The Integration of Value Assessment and Social Network Methods for Breast Health Navigation Among African Americans

OBJECTIVES

A major strategy to reduce the impact of breast cancer (BC) among African Americans (AA) is patient navigation, defined here as individualized assistance for reducing barriers to healthcare use. The primary focus of this study was to estimate the added value of incorporating breast health promotion by navigated participants and the subsequent BC screenings that network members may obtain.

METHODS

In this study, we compared the cost-effectiveness of navigation across 2 scenarios. First, we examine the effect of navigation on AA participants (scenario 1). Second, we examine the effect of navigation on AA participants and their networks (scenario 2). We leverage data from multiple studies in South Chicago. Our primary outcome (BC screening) is intermediate, given limited available quantitative data on the long-term benefits of BC screening for AA populations.

RESULTS

When considering participant effects alone (scenario 1), the incremental cost-effectiveness ratio was $3845 per additional screening mammogram. When including participant and network effects (scenario 2), the incremental cost-effectiveness ratio was $1098 per additional screening mammogram.

CONCLUSION

Our findings suggest that inclusion of network effects can contribute to a more precise, comprehensive assessment of interventions for underserved communities.

Patient Navigation Can Improve Breast Cancer Outcomes among African American Women in Chicago: Insights from a Modeling Study

African American (AA) women experience much greater mortality due to breast cancer (BC) than non-Latino Whites (NLW). Clinical patient navigation is an evidence-based strategy used by healthcare institutions to improve AA women's breast cancer outcomes. While empirical research has demonstrated the potential effect of navigation interventions for individuals, the population-level impact of navigation on screening, diagnostic completion, and stage at diagnosis has not been assessed. An agent-based model (ABM), representing 50-74-year-old AA women and parameterized with locally sourced data from Chicago, is developed to simulate screening mammography, diagnostic resolution, and stage at diagnosis of cancer. The ABM simulated three counterfactual scenarios: (1) a control setting without any navigation that represents the "standard of care"; (2) a clinical navigation scenario, where agents receive navigation from hospital-affiliated staff; and (3) a setting with network navigation, where agents receive clinical navigation and/or social network navigation (i.e., receiving support from clinically navigated agents for breast cancer care). In the control setting, the mean population-level screening mammography rate was 46.3% (95% CI: 46.2%, 46.4%), the diagnostic completion rate was 80.2% (95% CI: 79.9%, 80.5%), and the mean early cancer diagnosis rate was 65.9% (95% CI: 65.1%, 66.7%). Simulation results suggest that network navigation may lead up to a 13% increase in screening completion rate, 7.8% increase in diagnostic resolution rate, and a 4.9% increase in early-stage diagnoses at the population-level. Results suggest that systems science methods can be useful in the adoption of clinical and network navigation policies to reduce breast cancer disparities.

Healthcare Predictors of Information Dissemination About Genetic Risks

Objectives

Despite the benefits of genetic counseling and testing (GCT), utilization is particularly low among African American (AA) women who exhibit breast cancer features that are common in BRCA-associated cancer. Underutilization is especially problematic for AA women who are more likely to die from breast cancer than women from any other race or ethnicity. Due to medical mistrust, fear, and stigma that can be associated with genetic services among racial/ethnic minorities, reliance on trusted social networks may be an impactful strategy to increase dissemination of knowledge about hereditary cancer risk. Informed by the social cognitive theory, the purpose of this study is to determine: 1) which AA patients diagnosed with breast cancer and with identified hereditary risk are sharing information about hereditary risk with their networks; 2) the nature of the information dissemination; and 3) if personal GCT experiences is associated with dissemination of information about hereditary risk.

Methods

Among consented participants (n = 100) that completed an interview administered using a 202-item questionnaire consisting of open- and closed-ended questions, 62 patients were identified to be at higher risk for breast cancer. Descriptive statistics, bivariable chi-square, Pearson’s exact tests, and regression analyses were conducted to examine differences in characteristics between high-risk participants who disseminated hereditary risk information and participants who did not.

Results

Among high-risk participants, 25 (40%) indicated they had disseminated information about hereditary risk to at least one member in their family/friend network and 37 (60%) had not. Receipt of both provider recommendations and receipt of GCT services was associated with greater odds of disseminating information about hereditary risk with networks, OR = 4.53, 95%CI [1.33, 15.50], p = .02.

Conclusion

Interventions that increase self-efficacy gained through additional personalized knowledge and experience gained through provider recommendations and by undergoing GCT may facilitate information dissemination among social/familial networks.

Abstract PO-080: Do African American informal caregivers’ breast cancer fear and cultural beliefs predict the dissemination of breast cancer misinformation and lower mammogram uptake among their social networks?

Introduction: African American women experience a disproportionate burden of breast cancer morbidity and mortality. For African American breast cancer survivors, members of their social networks often act as informal caregivers - offering social support and assisting with treatment adherence. They may thus serve as opinion leaders within their own social networks, given their personal experiences with the breast cancer survivor. Nonetheless, informal caregivers are not formally trained and may be vulnerable to breast cancer cultural beliefs and fear related to breast cancer. For this study, we examined: 1) if informal caregivers’ breast cancer cultural beliefs and fear were predictive of breast cancer misinformation shared among their social networks and, 2) if misinformation shared led to lower mammogram uptake among their networks. Methods: This is a secondary analysis of the Offering African Survivors Increased Support (OASIS) study, which assessed African American breast cancer survivors’ experiences with cancer care. To be eligible, subjects had to be: 1) identified as an informal caregiver by a survivor, 2) female, and, 3) of breast cancer screening age (50-74 years). Recruitment took place from Feb 2019 – Mar 2020.

Subjects took part in 60-90 minute in-person or telephone surveys and received an incentive for participation. Validated scales were used in the survey tool to quantify cultural beliefs and fear, spread of breast cancer misinformation, and mammogram uptake. Results: 142 informal caregivers were recruited. All were African American, 56% were 50-62 years of age, 95% had a primary care provider, and 82% had a mammogram in the past year. Overall, 65% reported ≥1 breast cancer cultural belief and all reported breast cancer fear. On average, informal caregivers reported 1.55 (range: 0-15) cultural beliefs and a moderate level of fear (score=19.72, 8-32). 18.3% of informal caregivers shared breast cancer misinformation to their networks.

Informal caregivers who reported ≥1 cultural belief had 74% greater odds of sharing misinformation to their networks (OR=1.74, 95%CI [1.32, 2.29], p<.0001). Among the 341 social network members of informal caregivers who were women and 50-74 years of age, those who received misinformation were 63% less likely to obtain a mammogram (OR=0.37, 95%CI [0.14, 0.94], p=0.04). Conclusion: Informal caregivers who reported breast cancer cultural beliefs were significantly more likely to share breast cancer misinformation to their social networks and social network members who received this misinformation were significantly less likely to receive mammograms. These results may inform planning for health education efforts and community-healthcare interventions that address breast cancer cultural beliefs and promote mammogram uptake among African American women. Future research will assess key themes in breast cancer misinformation shared and differences in misinformation shared from informal caregivers to their networks based on relationship type.

Citation Format: Nyahne Q. Bergeron, Mona Strahan, Shaila Strayhorn, Anita Rong, Misael Villegas, Nancy Rayas, Stephanie Jara, Izalia Ruiz, Aditya Khanna, Dana Villines, Karriem Watson, Carol Ferrans, Yamilé Molina. Do African American informal caregivers’ breast cancer fear and cultural beliefs predict the dissemination of breast cancer misinformation and lower mammogram uptake among their social networks? [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-080.

Abstract PO-062: An exploration of patient navigation on various outcomes of African American breast cancer survivors

Introduction: Patient navigation (PN) programs are used throughout the cancer continuum to address barriers faced by African American women and other vulnerable populations. Research has suggested PN can be effective in improving screening and diagnostic care uptake; however, less research has examined its effects post-diagnosis. Although effective for its short-term outcomes (e.g., receipt of screening; care decisions; stage at diagnosis), PN may be limited in its long-term effects during survivorship (e.g., quality of life). Therefore, the objective of this study was to assess the effect of PN on four outcomes of African American breast cancer survivors (BCS): shared decision making (SDM) when undergoing diagnostic care; receipt of an early stage diagnosis; and, current quality of life. Methods: This study was a secondary analysis of the OASIS (Offering African American Survivors Increased Support) study, which followed African American BCS who obtained care at a Chicago-based hospital during or after the Patient Navigation in Medically Underserved Areas (PNMUA) study. Navigated women experienced largely phone- based navigation through screening, diagnostic care, and treatment. Eligibility criteria included: African American race; 18+ years old; receipt of breast healthcare in the study hospital during or after PN trial was implemented; and, receipt of a breast cancer diagnosis. We conducted multivariate logistic (SDM, early stage diagnosis) and linear regression models (quality of life measured with current mental and physical well-being using SF-12 scale) that were adjusted by age, socioeconomic status (income, education, insurance status) and year of diagnosis. Results: The average age of our sample was 66.28 (SD = 9.54). Approximately 26% of the sample had ≤ 12 years of education; 35% were married; 49% had an annual household income of ≤$50,000; and 64% had private insurance. Navigated women had greater odds of reporting shared decision making with their providers during diagnostic visits, non-nav: 26% vs. nav: 44%, OR = 3.48, 95%CI [1.08, 11.15], p = 0.04. There were no differences, however, between navigated and non-navigated women regarding odds of an early stage diagnosis and current quality of life (ps = 0.62-0.94). Conclusion: Navigated women’s greater propensity to engage in SDM compared with non-navigated women aligns with past research and suggests PN is effective for changing patients’ behaviors when actively engaged with navigators. However, we did not find that PN was associated with stage at diagnosis. Further, the absence of an association on current mental and physical well-being suggests that PN may have limited long-term effects. Limitations include use of self-report data and a small, convenience-based sample. Further research should assess how patient navigation can be adapted to have more sustained effects in the long term.

Citation Format: Agnieszka M. Mynarska, Shaila M. Strayhorn, Tynetta Hill-Muhammad, Nyahne Q. Bergeron, Desmona C. Strahan, Stephanie L. Jara, Nancy Rayas, Anita Rong, Misael Villegas, Dana Villines, Karriem S. Watson, Aditya Khanna, Yamilé Molina. An exploration of patient navigation on various outcomes of African American breast cancer survivors [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-062.

Abstract D025: “Place it in God’s hands”: Exploring the influence of sources of social support and religious coping practices of African American breast cancer survivors

Background: Religious coping (i.e. religious practices or beliefs that help an individual adapt to a stressful situation) has been shown to help African American breast cancer survivors obtain a better quality of life as well as find purpose from their cancer experience. Both prayer and church attendance are believed to be the most common religious coping practices among African American breast cancer survivors. However, relatively little is known about: 1) the relative commonness of religious coping practices; and, 2) which sources of social support (i.e. church members, clergy leaders, family, and friends) may also influence religious coping among survivors. Objective(s): To assess the prevalence of religious coping mechanisms and the sources of social support who influence African American breast cancer survivors. Methods: The current study was a secondary analysis of the OASIS (Offering African American Survivors Increased Support) study. Participants were eligible for this study if they identified as being an African American female adult and were diagnosed between 2011-2014 within a local hospital in Chicago, IL. Eligible participants answered a modified version of the Church-based Social Support Scale and responded to open-ended questions related to their social support experiences by members of their social network. Results: A total of 33 participants completed the questionnaire at the time of data analysis. Weekly religious service attendance was highly prevalent among study participants post-diagnosis (n=12, 36.4%). Approximately eighteen percent of survivors (n=6) reported praying throughout their breast cancer journey. No participants reported receiving prayer from their church members or clergy leaders. However, nine participants (27.3%) expressed that a family member and/or a friend offered to pray for them throughout their cancer experience. Conclusion: There was a relatively high prevalence of church attendance. Family and friends appeared to be the more common source of influence in the form of religious coping through prayer. Future researchers should consider partnering with both family and friends when conducting faith-based and religious-based interventions to improve quality of life among African American breast cancer survivors.

Citation Format: Shaila M. Strayhorn, Nyahne Q Bergeron, Desmona Strahan, Aditya Khanna, Kariem Watson, Dana Villines, Yamilé Molina. “Place it in God’s hands”: Exploring the influence of sources of social support and religious coping practices of African American breast cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D025.

Abstract A023: Do African American informal caregivers’ breast cancer fear and cultural misconceptions predict the spread of breast cancer misinformation among their social networks?

Introduction: African American women experience a disproportionate burden of breast cancer morbidity and mortality. Members of African American breast cancer survivors’ social networks often act as informal caregivers, offering psychosocial support, sharing important information, and assisting with treatment adherence. They may thus serve as opinion leaders within their own social networks, especially if they are also women and are within the recommended age for breast cancer screening. Nonetheless, informal caregivers are not formally trained and may be vulnerable to cultural misconceptions and higher levels of fear through their firsthand experiences as caregivers. Understanding the relationship between breast cancer cultural misconceptions, fear and the spread of misinformation among the social networks is crucial; yet, little research has been done in this area. Methods: This is a secondary analysis of the Offering African Survivors Increased Support (OASIS) study, which assesses African American breast cancer survivors’ experiences with cancer care. To be eligible, participants had to be: 1) identified as a support person by a survivor; 2) female; and, 3) 50-74 years old. We used the validated Ferrans Cultural Beliefs and Champion Breast Cancer Fear scales to quantify cultural misconceptions and fear retrospectively. For social network dissemination, we used a modified Burt’s General Social Survey instrument and coded open-ended fields regarding communication between caregivers and up to 5 network caregivers. Results: 30 informal caregivers were surveyed. Sixty percent reported at least one cultural misconception, the most common misconception being “If breast cancer is cut open in surgery, it will grow faster.” Approximately 33% further disseminated cultural misconceptions to 2 or more people within their networks. After adjusting for education, our multivariable linear regression suggested that informal caregivers who report greater breast cancer fear (Std B = 0.46, p = .008) and more misconceptions (Std B = 0.44, p = .02) disseminated cultural misconceptions to more people within their network. Conclusion: Informal caregivers that reported greater misconceptions and fear related to breast cancer were significantly more likely to share breast cancer misinformation to their social networks. These results show the value of initiatives in clinical and community settings that address these misconceptions and support increased breast cancer screening. Future research will assess the specific recipients of miscommunication (e.g., family, friends) and how this miscommunication is associated with the likelihood of obtaining breast cancer screening among their networks.

Citation Format: Nyahne Q Bergeron, Mona Strahan, Shaila Strayhorn, Aditya Khanna, Dana Villines, Karriem Watson, Carol Ferrans, Yamile Molina. Do African American informal caregivers’ breast cancer fear and cultural misconceptions predict the spread of breast cancer misinformation among their social networks? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A023.

Cross-Sector Collaboration in the High-Poverty Setting: Qualitative Results from a Community-Based Diabetes Intervention

OBJECTIVE

To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center.

DATA SOURCE

Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago.

STUDY DESIGN

In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention.

DATA COLLECTION METHODS

Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory.

PRINCIPAL FINDINGS

All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration.

CONCLUSIONS

We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities.

The two rat alpha 2,6-sialyltransferase (ST6Gal I) isoforms: evaluation of catalytic activity and intra-Golgi localization

alpha2,6-Sialyltransferase (ST6Gal I) functions in the Golgi to terminally sialylate the N-linked oligosaccharides of glycoproteins. Interestingly, rat ST6Gal I is expressed as two isoforms, STtyr and STcys, that differ by a single amino acid in their catalytic domains. In this article, our goal was to evaluate more carefully possible differences in the catalytic activity and intra-Golgi localization of the two isoforms that had been suggested by earlier work. Using soluble recombinant STtyr and STcys enzymes and three asialoglycoprotein substrates for in vitro analysis, we found that the STcys isoform was somewhat more active than the STtyr isoform. However, we found no differences in isoform substrate choice when these proteins were expressed in Chinese hamster ovary cells, and sialylated substrates were detected by lectin blotting. Immuno-fluorescence and immunoelectron microscopy revealed differences in the relative levels of the isoforms found in the endoplasmic reticulum (ER) and Golgi of transiently expressing cells but similar intra-Golgi localization. STtyr was restricted to the Golgi in most cells, and STcys was found in both the ER and Golgi. The ER localization of STcys was especially pronounced with a C-terminal V5 epitope tag. Ultrastructural and deconvolution studies of immunostained HeLa cells expressing STtyr or STcys showed that within the Golgi both isoforms are found in medial-trans regions. The similar catalytic activities and intra-Golgi localization of the two ST6Gal I isoforms suggest that the particular isoform expressed in specific cells and tissues is not likely to have significant functional consequences.