 95% CI = 2.699-9.764; medium risk: aOR = 3.649, 95% CI = 2.696-4.938), and completed genetic testing (high risk: aOR = 8.531, 95% CI = 3.666-19.851; medium risk aOR = 3.057, 95% CI = 1.835-5.094). Those who perceived themselves as being more likely to develop cancer than the average woman were more likely to engage in genetic counseling (aOR = 1.916, 95% CI = 1.334-2.752), discuss genetic testing (aOR = 3.314, 95% CI = 2.463-4.459) or have had genetic testing (aOR = 1.947, 95% CI = 1.13-3.54). Personal cancer history was also a significant predictor of likelihood to have engaged in genetic services. Our findings highlight: (1) potential under-utilization of cancer genetic services among high risk populations in the U.S. and (2) differences in genetic services use based on individual's characteristics such as self-reported familial risk, personal history, and beliefs about risk of cancer. These results align with other studies which have noted that awareness and use of genetic services are low in the general population and likely not reaching individuals who could benefit most from screening for inherited cancers. Efforts to promote public awareness of familial cancer risk may lead to better uptake of cancer genetic services.
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Affiliation(s)
- Caitlin G Allen
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30307, USA.
| | - Megan Roberts
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Yue Guan
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30307, USA.
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