The development and validation of a patient-reported outcome measure to assess financial hardship among older cancer survivors in China: hardship and recovery with distress survey

Background

Financial hardship has been described as a patient's economic experiencefollowing cancer-related treatment. Standardized patient-reported outcome measures(PROM) to assess this distress has not been well-studied, especially among older cancer survivors.

Objective

The aim of this study was to develop and validate PROM for assessing the financial hardship of older cancer survivors in China.

Methods

Items were generated using qualitative interviews and literature review. Items were screened based on Delphi expert consultation and patients' opinions. Item response theory (IRT) and classical test theory (CTT) were used to help reduce items. Retained items formed a pilot instrument that was subjected to psychometric testing. A cut-off score for the new instrument for predicting poor quality of life was identified by receiver operating characteristic (ROC) analysis.

Results

Qualitative interviews and literature review generated 135 items, which were reduced to 60 items because of redundancy. Following Delphi expert consultation and patients' evaluation, 24 items with high importance were extracted. Sixteen items were selected due to satisfactory statistical analysis based on CTT and IRT. Ten items were retained and comprised 2 domains after loadings in exploratory factor analysis (EFA). Internal consistency was satisfactory (α = 0.838). Test-retest reliability was good (intraclass correlation, 0.909). The ROC analysis suggested that the cut-off of 18.5 yielded an acceptable sensitivity and specificity.

Conclusions

The PROM for Hardship and Recovery with Distress Survey (HARDS) consists of 10 items that specifically reflect the experiences of financial hardship among older Chinese cancer survivors, and it also showed good reliability and validity in clinical settings.

A Qualitative Study of Healthcare Experience Among Chinese Homebound Adults Receiving Home-Based Medical Care

Home-based medical care (HBMC) is emerging in China, but research understanding the efficiency and effectiveness of this new care model is rare. In this study, researchers interviewed 17 Chinese homebound adults aged 45 and older (53% females, mean age=76) who have received HBMC, and collected detailed information regarding their experiences and attitudes toward HBMC. Participants were recruited from healthcare institutions in Shanghai, Jinan, and Zhangqiu of China. The evaluation of patients’ experiences with HBMC yielded both positive and negative aspects. Positive experiences included 1) the delivery method was convenient for homebound patients; 2) health problems could be detected timely because doctors visited patients regularly; 3) home care providers had better bedside manners and professional skills than hospital-based providers; 4) the medical insurance covered the cost of home care services. Negative experiences related to the supply and quality of care, including 1) the scope of current HBMC services was too limited to meet the needs of homebound patients; 2) the visit time was too short; 3) healthcare providers’ professional skills varied greatly. Findings from this study suggest that the HBMC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HBMC in China. Educational programs may be created to train more HBMC providers and improve their professional skills.

Mental Health of Homebound Older Adults in China: The Moderating Effect of Loneliness

Homebound older adults are confined to their homes due to physical, mental, or social limitations, which contributes to elevated levels of depression. However, the mental health status of the homebound population in China is relatively overlooked. This study compares mental health status between homebound and non-homebound older adults, and examines the moderation effect of loneliness. The sample consists of 1,301 older adults aged 60 and over (39% homebound, 49% females, mean age = 69) from Shandong Aging and Health Survey, conducted by Shandong Provincial Government in 2019. Mental health status was measured by feelings of depression, not cheerful, bored, not calm or peaceful, and not happy. Compared to non-homebound older adults, homebound older adults tend to be older, lower educated, live in rural areas, and in worse health conditions. Results from generalized linear regression models show that controlling for demographic and physical health status, homebound population were more likely to have worse mental health status than other Chinese older adults. Feeling lonely, isolated, or lack of companionship intensifies the adverse effects of being homebound on older adults’ mental health. Findings from this study suggest that homebound older adults in China had both physical and psychological sufferings. Social programs and interventions may be designed to improve homebound older adults’ mental health. As the number of homebound older adults increases in China, medical care models may be tailored to improve the accessibility of healthcare services among people who are confined to their homes.

Turnover Intention Among Direct Care Workers of Older Adults in Chinese Hospitals and Nursing Homes

High retention rates among direct care workers (DCWs) affect the quality of aged care. However, limited research has explored factors associated with retention in the Chinese aged care industry. This study compared turnover intention and job satisfaction among DCWs in Chinese hospitals and nursing homes. A total 370 DCWs from 7 hospitals (297 contractual, 73 non-contractual) and 311 DCWs from 7 nursing homes (27 contractual, 284 non-contractual) located in Fujian, China were recruited to fill out a questionnaire. Overall, DCWs from hospitals reported lower turnover intention (20.5 % vs 37.0%) and higher levels of job satisfaction (31.1% vs 16.4%) than DCWs from nursing homes. Specifically, contractual DCWs from hospitals indicated lower turnover intention (14.8%) than non-contractual DCWs from hospitals (43.8%) and both types of DCWs from nursing homes (36.3% and 44.4%). Higher job satisfaction was associated with lower turnover intention, but did not mediate the association between DCW types and turnover intention. Findings suggested that the government and institutions should help DCWs complete the identity transformation from non-contractual DCWs to contractual DCWs to enhance job security and benefits. For nursing home DCWs, licensing and registration requirements shall meet the standards for hospital DCWs. Attention is also to be paid to working conditions and staff welfare of DCWs, including social insurance, pensions, and trainings, to improve job satisfaction and reduce turnover intention.

Opioid Epidemic or Pain Crisis? Using the Virginia All Payer Claims Database to Describe Opioid Medication Prescribing Patterns and Potential Harms for Patients With Cancer

PURPOSE:

A key challenge regarding the current opioid epidemic is understanding how concerns regarding opioid-related harms affect access to pain management, an essential element of cancer care. In certain regions of the United States where disproportionately high cancer mortality and opioid fatality rates coexist (such as southwest Virginia in central Appalachia), this dilemma is particularly pronounced.

METHODS:

This longitudinal, exploratory, secondary analysis used the Commonwealth of Virginia All Payer Claims Database to describe prescription opioid medication (POM) prescribing patterns and potential harms for adult patients with cancer living in rural southwest Virginia between 2011 and 2015. Descriptive and inferential statistical analyses were conducted at the patient, prescriber, and prescription levels to identify patterns and predictors of POM prescribing and potential harms. To explore geographic patterns, choropleth and heat maps were created.

RESULTS:

Of the total sample of patients with cancer (n = 4,324), less than 25% were prescribed a Controlled Substance Schedule II POM at least three times in any study year. More than 60% of patients never received a Controlled Substance Schedule II POM prescription. Six hundred fifty-two patients (15.1%) experienced 1,599 hospitalizations for any reason; 10 or fewer patients were admitted for 11 opioid use disorder–related hospitalizations. The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of POM prescriptions; and geographic disparities where opioid overdoses are occurring versus where POM prescription use is highest.

CONCLUSION:

These findings have significant opioid policy and practice implications related to the need for cancer-specific prescribing guidelines, how to optimally allocate health delivery services, and the urgent need to improve data interoperability and access related to POMs.

The Effectiveness of Medicare Wellness Visits in Accessing Preventive Screening

INTRODUCTION

Under the American Affordable Care Act, Medicare insurance beneficiaries receive free Annual Wellness Visits (AWV); there is a need to examine the effectiveness of these visits. The purpose of this study is to examine their impact on subsequent screening rates.

METHODS

Using 2011-2014 Medicare FFS (fee-for-service) claims data, seven preventive care services, including vaccinations and cancer screenings were compared among beneficiaries who received and did not receive AWVs. Inverse probability treatment weights were used to achieve covariate balance between groups.

RESULTS

Nonrecipients were less likely to receive any of the 7 services compared with recipients of AWVs (63% vs 88%). The total number of services that the AWVs group received was 62% higher than nonrecipients. Subgroup analyses show that wellness visits were high across age groups, race/ethnic groups, rural/urban context, and counties of different economic development status.

CONCLUSION

These results are consistent with the view that wellness visits improve screening rates and thus serve to reduce cancer burden.

Abstract B21: Factors associated with mammography use among foreign-born women and changes over time

Background: Disparities in mammography screening remain a problem for immigrant women, while the foreign-born population has been increasing for decades in the United States. Recent studies indicate that factors associated with mammography use may have changed. Little research has been done to analyze the changing patterns of factors associated with mammography use among immigrant women. Purpose: To address these knowledge gaps, this study (1) compares age-adjusted mammography rates among immigrants by certain characteristics in 2000 and 2008; and (2) examines the factors associated with recent mammography use among immigrant women at these two time points.

Methods: National Health Interview Survey 2000 and 2008 data were used to calculate population-based descriptive statistics adjusted for survey design. Multivariate logistic regressions were used to determine factors associated with recent mammography use among immigrant women.

Results: The mammography rates rose from 60.18% in 2000 to 65.47% in 2008 among foreign-born women. Immigrants having poor access to health care, those who recently immigrated, younger immigrants, and those with low education had the lowest mammography rates at both time points. After adjusting for covariates, lack of access to health care persistently contributes to the lower percentage of mammography screening among immigrants. Longer residency in the U.S. was associated with a higher chance of receiving mammography among immigrants in 2000 but not in 2008. In contrast, age 50–64 compared to age 65 or older was associated with a higher chance of receiving mammography among immigrants in 2008 but not in 2000.

Conclusion: Mammography rates have improved over time among immigrant women and some disparities are decreasing, however, lack of health care access remains an important barrier to breast cancer screening for this population.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B21.

Abstract A96: Breast cancer screening resources and early-stage diagnosis in Appalachia: A geospatial perspective

Background: National Cancer Institute has designated Appalachia as a priority area characterized by significant disparities in cancer outcomes. However, little research focuses on the availability of cancer care resources in this region and how resource availability may relate to cancer outcomes. This paper will describe the distribution of breast cancer screening resources in Appalachia and examine the relationship between screening resources and breast cancer stage at diagnosis at the population level.

Method: Early stage breast cancer as a percent of all breast cancer cases are computed based on the county-level registry data from the four Appalachian states during 2000–2008. Availability of breast cancer screening providers and facilities are estimated for these Appalachian states. Descriptive analysis, exploratory spatial data analysis, and spatial regression are conducted.

Results: Appalachian counties have significantly fewer primary physicians, OB/GYN specialists, and diagnostic radiologists per capita than non-Appalachian counties. Spatial analysis demonstrates moderate clustering of scarce breast cancer screening resources and low percentages of early stage breast cancer in West Virginia and Appalachian Kentucky. Those diagnosed at early stages were 67.92% of all Appalachian cases vs. 68.34% of non-Appalachian breast cancer patients. The number of diagnostic radiologists per capita is significantly associated with the percentage of early stage breast cancer incidence when controlling for covariates such as county level poverty rates, uninsurance rate, percentage of adults with college degree, and primary care resources.

Conclusions: Fewer diagnostic radiologists per capita in West Virginia and Appalachia Kentucky is associated with lower percentage of early stage breast cancer incidence in the Central Appalachia region. Public health interventions should include policies and regulations to improve breast cancer screening resources in this region.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A96.