Practical Tips for Establishing Partnerships With Academic Researchers: A Resource Guide for Community-Based Organizations

BACKGROUND

Research exists on strategies for successful conduct of community-based participatory research (CBPR). Unfortunately, few published resources are available to advise community-based organizations (CBOs) on preparation for and engagement in CBPR.

OBJECTIVES

We aimed to create a resource for CBOs that describes how an organization can prepare for and participate in CBPR.

METHODS

We used a case study approach of one CBO with a decade-long history of collaboration with academic researchers. We identified lessons learned through a retrospective review of organizational records and the documentation of experiences by CBO leadership and research partners. The findings were then labeled according to CBPR Partnership Readiness Model dimensions.

LESSONS LEARNED

The review of CBO documents and key informant interviews yielded ten practical tips to increase organizational readiness for and engagement in CBPR.

CONCLUSIONS

By understanding the best practices for organizational readiness for and participation in CPBR, CBOs will be better equipped to actively participate in community-academic partnerships.

Discussing race-related limitations of genomic testing for colon cancer risk: implications for education and counseling

This study examines communication about limitations of genomic results interpretation for colon cancer risk during education and counseling of minority participants. As part of a larger study conducted from 2010 to 2012, participants recruited from a large primary care clinic were offered testing for a research panel of 3 genomic markers (single nucleotide polymorphisms or SNPs) for colorectal cancer risk. Genetic counselors conducted pre- and post-test sessions which included discussion of limitations of result interpretation due to the lack of racial/ethnic diversity in research populations from which risk data are derived. Sessions were audio-recorded, transcribed and thematically analyzed. Many participants did not respond directly to this limitation. Among the participants that responded directly to this race-related limitation, many responses were negative. However, a few participants connected the limited minority information about SNPs with the importance of their current research participation. Genetic counselor discussions of this limitation were biomedically focused with limited explanations for the lacking data. The communication process themes identified included: low immediacy (infrequent use of language directly involving a participant), verbal dominance (greater speaking ratio of the counselor to the patient) and wide variation in the degree of interactivity (or the amount of turn-taking during the discussion). Placed within the larger literature on patient-provider communication, these present results provide insight into the dynamics surrounding race-related educational content for genomic testing and other emerging technologies. Clinicians may be better able to engage patients in the use of new genomic technology by increasing their awareness of specific communication processes and patterns during education or counseling sessions.

Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer

PURPOSE

Although guidelines recommend in-person counseling before BRCA1/BRCA2 gene testing, genetic counseling is increasingly offered by telephone. As genomic testing becomes more common, evaluating alternative delivery approaches becomes increasingly salient. We tested whether telephone delivery of BRCA1/2 genetic counseling was noninferior to in-person delivery.

PATIENTS AND METHODS

Participants (women age 21 to 85 years who did not have newly diagnosed or metastatic cancer and lived within a study site catchment area) were randomly assigned to usual care (UC; n = 334) or telephone counseling (TC; n = 335). UC participants received in-person pre- and post-test counseling; TC participants completed all counseling by telephone. Primary outcomes were knowledge, satisfaction, decision conflict, distress, and quality of life; secondary outcomes were equivalence of BRCA1/2 test uptake and costs of delivering TC versus UC.

RESULTS

TC was noninferior to UC on all primary outcomes. At 2 weeks after pretest counseling, knowledge (d = 0.03; lower bound of 97.5% CI, -0.61), perceived stress (d = -0.12; upper bound of 97.5% CI, 0.21), and satisfaction (d = -0.16; lower bound of 97.5% CI, -0.70) had group differences and confidence intervals that did not cross their 1-point noninferiority limits. Decision conflict (d = 1.1; upper bound of 97.5% CI, 3.3) and cancer distress (d = -1.6; upper bound of 97.5% CI, 0.27) did not cross their 4-point noninferiority limit. Results were comparable at 3 months. TC was not equivalent to UC on BRCA1/2 test uptake (UC, 90.1%; TC, 84.2%). TC yielded cost savings of $114 per patient.

CONCLUSION

Genetic counseling can be effectively and efficiently delivered via telephone to increase access and decrease costs.

Behavioral and psychosocial responses to genomic testing for colorectal cancer risk

We conducted a translational genomic pilot study to evaluate the impact of genomic information related to colorectal cancer (CRC) risk on psychosocial, behavioral and communication outcomes. In 47 primary care participants, 96% opted for testing of three single nucleotide polymorphisms (SNPs) related to CRC risk. Participants averaged 2.5 of 6 possible SNP risk alleles (10% lifetime risk). At 3-months, participants did not report significant increases in cancer worry/distress; over half reported physical activity and dietary changes. SNP risk scores were unrelated to behavior change at 3-months. Many participants (64%) shared their SNP results, including 28% who shared results with a physician. In this pilot, genomic risk education, including discussion of other risk factors, appeared to impact patients' health behaviors, regardless of the level of SNP risk. Future work can compare risk education with and without SNP results to evaluate if SNP information adds value to existing approaches.

Through the lens of culture: quality of life among Latina breast cancer survivors

Latinas have lower quality of life than Caucasian cancer survivors but we know little about factors associated with quality of life in this growing population. Bilingual staff conducted interviews with a national cross-sectional sample of 264 Latina breast cancer survivors. Quality of life was measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B). Regression models evaluated associations between culture, social and medical context and overall quality of life and its subdomains. Latina survivors were 1-5 years post-diagnosis and reported a lower mean quality of life score compared to other published reports of non-Latina survivors (M = 105; SD = 19.4 on the FACT-B). Culturally based feelings of breast cancer-related stigma and shame were consistently related to lower overall quality of life and lower well-being in each quality of life domain. Social and medical contextual factors were independently related to quality of life; together cultural, social and medical context factors uniquely accounted for 62 % of the explained model variance of overall quality of life (Adjusted R (2) = 0.53, P < 0.001). Similar relationships were seen for quality of life subdomains in which cultural, social, and medical contextual variables independently contributed to the overall variance of each final model: physical well-being (Adjusted R (2) = 0.23, P < .001), social well-being (Adjusted R (2) = 0.51, P < 0.001), emotional well-being (Adjusted R (2) = 0.28, P < 0.001), functional well-being (Adjusted R (2) = 0.41, P < 0.001), and additional breast concerns (Adjusted R (2) = 0.40, P < 0.001). Efforts to improve Latinas' survivorship experiences should consider cultural, social, and medical contextual factors to close existing quality of life gaps between Latinas and other survivors.

Longitudinal changes in patient distress following interactive decision aid use among BRCA1/2 carriers: a randomized trial

BACKGROUND

Increasingly, women with a strong family history of breast cancer are seeking genetic testing as a starting point to making significant decisions regarding management of their cancer risks. Individuals who are found to be carriers of a BRCA1 or BRCA2 mutation have a substantially elevated risk for breast cancer and are frequently faced with the decision of whether to undergo risk-reducing mastectomy.

OBJECTIVE

In order to provide BRCA1/2 carriers with ongoing decision support for breast cancer risk management, a computer-based interactive decision aid was developed and tested against usual care in a randomized controlled trial.

DESIGN

. Following genetic counseling, 214 female (aged 21-75 years) BRCA1/2 mutation carriers were randomized to usual care (UC; n = 114) or usual care plus decision aid (DA; n = 100) arms. UC participants received no further intervention; DA participants were sent the CD-ROM-based decision aid to view at home.

MAIN OUTCOME MEASURES

The authors measured general distress, cancer-specific distress, and genetic testing-specific distress at 1-, 6-, and 12-month follow-up time points postrandomization.

RESULTS

Longitudinal analyses revealed a significant longitudinal impact of the DA on cancer-specific distress (B = 5.67, z = 2.81, P = 0.005), which varied over time (DA group by time; B = -2.19, z = -2.47, P = 0.01), and on genetic testing-specific distress (B = 5.55, z = 2.46, P = 0.01), which also varied over time (DA group by time; B = -2.46, z = -2.51, P = 0.01). Individuals randomized to UC reported significantly decreased distress in the month following randomization, whereas individuals randomized to the DA maintained their postdisclosure distress over the short term. By 12 months, the overall decrease in distress between the 2 groups was similar.

CONCLUSION

This report provides new insight into the long-term longitudinal effects of DAs.

Abstract B8: Predictors of BRCA1/2 genetic testing in a population of newly diagnosed breast cancer patients

B8

Genetic testing for mutations in BRCA1 and BRCA2 (BRCA1/2) can influence surgical decisions for newly diagnosed breast cancer patients. The goal of this study was to examine predictors of BRCA1/2 testing in a population of newly diagnosed breast cancer patients, prior to definitive surgery. In this prospective trial participants were randomized in a 2:1 ratio to receive Rapid Genetic Counseling (RGC) or Usual Care (UC) following a baseline telephone interview. Those randomized to RGC were asked to complete genetic counseling as quickly as possible with the option of pursuing BRCA1/2 testing. Participants in the UC group were not formally referred for genetic counseling but could self-refer. Eligibility criteria included women diagnosed with breast cancer &lt;50 years of age or diagnosed with breast cancer ≥50 years of age with a family history of breast cancer &lt;50 years or ovarian cancer at any age. All newly diagnosed women who met our eligibility criteria were directly recruited from breast surgery clinics.

Of the 126 women that have been randomized to the RGC group, 60 (47.6%) underwent BRCA1/2 testing. In bivariate analyses, predictors of BRCA1/2 testing included higher a priori risk of BRCA1/2 mutation calculated by BRCAPRO score, number of first degree relatives with breast and/or ovarian cancer, age less than 45 years, marital status, Jewish ethnicity, greater genetic testing knowledge, stronger preference for bilateral mastectomy, higher perceived risk of a second breast cancer, and higher perceived risk of a breast cancer recurrence. Participants who did not receive a specific surgical recommendation were more likely to undergo genetic testing as were participants who discussed genetic counseling with their physicians. Finally, women who were particularly concerned about the effect of surgery on body image were more likely to pursue genetic testing.

To identify independent predictors of pre-surgical genetic testing, we entered all variables with significant bivariate associations to genetic testing into a backward logistic regression. The final logistic model included the following five variables: BRCAPRO score (OR=1.07, 95% CI=1.02, 1.12), marital status (OR=3.71, 95% CI=1.19, 11.54), perceived risk of breast cancer recurrence (OR=1.03, 95% CI=1.00-1.06), lack of surgical recommendation (OR=1.16, 95% CI=1.00-1.35), discussion of genetic counseling with a physician (OR=9.70, 95% CI=3.11, 30.24) and concerns regarding body image (OR=3.20, 95% CI=1.17, 8.74). The two variables most strongly related to genetic testing were BRCAPRO score (p=.003) and discussion of genetic counseling with a physician (p&lt;.001). Surprisingly, perceived risk of recurrence was independently associated with testing while perceived risk of a contralateral breast cancer was not, raising the possibility that participants might not fully understand the distinction between a recurrence and a new primary cancer. These results suggest that newly diagnosed patients who are not provided with a specific surgical recommendation may be interested in BRCA1/2 testing to assist in their decision-making. The data also confirm prior reports that physician recommendation is a critical predictor of interest and utilization of genetic counseling and testing.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):B8.