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Cartwright K, Kanda D, Kosich M, Sheche J, Leekity S, Edwardson N, Pankratz VS, Mishra SI. Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: identifying cornerstones for building effective mammogram screening intervention programs. Cancer Causes Control 2024; 35:583-595. [PMID: 37940784 PMCID: PMC10960741 DOI: 10.1007/s10552-023-01814-8] [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: 02/02/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Breast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and behaviors of Zuni women in the Southwest United States (U.S.). METHODS In 2020 and 2021, a survey was administered to better understand cancer screening patterns in Zuni Pueblo; 110 women from 50 to 75 years of age were recruited to respond to the breast cancer screening portion. Inclusion criteria included self-identifying as AI, a member of the Zuni tribe, or married to a Zuni tribal member, and meeting the age and gender requirements. Descriptive statistics and bivariate analyses were conducted examining the associations between measures of breast cancer knowledge, beliefs, and behaviors and breast cancer screening status (never, ever/non-compliant, and ever/compliant). RESULTS Of survey participants, 47.3% have had a breast cancer screening and are up-to-date, 39.1% have had a screening in the past but are not up-to-date, and 13.6% have never been screened. Age was the only statistically significant socioeconomic predictor of breast cancer screening; the median (interquartile range) ages of each group are 62 (54, 68) ever/compliant, 56 (54, 68) ever/non-compliant, and 53 (51, 55) never (p-value < 0.001). Significant differences by health status and access to medical care include having a regular health care provider and going to see a provider for routine check-ups. The survey also shows differences in knowledge about breast cancer risk factors, beliefs, and behaviors. Women across all three screening statuses reported that they would get screened if encouraged by a health care provider. CONCLUSION While survey respondents report a relatively high rate of ever having had a breast cancer screening, less than half are compliant with screening guidelines, which shows there is an opportunity to improve breast cancer screening rates. With culturally tailored interventions, providers have the potential to improve breast cancer screening for Zuni women.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA.
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Mikaela Kosich
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Judith Sheche
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Samantha Leekity
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
- Departments of Pediatric and Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
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Gupta S, Barnes A, Brenner AT, Campbell J, Davis M, English K, Hoover S, Kim K, Kobrin S, Lance P, Mishra SI, Oliveri JM, Reuland DS, Subramanian S, Coronado GD. Mail-Based Self-Sampling to Complete Colorectal Cancer Screening: Accelerating Colorectal Cancer Screening and Follow-up Through Implementation Science. Prev Chronic Dis 2023; 20:E112. [PMID: 38060411 PMCID: PMC10723083 DOI: 10.5888/pcd20.230083] [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] [Indexed: 12/17/2023] Open
Abstract
Introduction Leveraging cancer screening tests, such as the fecal immunochemical test (FIT), that allow for self-sampling and postal mail for screening invitations, test delivery, and return can increase participation in colorectal cancer (CRC) screening. The range of approaches that use self-sampling and mail for promoting CRC screening, including use of recommended best practices, has not been widely investigated. Methods We characterized self-sampling and mail strategies used for implementing CRC screening across a consortium of 8 National Cancer Institute Cancer Moonshot Initiative Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) research projects. These projects serve diverse rural, urban, and tribal populations in the US. Results All 8 ACCSIS projects leveraged self-sampling and mail to promote screening. Strategies included organized mailed FIT outreach with mailed invitations, including FIT kits, reminders, and mailed return (n = 7); organized FIT-DNA outreach with mailed kit return (n = 1); organized on-demand FIT outreach with mailed offers to request a kit for mailed return (n = 1); and opportunistic FIT-DNA with in-clinic offers to be mailed a test for mailed return (n = 2). We found differences in patient identification strategies, outreach delivery approaches, and test return options. We also observed consistent use of Centers for Disease Control and Prevention Summit consensus best practice recommendations by the 7 projects that used mailed FIT outreach. Conclusion In research projects reaching diverse populations in the US, we observed multiple strategies that leverage self-sampling and mail to promote CRC screening. Mail and self-sampling, including mailed FIT outreach, could be more broadly leveraged to optimize cancer screening.
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Affiliation(s)
- Samir Gupta
- University of California, San Diego, 3350 La Jolla Village Dr, MC 111D, PO Box 12194, San Diego, CA 92160
- Jennifer Moreno VA Healthcare System, San Diego, California
| | - Autumn Barnes
- RTI International, Research Triangle Park, North Carolina
| | - Alison T Brenner
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill
| | - Janis Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City
| | | | - Kevin English
- Albuquerque Area Indian Health Board, Inc, Albuquerque, New Mexico
| | - Sonja Hoover
- RTI International, Research Triangle Park, North Carolina
| | - Karen Kim
- University of Chicago Medicine, Chicago, Illinois
| | - Sarah Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus
| | - Daniel S Reuland
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill
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Edwardson N, Kosich M, Shane Pankratz V, Sheche J, Cartwright K, Kanda D, Leekity S, Mishra SI. Preferences for CPSTF-Recommended Intervention Approaches for Increasing Cancer Screening Among Screen-Eligible Adults in Zuni Pueblo, USA. Prev Med Rep 2023; 36:102453. [PMID: 37840594 PMCID: PMC10568296 DOI: 10.1016/j.pmedr.2023.102453] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/22/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
We identified preferences toward Community Preventive Services Task Force (CPSTF)-recommended intervention approaches among screen-eligible Zuni Pueblo members in New Mexico, USA and assessed if there were significant differences in those preferences, with the goal of informing the selection of intervention approaches for use in the Zuni Pueblo. We utilize data from a population-based survey (n = 280) focused on 15 CPSTF-recommended intervention approaches designed to improve screening for cervical, breast, and/or colorectal cancer screening. Model-adjusted results suggest some intervention approaches garnered significantly higher support than others. We offer six, data-driven recommendations for consideration by public health practitioners as they endeavor to improve cancer prevention in the Zuni Pueblo. This study provides a replicable model for other public health practitioners and health services researchers to incorporate community preferences in community-level intervention approach selection.
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Affiliation(s)
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
| | - V. Shane Pankratz
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
| | - Kate Cartwright
- University of New Mexico, School of Public Administration, USA
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
| | - Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, USA
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Cartwright K, Kosich M, Gonya M, Kanda D, Leekity S, Sheche J, Edwardson N, Pankratz VS, Mishra SI. Cervical Cancer Knowledge and Screening Patterns in Zuni Pueblo Women in the Southwest United States. J Cancer Educ 2023; 38:1531-1538. [PMID: 37046142 PMCID: PMC10097513 DOI: 10.1007/s13187-023-02295-8] [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: 03/26/2023] [Indexed: 05/27/2023]
Abstract
American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey (n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - Mikaela Kosich
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Madison Gonya
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM USA
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Samantha Leekity
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Judith Sheche
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - V. Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM USA
| | - Shiraz I. Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Departments of Pediatric and Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
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Mishra SI, Adsul P, Leekity S, Rodman J, Sussman AL, Kelly K, Sheche J, Faber T, Shah V. A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico. Cancer Causes Control 2023; 34:855-871. [PMID: 37277513 PMCID: PMC10460346 DOI: 10.1007/s10552-023-01721-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Affiliation(s)
- Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Prajakta Adsul
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131 USA
| | - Keith Kelly
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Thomas Faber
- Albuquerque Area Indian Health Service, 4101 Indian School Rd, NE, Albuquerque, NM 87110 USA
| | - Vallabh Shah
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
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Edwardson N, Cartwright K, Sheche J, Pankratz VS, Kosich M, Kanda D, Leekity S, Mishra SI. Colorectal Cancer Screening Among Adults in Zuni Pueblo: Factors Associated with FOBT and Colonoscopy Utilization. J Community Health 2023; 48:565-575. [PMID: 36752868 PMCID: PMC9906599 DOI: 10.1007/s10900-023-01196-7] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven attitudes toward and knowledge of colorectal cancer and experience increased barriers to healthcare access. In this study, we describe the results of a survey among CRC screen-eligible members of Zuni Pueblo (N = 218) on an array of questions regarding CRC screening behaviors, knowledge, satisfaction with and access to healthcare services, social support for CRC screening, perceptions toward FOBT, and preference for evidence-based interventions or strategies for improving CRC screening rates. Results from the multivariable model suggest age, having a regular healthcare provider, and harboring fewer negative perceptions toward FOBT are key drivers of ever completing CRC screening. Respondents reported strong support for Community Guide-recommended interventions and strategies for increasing CRC screening for nearly all proposed interventions. Results confirm the need for multilevel, multicomponent interventions, with a particular focus on improving Zuni Pueblo community members' access to a regular source of care, improving knowledge of CRC risk factor, and addressing negative perceptions toward CRC screening. These results provide critical, community-specific insight into better understanding the drivers of low guideline-adherent screening rates and inform local healthcare providers and community leaders of context-specific strategies to improve CRC screening in Zuni Pueblo.
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Affiliation(s)
- Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, USA.
| | - Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, USA
| | - Judith Sheche
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - V Shane Pankratz
- Department of Internal Medicine, Health Sciences Center, University of New Mexico, University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - Mikaela Kosich
- Departments of Pediatrics and Family and Community Medicine, Comprehensive Cancer Center, University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center and University of New Mexico, Albuquerque, USA
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - Shiraz I Mishra
- Departments of Pediatrics and Family and Community Medicine, Comprehensive Cancer Center, University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center and University of New Mexico, Albuquerque, USA
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7
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Coronado GD, Ferrari RM, Barnes A, Castañeda SF, Cromo M, Davis MM, Doescher MP, English K, Hatcher J, Kim KE, Kobrin S, Liebovitz D, Mishra SI, Nodora JN, Norton WE, Oliveri JM, Reuland DS, Subramanian S, Thompson JH, Paskett ED. Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative. J Natl Cancer Inst 2023; 115:680-694. [PMID: 36810931 PMCID: PMC10248850 DOI: 10.1093/jnci/djad032] [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] [Received: 10/11/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Although patient navigation has shown promise for increasing participation in colorectal cancer screening and follow-up, little evidence is available to guide implementation of patient navigation in clinical practice. We characterize 8 patient navigation programs being implemented as part of multi-component interventions of the National Cancer Institute's Cancer Moonshot Accelerating Colorectal Cancer Screening and Follow-Up Through Implementation Science (ACCSIS) initiative. METHODS We developed a data collection template organized by ACCSIS framework domains. The template was populated by a representative from each of the 8 ACCSIS research projects. We report standardized descriptions of 1) the socio-ecological context in which the navigation program was being conducted, 2) navigation program characteristics, 3) activities undertaken to facilitate program implementation (eg, training), and 4) outcomes used in program evaluation. RESULTS ACCSIS patient navigation programs varied broadly in their socio-ecological context and settings, the populations they served, and how they were implemented in practice. Six research projects adapted and implemented evidence-based patient navigation programs; the remaining projects developed new programs. Five projects began navigation when patients were due for initial colorectal cancer screening; 3 projects began navigation later in the screening process, when patients were due for follow-up colonoscopy after an abnormal stool-test result. Seven projects relied on existing clinical staff to deliver the navigation; 1 hired a centralized research navigator. All project researchers plan to evaluate the effectiveness and implementation of their programs. CONCLUSIONS Our detailed program descriptions may facilitate cross-project comparisons and guide future implementation and evaluation of patient navigation programs in clinical practice.
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Affiliation(s)
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, Carolina Cancer Screening Initiative, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Autumn Barnes
- Research Triangle International, Research Triangle Park, NC, USA
| | - Sheila F Castañeda
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA, USA
| | - Mark Cromo
- Department of Internal Medicine, Healthy Kentucky Research Building, University of Kentucky, Lexington, KY, USA
| | - Melinda M Davis
- Department of Family Medicine and School of Public Health, Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, OR, USA
| | - Mark P Doescher
- Department of Family and Preventive Medicine, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc, Albuquerque, NM, USA
| | - Jenna Hatcher
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Sarah Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - David Liebovitz
- Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center and Departments of Pediatrics and Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jesse N Nodora
- Department of Family Medicine and Public Health, Moores UC San Diego Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jill M Oliveri
- Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, Carolina Cancer Screening Initiative, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Electra D Paskett
- Department of Internal Medicine, College of Medicine and Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
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Cartwright K, Leekity S, Sheche J, Kanda D, Kosich M, Rodman J, Gonya M, Kelly K, Edwardson N, Pankratz VS, Mishra SI. Health Literacy, Health Numeracy, and Cancer Screening Patterns in the Zuni Pueblo: Insights from and Limitations of "Standard" Questions. J Cancer Educ 2023; 38:1023-1033. [PMID: 36334245 PMCID: PMC9638364 DOI: 10.1007/s13187-022-02227-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 05/31/2023]
Abstract
American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50-75 and women ages 21-75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the "standard" questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - Samantha Leekity
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Judith Sheche
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Deborah Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Mikaela Kosich
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Joseph Rodman
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Madison Gonya
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - Keith Kelly
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM USA
| | - V. Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Department of Internal Medicine, University of New Mexico, Albuquerque, USA
| | - Shiraz I. Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM USA
- Departments of Pediatrics and Family and Community Medicine, University of New Mexico, Albuquerque, NM USA
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Schuster ALR, Crossnohere NL, Bachini M, Blair CK, Carpten JD, Claus EB, Colditz GA, Ding L, Drake BF, Fields RC, Janeway KA, Kwan BM, Lenz HJ, Ma Q, Mishra SI, Paskett ED, Rebbeck TR, Ricker C, Stern MC, Sussman AL, Tiner JC, Trent JM, Verhaak RGW, Wagle N, Willman C, Bridges JFP. Priorities to Promote Participant Engagement in the Participant Engagement and Cancer Genome Sequencing (PE-CGS) Network. Cancer Epidemiol Biomarkers Prev 2023; 32:487-495. [PMID: 36791345 PMCID: PMC10068438 DOI: 10.1158/1055-9965.epi-22-0356] [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] [Received: 09/06/2022] [Revised: 11/21/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Engaging diverse populations in cancer genomics research is of critical importance and is a fundamental goal of the NCI Participant Engagement and Cancer Genome Sequencing (PE-CGS) Network. Established as part of the Cancer Moonshot, PE-CGS is a consortium of stakeholders including clinicians, scientists, genetic counselors, and representatives of potential study participants and their communities. Participant engagement is an ongoing, bidirectional, and mutually beneficial interaction between study participants and researchers. PE-CGS sought to set priorities in participant engagement for conducting the network's research. METHODS PE-CGS deliberatively engaged its stakeholders in the following four-phase process to set the network's research priorities in participant engagement: (i) a brainstorming exercise to elicit potential priorities; (ii) a 2-day virtual meeting to discuss priorities; (iii) recommendations from the PE-CGS External Advisory Panel to refine priorities; and (iv) a virtual meeting to set priorities. RESULTS Nearly 150 PE-CGS stakeholders engaged in the process. Five priorities were set: (i) tailor education and communication materials for participants throughout the research process; (ii) identify measures of participant engagement; (iii) identify optimal participant engagement strategies; (iv) understand cancer disparities in the context of cancer genomics research; and (v) personalize the return of genomics findings to participants. CONCLUSIONS PE-CGS is pursuing these priorities to meaningfully engage diverse and underrepresented patients with cancer and posttreatment cancer survivors as participants in cancer genomics research and, subsequently, generate new discoveries. IMPACT Data from PE-CGS will be shared with the broader scientific community in a manner consistent with participant informed consent and community agreement.
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Affiliation(s)
- Anne LR. Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Norah L. Crossnohere
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque, New Mexico
| | - John D. Carpten
- Institute of Translational Genomics, Department of Translational Genomics, Keck School of Medicine USC, Norris Comprehensive Cancer Center, Los Angeles, California
| | - Elizabeth B. Claus
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Graham A. Colditz
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, Missouri
| | - Li Ding
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Bettina F. Drake
- Division of Public Health Sciences, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, Missouri
| | - Ryan C. Fields
- Division of General Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, Missouri
| | - Katherine A. Janeway
- Dana-Farber / Boston Children's Cancer and Blood Disorders Center, and Broad Institute of MIT and Harvard, Harvard Medical School, Boston, Massachusetts
| | - Bethany M. Kwan
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Heinz-Josef Lenz
- Keck School of Medicine of USC, Norris Comprehensive Cancer Center, Los Angeles, California
| | - Qin Ma
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Timothy R. Rebbeck
- Harvard TH Chan School of Public Health, Broad Institute of MIT and Harvard, and the Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charité Ricker
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine USC, Norris Comprehensive Cancer Center, Los Angeles, California
| | - Mariana C. Stern
- Department of Population and Public Health Sciences & Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, Los Angeles, California
| | - Andrew L. Sussman
- Department of Family and Community Medicine, University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque, New Mexico
| | - Jessica C. Tiner
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jeffrey M. Trent
- Translational Genomics Research Institute part of City of Hope, Phoenix, Arizona
| | - Roel GW. Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Nikhil Wagle
- Dana-Farber Cancer Institute, Broad Institute of MIT and Harvard, Harvard Medical School, Dana-Farber/Harvard Cancer Center, and Count Me In, Boston, Massachusetts
| | - Cheryl Willman
- Department of Laboratory Medicine and Pathology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota
- University of New Mexico School of Medicine and Comprehensive Cancer Center, Albuquerque, New Mexico
| | - John FP. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
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10
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Page-Reeves J, Murray-Krezan C, Burge MR, Mishra SI, Regino L, Bleecker M, Perez D, McGrew HC, Bearer EL, Erhardt E. A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management. medRxiv 2023:2023.01.31.23285236. [PMID: 36778329 PMCID: PMC9915824 DOI: 10.1101/2023.01.31.23285236] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.
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Affiliation(s)
- Janet Page-Reeves
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Cristina Murray-Krezan
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Shiraz I. Mishra
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lidia Regino
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Molly Bleecker
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Daniel Perez
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Elaine L. Bearer
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
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11
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Safi S, Ghahate D, Bobelu J, Sussman AL, Rodman J, Wandinger-Ness A, Mishra SI, Faber T, Willman C, Shah V. Assessing Knowledge and Perceptions About Cancer Among American Indians of the Zuni Pueblo, NM. J Cancer Educ 2022; 37:1752-1759. [PMID: 33963443 PMCID: PMC8788106 DOI: 10.1007/s13187-021-02023-0] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 05/31/2023]
Abstract
American Indians (AIs) in New Mexico have lower cancer screening rates compared to other populations and are more likely to be diagnosed with cancer at an advanced stage of the disease as reported by Li et al. (Archives of Internal Medicine 163(1):49-56, 2003). AIs also have the lowest 5-year cancer survival rates compared to any ethnic/racial group in the USA as reported by Clegg et al. (Arch Intern Med 162:1985-1993, 2002) and Edwards et al. (Cancer 97:1407-1427, 2005). Numerous barriers such as cultural beliefs, fear, fatalism, mistrust, stigma, and lack of culturally appropriate interventions could contribute to low cancer screening rates as reported by Daley et al. (J Health Dispar Res Pract 5(2), 2012); Filippi et al. (J Prim Care Community Health 4(3):160-166, 2013); James et al. (Prev Chronic Dis 10:E170, 2013); and Schumacher et al. (Cancer Causes Control 19(7):725-737, 2008). Trained Community Health Representatives (CHRs) from the Zuni Pueblo and native Zuni undergraduate students led six 1-h focus group sessions using a structured focus group guide with probes. The focus groups were conducted among 51 participants from different age groups (20-29 years, n = 19; 30-49 years, n = 17; and 50 years and older, n = 15) stratified by sex. Focus groups were conducted in both English and Shiwi (Zuni) languages. Sessions were audio recorded, and team members took notes. CHRs transcribed the notes and audio recordings, and created a codebook for qualitative data analysis. In the focus groups, participants provided Zuni-specific cultural context, opinion, and experience regarding (1) general knowledge about cancer, (2) cancer risk, (3) cancer risk reduction, (4) personal experiences with cancer, and (5) culturally competent delivery of cancer information and resources. Understanding the perceptions of cancer within the Zuni Pueblo is an essential component in the development of interventional/preventative measures and improvement of current care. Ultimately, this information will provide a basis for the next steps in culturally sensitive cancer care for the Zuni Pueblo.
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Affiliation(s)
- Safia Safi
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Donica Ghahate
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jeanette Bobelu
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Angela Wandinger-Ness
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Thomas Faber
- Indian Health Service, Zuni Comprehensive Care Center, Zuni, NM, USA
| | - Cheryl Willman
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Vallabh Shah
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- Department of Biochemistry and Molecular Biology, School of Medicine, University of New Mexico, MSC 08 4670, Albuquerque, NM, 87131, USA.
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12
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Pankratz VS, Kanda D, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. Colorectal Cancer Survival Trends in the United States From 1992 to 2018 Differ Among Persons From Five Racial and Ethnic Groups According to Stage at Diagnosis: A SEER-Based Study. Cancer Control 2022; 29:10732748221136440. [PMID: 36264283 PMCID: PMC9597478 DOI: 10.1177/10732748221136440] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Survival following colorectal cancer (CRC) has improved in the US since 1975, but there is limited information on stage-specific survival trends among racial and ethnic subgroups. Objectives The purpose of this study was to estimate and compare trends in 1- and 5-year CRC cause-specific survival in the United States by both stage and race/ethnicity. Methods We performed a retrospective cohort study of individuals diagnosed with CRC using the 1992-2018 Surveillance, Epidemiology and End Results (SEER) database. We estimated and compared time trends in 1- and 5-year survival for CRC stage by race/ethnicity. Results Data from 399 220 individuals diagnosed with CRC were available. There were significant differences in stage-specific 1-year survival trends by race and ethnicity. Differences were most notable for distant stage CRC: survival probabilities increased most consistently for non-Hispanic American Indian/Alaska Native (AIAN) and Black (NHB) persons, but their trend lines were lower than those of Hispanic, and non-Hispanic Asian/Pacific Islander (API) and White (NHW) persons, whose initially greater gains appear to be slowing. Although the data do not support significant racial/ethnic differences in 5-year CRC survival trends by stage, AIAN and NHB persons have the lowest average survival probabilities for multiple CRC stages, and no racial/ethnic group has 5-year survival probabilities above 20% for distant-stage CRC. Conclusion Although there has been an overall improvement in adjusted CRC-specific survival probabilities since 1992, AIAN and NHB persons continue to experience worse prognosis than those of other races/ethnicities. This highlights the importance of reinvigorating efforts to understand the causes of mortality in CRC, including those which may differ according to an individual’s race or ethnicity.
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Affiliation(s)
- Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Vernon S. Pankratz, PhD, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC 07 4025, Albuquerque, NM 87131-0001, USA.
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shiraz I. Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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13
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Pankratz VS, Kosich M, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. American Indian/Alaska Native and black colon cancer patients have poorer cause-specific survival based on disease stage and anatomic site of diagnosis. Cancer Epidemiol 2022; 80:102229. [PMID: 35872382 PMCID: PMC9482950 DOI: 10.1016/j.canep.2022.102229] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Studies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic disparities in side- and stage-specific survival, we evaluated 5-year CC cause-specific survival probabilities for five racial/ethnic groups by anatomic site (right or left colon) and stage (local, regional, distant). METHODS We obtained cause-specific survival probability estimates from National Cancer Institute's population-based Surveillance, Epidemiology, and End Results (SEER) for CC patients grouped by five racial/ethnic groups (Non-Hispanic American Indian/Alaska Native [AIAN], Non-Hispanic Asian/Pacific Islander [API], Hispanic, Non-Hispanic Black [NHB], and Non-Hispanic White [NHW]), anatomic site, stage, and other patient and SEER registry characteristics. We used meta-regression approaches to identify factors that explained differences in cause-specific survival. RESULTS Diagnoses of distant-stage CC were more common among NHB and AIAN persons (>22 %) than among NHW and API persons (< 20 %). Large disparities in anatomic site-specific survival were not apparent. Those with right-sided distant-stage CC had a one-year cause-specific survival probability that was 16.4 % points lower (99 % CI: 12.2-20.6) than those with left-sided distant-stage CC; this difference decreased over follow-up. Cause-specific survival probabilities were highest for API, and lowest for NHB, persons, though these differences varied substantially by stage at diagnosis. AIAN persons with localized-stage CC, and NHB persons with regional- and distant-stage CC, had significantly lower survival probabilities across follow-up. CONCLUSIONS There are differences in CC presentation according to anatomic site and disease stage among patients of distinct racial and ethnic backgrounds. This, coupled with the reality that there are persistent survival disparities, with NHB and AIAN persons experiencing worse prognosis, suggests that there are social or structural determinants of these disparities. Further research is needed to confirm whether these CC cause-specific survival disparities are due to differences in risk factors, screening patterns, cancer treatment, or surveillance, in order to overcome the existing differences in outcome.
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Affiliation(s)
- V Shane Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America.
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Nicholas Edwardson
- University of New Mexico, School of Public Administration, the United States of America
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., the United States of America
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, the United States of America; Department of Pediatrics, University of New Mexico Health Sciences Center, the United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, the United States of America
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14
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Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022. [PMID: 35756657 DOI: 10.3389/fonc.2022.841951:10.3389/fonc.2022.841951] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. METHODS Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. RESULTS A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. CONCLUSION Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
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Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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15
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Myers KJ, Jaffe T, Kanda DA, Pankratz VS, Tawfik B, Wu E, McClain ME, Mishra SI, Kano M, Madhivanan P, Adsul P. Reaching the "Hard-to-Reach" Sexual and Gender Diverse Communities for Population-Based Research in Cancer Prevention and Control: Methods for Online Survey Data Collection and Management. Front Oncol 2022; 12:841951. [PMID: 35756657 PMCID: PMC9213655 DOI: 10.3389/fonc.2022.841951] [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: 12/23/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Around 5% of United States (U.S.) population identifies as Sexual and Gender Diverse (SGD), yet there is limited research around cancer prevention among these populations. We present multi-pronged, low-cost, and systematic recruitment strategies used to reach SGD communities in New Mexico (NM), a state that is both largely rural and racially/ethnically classified as a "majority-minority" state. Methods Our recruitment focused on using: (1) Every Door Direct Mail (EDDM) program, by the United States Postal Services (USPS); (2) Google and Facebook advertisements; (3) Organizational outreach via emails to publicly available SGD-friendly business contacts; (4) Personal outreach via flyers at clinical and community settings across NM. Guided by previous research, we provide detailed descriptions on using strategies to check for fraudulent and suspicious online responses, that ensure data integrity. Results A total of 27,369 flyers were distributed through the EDDM program and 436,177 impressions were made through the Google and Facebook ads. We received a total of 6,920 responses on the eligibility survey. For the 5,037 eligible respondents, we received 3,120 (61.9%) complete responses. Of these, 13% (406/3120) were fraudulent/suspicious based on research-informed criteria and were removed. Final analysis included 2,534 respondents, of which the majority (59.9%) reported hearing about the study from social media. Of the respondents, 49.5% were between 31-40 years, 39.5% were Black, Hispanic, or American Indian/Alaskan Native, and 45.9% had an annual household income below $50,000. Over half (55.3%) were assigned male, 40.4% were assigned female, and 4.3% were assigned intersex at birth. Transgender respondents made up 10.6% (n=267) of the respondents. In terms of sexual orientation, 54.1% (n=1371) reported being gay or lesbian, 30% (n=749) bisexual, and 15.8% (n=401) queer. A total of 756 (29.8%) respondents reported receiving a cancer diagnosis and among screen-eligible respondents, 66.2% reported ever having a Pap, 78.6% reported ever having a mammogram, and 84.1% reported ever having a colonoscopy. Over half of eligible respondents (58.7%) reported receiving Human Papillomavirus vaccinations. Conclusion Study findings showcase effective strategies to reach communities, maximize data quality, and prevent the misrepresentation of data critical to improve health in SGD communities.
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Affiliation(s)
- Katie J Myers
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Talya Jaffe
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - Deborah A Kanda
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States
| | - V Shane Pankratz
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Bernard Tawfik
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Emily Wu
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Obstetrics and Gynecology, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Molly E McClain
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, AZ, United States.,Comprehensive Cancer Center, University of Arizona, Tucson, AZ, United States.,Public Health Research Institute of India, Mysuru, India
| | - Prajakta Adsul
- Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, United States.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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16
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Adsul P, Myers KJ, Kanda D, Jaffe T, Tawfik B, Wu E, McClain M, Pankratz S, Mishra SI, Nair U, Stimatze T, Madhivanan P, Kano MA. Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5533] [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: 11/20/2022] Open
Abstract
5533 Background: Population-based studies to examine cervical cancer screening (CCS) and prevention among sexual and gender diverse (SGD) individuals have been limited. We conducted a state-wide survey in New Mexico to examine differences in CCS and HPV vaccination uptake based on gender and sexual orientation. Methods: The survey was advertised using mailed flyers, social media, and targeted internet ads across the state. We received a total of 2534 responses, of which 797 respondents were CCS eligible (i.e., between 21-65 years old, had a cervix, and did not have a prior cervical cancer diagnosis) and provided information about CCS and were included in this analysis. Descriptive statistics were conducted using SAS 9.4. Results: Of the 797 respondents, 83% were 21 - 40 years old, 44% were white, 34% reported an annual household income below $50,000, 83% were employed, 81% had health insurance, and 73% reported having a primary care provider. Fourteen percent were transgender men or nonbinary, 86% were cisgender women, 34% were bisexual, 48% were lesbian, and 18% were queer. While there were no statistical differences in self-reported CCS based on gender identity, 31% of cisgender women and 25% of transgender men and nonbinary individuals reported never receiving a Pap test. The top reason for never receiving a Pap test among cisgender women was that their healthcare provider told them they did not need it (17%) and for transgender men and nonbinary individuals the top reasons were that they had an HPV vaccine (21%) or that it was too painful, unpleasant, or embarrassing (21%). There were significant statistical differences based on sexual orientation for receiving a Pap test (p < 0.001) and for being up to date on screening (Pap test in the past 3 years, a co-test, or primary HPV test in the past 5 years) (p = 0.03). Among lesbians, 39% reported never having a Pap test, compared with 17% of bisexuals and 30% of queer individuals. For lesbians, the top reason for not receiving a Pap test was not knowing that Pap tests existed (19%), while the top reason for both bisexual and queer individuals was that their healthcare provider told them they did not need it (17% and 19%, respectively). No significant differences were noted in HPV vaccination uptake among respondents. Conclusions: In order to address sexual orientation differences noted in our study, future research is needed to explore mechanisms through which these differences operate using community-based approaches. Additionally, educational interventions inclusive of different gender identities and sexual orientations are needed to improve motivations for screening uptake among SGD individuals. Finally, specific considerations for SGD individuals should be incorporated into screening recommendations and guidelines and clearly communicated to providers, further enabling them to make recommendations for these populations.
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Affiliation(s)
- Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | | | - Bernard Tawfik
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Emily Wu
- University of New Mexico Cancer Center, Albuquerque, NM
| | | | - Shane Pankratz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Uma Nair
- University of South Florida, Tampa, FL
| | | | - Purnima Madhivanan
- University of Arizona, Department of Health Promotion Sciences, Tucson, AZ
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17
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Rebbeck TR, Bridges JFP, Mack JW, Gray SW, Trent JM, George S, Crossnohere NL, Paskett ED, Painter CA, Wagle N, Kano M, Nez Henderson P, Henderson JA, Mishra SI, Willman CL, Sussman AL. A Framework for Promoting Diversity, Equity, and Inclusion in Genetics and Genomics Research. JAMA Health Forum 2022; 3:e220603. [PMID: 35755401 PMCID: PMC9223088 DOI: 10.1001/jamahealthforum.2022.0603] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 09/13/2023] Open
Abstract
IMPORTANCE Research into the genetic and genomic ("genomics") foundations of disease is central to our understanding of disease prevention, early detection, diagnostic accuracy, and therapeutic intervention. Inequitable participation in genomics research by historically excluded populations limits the ability to translate genomic knowledge to achieve health equity and ensure that findings are generalizable to diverse populations. OBSERVATIONS We propose a novel framework for promoting diversity, equity, and inclusion in genomics research. Building on principles of community-based participatory research and collective impact frameworks, the framework can guide our understanding of the social, cultural, health system, policy, community, and individual contexts in which engagement and genomics research are being done. Our framework highlights the involvement of a multistakeholder team, including the participants and communities to be engaged, to ensure robust methods for recruitment, retention, return of genomic results, quality of engagement, follow-up, and monitoring of participants. CONCLUSIONS AND RELEVANCE The proposed engagement framework will guide investigators in optimizing equitable representation in research and enhancing the rigor of genomics investigation.
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Affiliation(s)
- Timothy R Rebbeck
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - John F P Bridges
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jennifer W Mack
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Stacy W Gray
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jeffrey M Trent
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Suzanne George
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Norah L Crossnohere
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Electra D Paskett
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Corrie A Painter
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Nikhil Wagle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Miria Kano
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Patricia Nez Henderson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Jeffrey A Henderson
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Shiraz I Mishra
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Cheryl L Willman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
| | - Andrew L Sussman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts (Rebbeck); Dana-Farber Cancer Institute, Boston, Massachusetts (Rebbeck, Mack, George, Wagle); The Ohio State University, Columbus, Ohio (Bridges, Crossnohere, Paskett); City of Hope, Duarte, California (Gray); The Translational Genomics Research Institute, Phoenix, Arizona (Trent); Broad Institute to Broad Institute of MIT and Harvard and Count Me In, Cambridge, Massachusetts (Painter, Wagle); University of New Mexico Comprehensive Cancer Center and Health Sciences Center, Albuquerque (Kano, Mishra, Willman, Sussman); Black Hills Center for American Indian Health, Rapid City, South Dakota (Nez Henderson, Henderson); Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota (Willman)
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18
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Rodman J, Mishra SI, Adsul P. Improving Comprehensive Cancer Control State Plans for Colorectal Cancer Screening in the Four Corners Region of the United States. Health Promot Pract 2022:15248399211073803. [PMID: 35184614 DOI: 10.1177/15248399211073803] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) disparities continue to persist in the four corners region (states of New Mexico, Arizona, Utah, and Colorado) of the United States. The Comprehensive Cancer Control (CCC) state plans provide a policy and practice snapshot on how a state identifies and addresses its cancer burden. This study critically examines the four state plans to identify gaps and opportunities for cancer prevention and control. Using a conventional content analysis approach, we reviewed the CCC plans for CRC screening-related information, culminating in a conceptual framework that highlights three themes. First, states reported their cancer burden using national data from American Cancer Society, Centers for Disease Control and Prevention, or the NCI's Surveillance, Epidemiology, and End Results. Although these data informed specific goals and objectives, not all plans reported state-level data on CRC differences by specific social determinants of health and other characteristics. Second, it was not clear whether the interventions chosen to address state plan objectives were evidence-based and whether or not clearly described criteria were used for the selection of the interventions. Third, very limited information was provided in terms of state-specific contextual challenges and practical implementation of interventions. Study findings highlight opportunities to improve state-level cancer prevention and control efforts: first, by promoting the selection and adaptation of contextually relevant evidence-based interventions for this unique region; and second, through multidirectional engagement with communities, researchers, and policy and practice stakeholders. Such synergies in research and policies are vital for a coordinated and integrated approach to cancer prevention and control.
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Affiliation(s)
- Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA.,Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.,Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
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19
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Del Rosario A, Eldredge JD, Doorley S, Mishra SI, Kesler D, Page K. Hepatitis C virus care cascade in persons experiencing homelessness in the United States in the era of direct-acting antiviral agents: A scoping review. J Viral Hepat 2021; 28:1506-1514. [PMID: 34314081 PMCID: PMC9829430 DOI: 10.1111/jvh.13583] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 01/12/2023]
Abstract
The hepatitis C virus (HCV) care cascade has been well characterized in the general United States population and other subpopulations since curative medications have been available. However, information is limited on care cascade outcomes in persons experiencing homelessness. The main objective of this study was to map the available evidence on HCV care cascade outcomes in people experiencing homelessness in the U.S. in the era of direct-acting antiviral agents (DAAs). Primary and secondary outcomes included linkage to care (evaluation by a provider that can treat HCV) and sustained virologic response (SVR) or cure. Exploratory outcomes included other cascade data, like treatment initiation, which precedes SVR. PubMed was the primary database accessed for this scoping review. We characterized the HCV care cascade in people experiencing homelessness using sources of evidence published in 2014 onwards that reported the proportions of persons who were linked to care, achieved SVR, and completed other cascade steps. We synthesized our results into a scoping review. The proportion of persons linked to care among chronically infected cohorts with unstable housing ranged from 29.3% to 88.7%. Among those chronically infected, 5%-58.8% were started on DAAs and 5%-50% achieved SVR. In conclusion, these results show that persons experiencing homelessness achieve high rates of linkage to care in non-specialist community-based settings compared to the general U.S. population pre-DAAs. However, DAA initiation was found to be a rate-limiting step along the care cascade, resulting in commensurate low rates of cure.
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Affiliation(s)
- Aubrey Del Rosario
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jonathan D Eldredge
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sara Doorley
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Shiraz I Mishra
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Denece Kesler
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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20
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Nedjat-Haiem FR, Cadet TJ, Parada H, Mishra SI, Bullock K. A National Survey of Social Workers Focusing on Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: Implication During COVID19. Am J Hosp Palliat Care 2021; 39:737-744. [PMID: 34409873 DOI: 10.1177/10499091211038503] [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: 11/15/2022] Open
Abstract
Social workers have a critical role on medical teams for facilitating effective conversations about advance care planning (ACP) in palliative and end-of-life care. Engaging patients in such conversations may be influenced by clinicians' attitudes. During the COVID19 pandemic, the need to examine barriers to serious illness care across healthcare settings and areas of specialty practice became abundantly clear. This study examines: (1) social workers' attitudes about ACP and (2) factors that influence the completion of advance directives (ADs). Using a cross-sectional study design, we surveyed 142 social workers on their knowledge, attitudes, and behaviors related to ADs. Using exploratory factor analyses, we identified 2 provider practice attitudes factors, 3 perceived barriers factors, and 2 perceived importance of AD factors. We then used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for each of the factors in association with the frequency social workers reported educating patients about ADs. While various positive and negative attitudes and barriers toward educating patients are important factors to consider, social workers' perceptions of the importance of engaging patients in ACP education was the most important factor that influenced their behaviors. The odds of always/often (vs. sometimes/rarely/never) educating patients about ADs in their practice were greater for those social workers who reported they see the importance of AD decision-making (OR = 3.21, 95%CI = 1.83-5.62) and confirming goals-of-care (OR = 1.76, 95%CI = 1.03-3.01). Social worker's ACP knowledge and skills for educating patients are important in initiating conversations prior to a health crisis, especially important for developing a comprehensive care plan.
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Affiliation(s)
| | - Tamara J Cadet
- School of Social Work, Simmons University, Boston, MA, USA
| | - Humberto Parada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Shiraz I Mishra
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Karen Bullock
- School of Social Work, North Carolina State University, Raleigh, NC, USA
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21
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Gittelsohn J, Belcourt A, Magarati M, Booth-LaForce C, Duran B, Mishra SI, Belone L, Jernigan VBB. Building Capacity for Productive Indigenous Community-University Partnerships. Prev Sci 2021; 21:22-32. [PMID: 30284683 DOI: 10.1007/s11121-018-0949-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 10/28/2022]
Abstract
This paper describes capacity development as a key aspect of community-based research with indigenous communities. University research engagement with indigenous communities includes extensive, and often negative, historical antecedents. We discuss strategies for developing effective, egalitarian, and balanced indigenous community-university relationships to build research capacity of these communities, and to create sustainable partnerships to improve health and wellness, and to reduce health disparities. We draw on the experience of eight investigators conducting research with indigenous communities to assess effective strategies for building and enhancing partnerships, including (1) supporting indigenous investigator development; (2) developing university policies and practices sensitive and responsive to Indigenous community settings and resources, and training for research; (3) developing community and scientifically acceptable research designs and practices; (4) aligning indigenous community and university review boards to enhance community as well as individual protection (e.g., new human subjects training for Indigenous research, joint research oversight, adaptation of shorter consent forms, appropriate incentives, etc.); (5) determining appropriate forms of dissemination (i.e., Indian Health Services provider presentation, community reports, digital stories, etc.); (6) best practices for sharing credit; and (7) reducing systematic discrimination in promotion and tenure of indigenous investigators and allies working in indigenous communities.
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Affiliation(s)
- Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Room W2041A, 615 North Wolfe St, Baltimore, MD, 21205-2179, USA.
| | - Annie Belcourt
- Department of Pharmacy Practice, University of Montana, Missoula, MT, USA
| | - Maya Magarati
- School of Social Work, Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
| | | | - Bonnie Duran
- School of Social Work, Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Lorenda Belone
- College of Education, The University of New Mexico, Albuquerque, NM, USA
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22
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Nedjat-Haiem FR, Cadet T, Parada H, Jones T, Jimenez EE, Thompson B, Wells KJ, Mishra SI. Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases. Am J Hosp Palliat Care 2020; 38:938-946. [PMID: 33153273 DOI: 10.1177/1049909120971829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. OBJECTIVE We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. METHODS This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). RESULTS The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being. CONCLUSION In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.
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Affiliation(s)
| | | | | | | | - Elvira E Jimenez
- 19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Beti Thompson
- 7286Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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23
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Mishra SI, Doescher MP, Hatcher J, English K, Rhoades D, Lance P, Pankratz S, Blanchard J, Edwardson N, Hopkins M, Sussman A, Nagykaldi Z, Jim C. Abstract C120: Evidence-based strategies to enhance colorectal cancer screening in American Indian communities. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-c120] [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
Despite the proven effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have some of the lowest CRC screening rates. Nearly two-thirds of US adults are current with US Preventive Services Task Force guidelines for CRC screening. In contrast, based on Indian Health Service (IHS) Government Performance and Results Act (GPRA) data, AI screening rates range from a low of 28% in the Phoenix Area, to 30% in the Albuquerque Area and a high of only 51% in the Oklahoma Area. The AI CRC Screening Consortium was formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma to address the major regional CRC screening disparities. The Consortium’s overall objective is to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC through the implementation of cost-effective multilevel, multicomponent evidence-based interventions (EBIs) across AI populations (on and off tribal lands) in the tri-state region. As part of the planning phase of the project (Year 1), we completed mixed-methods environmental scans (focus group and interviews, and readiness to change surveys) among tribal members and multisector healthcare providers practicing at Indian Health Service (IHS, I), Tribal (T), and Urban Indian (U) (I/T/U) healthcare facilities across the three states. In all, we conducted seven focus groups, 71 interviews, and three surveys at nine I/T/U healthcare facilities. We organized the focus group and interview data according to The Guide to Community Preventive Services (The Community Guide) recommendations for strategies to increase: community demand, community access, and provider delivery of CRC screening. We will provide quotes and summaries underscoring the EBIs and strategies recommended by the multisector healthcare action teams for implementation at their healthcare facilities. We will also describe the establishment of the Consortium and challenges experienced in conducting research with multiple tribal and federal entities and regulatory authorities. The use of community-academic participatory approaches has facilitated bidirectional and mutually beneficial knowledge integration, collaborative inter-dependent partnerships, equity in data ownership, and capacity enhancement. The scope of this project presents an opportunity to reduce CRC incidence and mortality affecting thousands of AIs. Our collaborative work will create opportunities for future research addressing the spectrum of CRC prevention, detection, and treatment in AI populations across the US.
Citation Format: Shiraz I Mishra, Mark P Doescher, Jennifer Hatcher, Kevin English, Dorothy Rhoades, Peter Lance, Shane Pankratz, Jessica Blanchard, Nicholas Edwardson, Michelle Hopkins, Andrew Sussman, Zsolt Nagykaldi, Cheyenne Jim. Evidence-based strategies to enhance colorectal cancer screening in American Indian communities [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 C120.
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Affiliation(s)
- Shiraz I Mishra
- 1University of New Mexico Health Sciences Center, Albuquerque, NM, USA,
| | - Mark P Doescher
- 2Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | | | - Kevin English
- 4Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA,
| | - Dorothy Rhoades
- 2Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | | | - Shane Pankratz
- 1University of New Mexico Health Sciences Center, Albuquerque, NM, USA,
| | | | | | - Michelle Hopkins
- 2Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | - Andrew Sussman
- 1University of New Mexico Health Sciences Center, Albuquerque, NM, USA,
| | - Zsolt Nagykaldi
- 2Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | - Cheyenne Jim
- 4Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA,
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English KC, Jim C, Hatcher J, Doescher MP, Mishra SI, Lance P, Rhoades D, Menon U. Abstract B004: Capacity development among patient navigators to enhance colorectal cancer control in American Indian-serving healthcare facilities in the U.S. Southwest and Southern Plains. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-b004] [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
According to the Institute of Medicine’s National Cancer Policy Forum, the American Cancer Society, and the National Cancer Institute, cancer screening programs are partly responsible for declining colorectal cancer (CRC) incidence and mortality rates in the U.S. Unfortunately, American Indians (AIs) have experienced either no change or an increase in CRC incidence and mortality, disproportionate diagnosis of late stage disease and poorer survival. While, nearly two-thirds of U.S. adults are current with United States Preventive Services Task Force (USPSTF) guidelines for CRC screening, AI screening rates range from only 28% to 51% in the Southwest and Southern Plains regions. One evidence-based intervention strategy for increasing CRC screening recommended by the Community Preventive Services Task Force (CPSTF) is patient navigation. By offering interpretation, transportation, social support, and culturally and linguistically appropriate education and outreach, patient navigators are able to reduce structural barriers and facilitate access to screening. While researchers have documented effectiveness of patient navigation towards enhancing cancer screening among AI populations, few studies have elucidated best practices for training patient navigators to serve in this capacity. As an effort of the AI CRC Screening Consortium formed by the National Cancer Institute-Designated Cancer Centers at the Universities of Arizona, New Mexico, and Oklahoma, we trained a cadre of 21 individuals to serve as patients navigators in six unique AI-serving health clinics and communities in Oklahoma, Arizona, and New Mexico. We used a unique blend of didactic and interactive training components (i.e. role playing, games, and group dialogues). The 2.5-day curriculum centered upon a set of nine modules that included digestive system anatomy, USPSTF CRC screening guidelines, stool-based test procedures, direct visualization test procedures, CRC risk factors, CRC diagnosis and treatment, Transtheoretical Model and Motivational Interviewing, and patient navigation tips. A 36-item pre-/post-test was administered to assess the impact of training upon navigator capacity. Paired-sample t-tests were utilized to analyze mean differences in scales measuring two key constructs – CRC-specific knowledge and self-efficacy to engage in CRC control efforts. Evaluation findings demonstrated statistically significance increases in both CRC knowledge scores (pre-test mean = 7.8/12.0 vs. post-test mean 10.9/12.0, p=0.000) and self-efficacy scores (pre-test mean = 3.8/5.0 vs. post-test mean = 4.8/5.0, p=0.001). These findings demonstrate the value of robust capacity development activities with patient navigators prior to intervention as a means of not only increase knowledge about CRC and its associated screenings, but to also engender significant readiness and confidence among patient navigators to integrate CRC control into practice.
Citation Format: Kevin C English, Cheyenne Jim, Jennifer Hatcher, Mark P Doescher, Shiraz I Mishra, Peter Lance, Dorothy Rhoades, Usha Menon. Capacity development among patient navigators to enhance colorectal cancer control in American Indian-serving healthcare facilities in the U.S. Southwest and Southern Plains [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 B004.
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Affiliation(s)
- Kevin C English
- 1Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA,
| | - Cheyenne Jim
- 1Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA,
| | | | - Mark P Doescher
- 3Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | | | | | - Dorothy Rhoades
- 3Oklahoma University Health Sciences Center, Oklahoma City, OK, USA,
| | - Usha Menon
- 5University of South Florida, Tampa, FL, USA
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Nedjat-Haiem FR, Cadet TJ, Amatya A, Thompson B, Mishra SI. Efficacy of Motivational Interviewing to Enhance Advance Directive Completion in Latinos With Chronic Illness: A Randomized Controlled Trial. Am J Hosp Palliat Care 2019; 36:980-992. [PMID: 31122037 DOI: 10.1177/1049909119851470] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/15/2022] Open
Abstract
BACKGROUND End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. OBJECTIVE The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. METHODS We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. RESULTS Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. CONCLUSION When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.
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Affiliation(s)
| | - Tamara J Cadet
- 2 School of Social Work, Simmons University, Boston, MA, USA.,3 Harvard School of Dental Medicine, Boston, MA, USA
| | - Anup Amatya
- 4 Department of Public Health Sciences, New Mexico State University, Las Cruces, NW, USA
| | - Beti Thompson
- 5 School of Public Health, University of Washington, Seattle, WA, USA
| | - Shiraz I Mishra
- 6 University of New Mexico Health Sciences Center, Albuquerque, NM, NM, USA
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Nedjat-Haiem FR, Cadet TJ, Amatya A, Mishra SI. Healthcare Providers' Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey. Am J Hosp Palliat Care 2018; 36:387-395. [PMID: 30486655 DOI: 10.1177/1049909118813720] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] Open
Abstract
BACKGROUND: Advance care planning for end-of-life care emerged in the mid-1970's to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. OBJECTIVE: Study aims examine providers' perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. DESIGN: To examine providers' views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. METHODS: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers' views toward AD education. RESULTS: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. CONCLUSION: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.
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Affiliation(s)
| | - Tamara J Cadet
- 2 School of Social Work, Simmons College, Boston, MA, USA
| | - Anup Amatya
- 3 Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Shiraz I Mishra
- 4 School of Medicine, University of New Mexico, Las Cruces, NM, USA
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Gonzales M, Qeadan F, Mishra SI, Rajput A, Hoffman RM. Racial-Ethnic Disparities in Late-Stage Colorectal Cancer Among Hispanics and Non-Hispanic Whites of New Mexico. Hisp Health Care Int 2018; 15:180-188. [PMID: 29237342 DOI: 10.1177/1540415317746317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/30/2022]
Abstract
INTRODUCTION Hispanics in New Mexico are diagnosed with more later-stage colorectal cancer (CRC) than non-Hispanic Whites (NHW). Our study evaluated the interaction of race/ethnicity and risk factors for later-stage III and IV CRC among patients in New Mexico. METHOD CRC patients ages 30 to 75 years ( n = 163, 46% Hispanic) completed a survey on key explanatory clinical, lifestyle, preventive health, and demographic variables for CRC risk. Adjusted logistic regression models examined whether these variables differentially contributed to later-stage CRC among NHW versus Hispanics. RESULTS Compared with NHW, Hispanics had a higher prevalence of later-stage CRC ( p = .007), diabetes ( p = .006), high alcohol consumption ( p = .002), low education ( p = .003), and CRC diagnosis due to symptoms ( p = .06). Compared with NHW, Hispanics reporting high alcohol consumption (odds ratio [OR] = 7.59; 95% confidence interval [CI] = 1.31-43.92), lower education (OR = 3.5; 95% CI = 1.28-9.65), being nondiabetic (OR = 3.23; 95% CI = 1.46-7.15), or ever smokers (OR = 2.4; 95% CI = 1.03-5.89) were at higher risk for late-stage CRC. Adjusting for CRC screening did not change the direction or intensity of the odds ratios. CONCLUSION The ethnicity-risk factor interactions, identified for late-stage CRC, highlight significant factors for targeted intervention strategies aimed at reducing the burden of later-stage CRC among Hispanics in New Mexico with broad applicability to other Hispanic populations.
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Affiliation(s)
| | - Fares Qeadan
- 1 University of New Mexico, Albuquerque, NM, USA
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Abstract
This article examines a unique data set randomly collected from Latinas (including 160 undocumented immigrants) and non-Hispanic white women in Orange County, California, including undocumented and documented Latina immigrants, Latina citizens, and non-Hispanic white women. Our survey suggests that undocumented Latinas are younger than documented Latinas, and immigrant Latinas are generally younger than U.S.-citizen Latinas and Anglo women. Undocumented and documented Latinas work in menial service sector jobs, often in domestic services. Most do not have job-related benefits such as medical insurance. Despite low incomes and likelihood of having children under age 18 living with them, their use of public assistance was low. Undocumented and documented Latina immigrants lived in households that often contained extended family members; they were more likely than other women in the study to lack a regular source of health care, to utilize health clinics, public health centers, and hospital emergency rooms rather than private physicians or HMOs, and to underutilize preventative cancer screening services. Despite their immigration status, undocumented Latina immigrants often viewed themselves as part of a community in the United States, which significantly influenced their intentions to stay in the United States. Contrary to much of the recent public policy debate over immigration, we did not find that social services influenced Latina immigrants’ intentions to stay in the United States.
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Nedjat-Haiem FR, Carrion IV, Gonzalez K, Bennett ED, Ell K, O’Connell M, Thompson B, Mishra SI. Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention. Am J Hosp Palliat Care 2018; 35:1091-1098. [DOI: 10.1177/1049909118763796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advance care planning (ACP) does not readily occur in medical settings and often gets missed. Older Latinos need ACP information to encourage advance directive (AD) completion indicating preferences for end-of-life (EOL) care. Objective: To explore the experiences with counseling using motivational interviewing (MI) techniques and social workers to encourage ACP communication among older Latinos with advance chronic diseases. This study describes stages of readiness to plan for EOL care. Design: We conducted a qualitative study with older Latinos who participated in a community-based intervention in Southern New Mexico. Methods: Participants in the intervention were selected because they received ACP education plus counseling involving MI to address resistance to ACP. Motivational interviewing counseling involved the following: (1) engaging in structured dialogue about ACP, (2) using and completing AD documentation, (3) encouraging ACP communication with providers and families, and (4) applying AD information into actionable behavior. We utilized a constant comparative method and thematic analysis to explore the meaning of older Latinos’ experiences with MI counseling and stages of change. Results: Participants (n = 32) were mostly women (74.3%), half born in the United States and half from Mexico in the United States on average for 31.75 (standard deviation 16.22) years. Many had less than sixth grade education (31.3%) or had not completed high school (21.9%). Key themes indicate the following stages of change: (1) precontemplation, (2) contemplation, (3) preparation, (4) ACP action, and (5) maintenance. Conclusion: This study contributes to the literature by identifying areas for adaption to enhance understanding and increase information to ultimately achieve the completion of ACP among Latinos.
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Affiliation(s)
| | | | | | | | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Mary O’Connell
- School of Social Work, New Mexico State University, Las Cruces, NM, USA
| | - Beti Thompson
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Shiraz I. Mishra
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
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Mishra SI, Rishel Brakey H, Kano M, Nedjat-Haiem FR, Sussman AL. Health related quality of life during cancer treatment: Perspectives of young adult (23-39 years) cancer survivors and primary informal caregivers. Eur J Oncol Nurs 2017; 32:48-54. [PMID: 29353632 DOI: 10.1016/j.ejon.2017.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/30/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE There is a paucity of information regarding health related quality of life (HRQoL) of young adults (YAs) with cancer and caregivers. Therefore, we characterize YA and caregiver perspectives on the impact of cancer and its treatment on HRQoL. METHODS We conducted descriptive qualitative in-depth, semi-structured interviews with YAs receiving cancer care at an academic health center in Albuquerque, New Mexico (USA) and primary informal caregivers. The interviews, conducted from September through December 2015, focused on perspectives on the impact of the disease and its treatment in terms of physical and emotional effects, coping, and strategies to enhance HRQoL. We used an iterative thematic analysis approach to identify emergent themes and create a coding structure. RESULTS We reached thematic saturation after interviewing 8 YAs and 8 caregivers. YAs and caregivers discussed cancer triggered challenges such as anxiety, depression, isolation, fear, and financial hardships. YAs and caregivers coped by maintaining positive perspectives, relying on friends and family, and prayer. Caregivers discussed how expectations for and experiences of a "good day" changed depending on their loved ones' stage of cancer treatment. YAs navigated challenges by focusing on activities and thoughts that provided meaning to their lives. YAs and caregivers suggested strategies to enhance HRQoL through patient/provider communication, support services, and decision making tools as potential mechanisms for grounding patient-centered interventions to improve cancer care. CONCLUSIONS Implications include the development and evaluation of informational and behavioral interventions tailored and targeted to address the pragmatic needs of YAs undergoing cancer treatment and informal caregivers.
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Affiliation(s)
- Shiraz I Mishra
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM 87131, USA; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131, USA; University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1201 Camino de Salud, Albuquerque, NM 87131, USA.
| | - Heidi Rishel Brakey
- University of New Mexico Clinical and Translational Science Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Miria Kano
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131, USA; University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1201 Camino de Salud, Albuquerque, NM 87131, USA
| | - Frances R Nedjat-Haiem
- New Mexico State University, School of Social Work, 1335 International Mall, Las Cruces, NM 88003, USA
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131, USA; University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1201 Camino de Salud, Albuquerque, NM 87131, USA
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Nedjat-Haiem FR, Carrion IV, Gonzalez K, Quintana A, Ell K, O'Connell M, Thompson B, Mishra SI. Implementing an Advance Care Planning Intervention in Community Settings with Older Latinos: A Feasibility Study. J Palliat Med 2017; 20:984-993. [PMID: 28467145 DOI: 10.1089/jpm.2016.0504] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/12/2022] Open
Abstract
BACKGROUND Older Latinos with serious medical conditions such as cancer and other chronic diseases lack information about advance care planning (ACP). ACP Intervention (ACP-I Plan) was designed for informational and communication needs of older Latinos to improve communication and advance directives (ADs). OBJECTIVE To determine the feasibility of implementing ACP-I Plan among seriously ill, older Latinos (≥50 years) in Southern New Mexico with one or more chronic diseases (e.g., cancer, heart disease, renal/liver failure, stroke, hypertension, diabetes, chronic obstructive pulmonary disease, and HIV/AIDS). DESIGN We conducted a prospective, pretest/post-test, two-group, randomized, community-based pilot trial by using mixed data collection methods. SETTING/SUBJECTS Older Latino/Hispanic participants were recruited from community-based settings in Southern New Mexico. METHODS All participants received ACP education, whereas the intervention group added: (1) emotional support addressing psychological distress; and (2) systems navigation for resource access, all of which included interactive ACP treatment decisional support and involved motivational interview (MI) methods. Purposive sampling was guided by a sociocultural framework to recruit Latino participants from community-based settings in Southern New Mexico. Feasibility of sample recruitment, implementation, and retention was assessed by examining the following: recruitment strategies, trial enrollment, retention rates, duration of MI counseling, type of visit (home vs. telephone), and satisfaction with the program. RESULTS We contacted 104 patients, enrolled 74 randomized to usual care 39 (UC) and treatment 35 (TX) groups. Six dropped out before the post-test survey, three from TX before the post-test survey because of sickness (n = 1) or could not be located (n = 2), and the same happened for UC. Completion rates were 91.4% UC and 92.3% TX groups. All participants were Latino/Hispanic, born in the United States (48%) or Mexico (51.4%) on average in the United States for 25 years; majority were female, 76.5%; 48.6% preferred Spanish; and 31.4% had less than sixth-grade education. Qualitative data indicate satisfaction with the ACP-I Plan intervention. CONCLUSIONS Based on enrollment and intervention completion rates, time to completion tests, and feedback from qualitative post-study, follow-up interviews, the ACP-I Plan was demonstrated to be feasible and perceived as extremely helpful.
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Affiliation(s)
| | - Iraida V Carrion
- 2 School of Social Work, University of South Florida , Tampa, Florida
| | - Krystyna Gonzalez
- 1 School of Social Work, New Mexico State University , Las Cruces, New Mexico
| | - Alejandra Quintana
- 1 School of Social Work, New Mexico State University , Las Cruces, New Mexico
| | - Kathleen Ell
- 3 Suzanne Dworak-Peck School of Social Work, University of Southern California , Los Angeles, California
| | - Mary O'Connell
- 1 School of Social Work, New Mexico State University , Las Cruces, New Mexico
| | - Beti Thompson
- 4 School of Public Health, University of Washington , Seattle, Washington
| | - Shiraz I Mishra
- 5 School of Medicine, University of New Mexico , Albuquerque, New Mexico
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Mishra SI, Brakey HR, Kano M, Sussman A. Abstract B24: Health related quality of life during cancer treatment: Perspectives of adolescent and young adult cancer patients and caregivers. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b24] [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
Cancer incidence among adolescent and young adults (AYAs) ages 15-39 has steadily increased over the past 25 years. Moreover, 5-year survival rates for AYAs has not improved in almost 30 years. AYAs with cancer often require an intensive treatment regimen, comprising surgery, chemotherapy, radiotherapy, or a combination. Cancer and its active treatment result in adverse effects, including physical and emotional effects and risk for additional cancers. These have a detrimental impact on health related quality of life (HRQoL) of AYAs with cancer. With a dearth of data to translate into evidence-guided interventions promoting HRQoL, we characterized patients' and caregivers' perspectives regarding cancer and its treatments' impact on HRQoL and strategies to enhance HRQoL.
METHODS
We conducted qualitative, in-depth semi-structured interviews with AYAs with cancer receiving care at the University of New Mexico (UNM) Pediatrics Hematology/Oncology Clinic and the UNM Comprehensive Cancer Center and caregivers. New Mexico is one of the four “minority-majority” states, with a multiethnic, multicultural, and geographically dispersed population with striking patterns of cancer health disparities. We used community engaged research methods and a purposeful sampling approach, to recruit eligible participants from diverse racial/ethnic and socio-economic backgrounds. We conducted audio-recorded interviews (September through December 2015) focusing on patients' and caregivers' perspectives on the impact of cancer, stressors, coping mechanisms, meaning of life, and strategies to enhance HRQoL. Investigators iteratively reviewed transcripts to create an initial coding structure and transcripts were imported into NVivo 10, a qualitative data analysis program, for final coding. We used the social determinants of health framework to categorize and interpret the data.
RESULTS
We reached thematic saturation after interviewing 10 AYAs and 10 caregivers, among which there were eight patient-caregiver dyads. AYAs and caregivers expressed acute stress, frustration, anger, and sadness as a result of the cancer diagnosis. AYAs felt a loss of sense of self-worth and self-esteem. Moreover, AYAs and caregivers experienced financial difficulties due to loss of work, reduced work hours, and expenses related to medical care and accommodations; some had to make hard decisions by choosing between basic necessities and medical treatment. AYAs felt stigmatized due to their treatment-related physical appearance and limitation. On a positive note, there were references to inner strength and resolve and discovering the true nature of friendships. When undergoing treatment, a “good day” would be doing “normal” things, spending time with loved ones. There was also the realization that life with cancer meant “live life to the fullest” and “make a difference and help as many people”. Strategies to cope with cancer included maintaining a positive outlook, family support, being engaged, finding distractions, faith, and spirituality.
CONCLUSIONS
Cancer and its treatment poses a tremendous emotional and financial burden on both patients and caregivers, which they addressed through reframing the meaning of life and positive active coping strategies. Effective interventions to enhance HRQoL among AYAs with cancer and caregivers need to focus on behavioral and lifestyle support coupled with education.
Citation Format: Shiraz I. Mishra, Heidi Rishel Brakey, Miria Kano, Andrew Sussman. Health related quality of life during cancer treatment: Perspectives of adolescent and young adult cancer patients and caregivers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B24.
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Affiliation(s)
| | | | - Miria Kano
- University of New Mexico, Albuquerque, New Mexico
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Saeed AI, Qeadan F, Sood A, VanderJagt DJ, Mishra SI, Hill DA, Peikert T, Sopori ML. A novel cytokine profile associated with cancer metastasis to mediastinal and hilar lymph nodes identified using fine needle aspiration biopsy - A pilot study. Cytokine 2016; 89:98-104. [PMID: 27599390 DOI: 10.1016/j.cyto.2016.08.011] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 12/14/2022]
Abstract
Cancer metastasis to the lymph nodes is indicative of a poor prognosis. An endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) biopsy is increasingly being used to sample paratracheal lymph nodes for simultaneous cancer diagnosis and staging. In this prospective, single-center study, we collected dedicated EBUS-FNA biopsies from 27 patients with enlarged paratracheal and hilar lymph nodes. Cytokines were assayed using Bio-Plex Pro human cancer biomarker panels (34 cytokines), in a Bio-Rad 200 suspension array system. A mean cytokine value was taken from each subject with more than 1 lymph node station EBUS-FNA biopsies. Malignant and benign histologic diagnoses were established in 16 and 12 patients, respectively. An initial analysis using the Kruskal-Wallis test with Sidak correction for multiple comparisons, showed significant elevation of sVEGFR-1, IL-6, VEGF-A, Angiopoeintin-2, uPA, sHER-2/neu and PLGF in malignant lymph node samples compared to benign samples. The univariate logistic regression analyses revealed that 6 cytokines were significant predictors and 1 cytokine (PLGF) was marginally significant for discrimination between benign and malignant samples. The prediction power of these cytokines as biomarkers were very high according to the area under the ROC curve. Multiple logistic regression for subsets of the seven cytokine combined; provided an almost complete discrimination between benign and malignant samples (AUC=0.989). For screening and diagnostic purposes, we presented the optimal discrimination cut-off for each cytokine: sVEGFR-1 (2124.5pg/mL), IL-6 (40.2pg/mL), VEGF-A (1060.1pg/mL), Angiopoeintin-2 (913.7pg/mL), uPA (248.1pg/mL), sHER-2/neu (5010pg/mL) and PLGF (93.4pg/mL). For the very first time, a novel cytokine profile associated with cancer metastasis to the paratracheal lymph nodes were reported.
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Affiliation(s)
- Ali I Saeed
- Department of Internal Medicine, Pulmonary Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Fares Qeadan
- Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Akshay Sood
- Department of Internal Medicine, Pulmonary Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Dorothy J VanderJagt
- Department of Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM, United States
| | - Shiraz I Mishra
- Departments of Pediatrics and Family and Community Medicine, University of New Mexico, University of New Mexico Cancer Center, Albuquerque, NM, United States
| | - Deirdre A Hill
- Cancer Research and Treatment Center, Departments of Internal Medicine, Division of Epidemiology, University of New Mexico, Albuquerque, NM, United States
| | - Tobias Peikert
- Department of Internal Medicine, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mohan L Sopori
- Lovelace Respiratory Research Institute, Albuquerque, NM, United States
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Mishra SI, Sussman AL, Murrietta AM, Getrich CM, Rhyne R, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Saeed AI, Hoffman RM. Patient Perspectives on Low-Dose Computed Tomography for Lung Cancer Screening, New Mexico, 2014. Prev Chronic Dis 2016; 13:E108. [PMID: 27536900 PMCID: PMC4993119 DOI: 10.5888/pcd13.160093] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION National guidelines call for annual lung cancer screening for high-risk smokers using low-dose computed tomography (LDCT). The objective of our study was to characterize patient knowledge and attitudes about lung cancer screening, smoking cessation, and shared decision making by patient and health care provider. METHODS We conducted semistructured qualitative interviews with patients with histories of heavy smoking who received care at a Federally Qualified Health Center (FQHC Clinic) and at a comprehensive cancer center-affiliated chest clinic (Chest Clinic) in Albuquerque, New Mexico. The interviews, conducted from February through September 2014, focused on perceptions about health screening, knowledge and attitudes about LDCT screening, and preferences regarding decision aids. We used a systematic iterative analytic process to identify preliminary and emergent themes and to create a coding structure. RESULTS We reached thematic saturation after 22 interviews (10 at the FQHC Clinic, 12 at the Chest Clinic). Most patients were unaware of LDCT screening for lung cancer but were receptive to the test. Some smokers said they would consider quitting smoking if their screening result were positive. Concerns regarding screening were cost, radiation exposure, and transportation issues. To support decision making, most patients said they preferred one-on-one discussions with a provider. They also valued decision support tools (print materials, videos), but raised concerns about readability and Internet access. CONCLUSION Implementing lung cancer screening in sociodemographically diverse populations poses significant challenges. The value of tobacco cessation counseling cannot be overemphasized. Effective interventions for shared decision making to undergo lung cancer screening will need the active engagement of health care providers and will require the use of accessible decision aids designed for people with low health literacy.
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Affiliation(s)
- Shiraz I Mishra
- Professor, Department of Pediatrics, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM 87131.
| | - Andrew L Sussman
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico
| | | | - Robert Rhyne
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Ellen J Reifler
- Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts
| | - Pamela H Wescott
- Informed Medical Decisions Foundation/Healthwise, Boston, Massachusetts
| | - Ali I Saeed
- Division of Pulmonary Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA
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Abstract
The authors examined the relationship among psychosocial vulnerability (stress) and resilience (adaptive potential) factors and three outcome measures, self-reported physical symptoms, positive and negative affect, and natural killer cell activity in 39 male and female older adults residing in a retirement community (mean age = 73.5). Although life events were directly related to physical health symptoms, both perceived stress and adaptive potential were significantly associated with positive and negative affect. There was a tendency for adaptive potential to buffer the effect of perceived stress on negative affect. However, natural killer cell activity was not significantly related to any psychosocial vulnerability and resilience factors in this small sample. Implications for studying the effects of stress on health in older adults are discussed.
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Morshed AB, Davis SM, Keane PC, Myers OB, Mishra SI. The Impact of the CHILE Intervention on the Food Served in Head Start Centers in Rural New Mexico. J Sch Health 2016; 86:414-23. [PMID: 27122141 PMCID: PMC4852386 DOI: 10.1111/josh.12393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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] [Received: 04/08/2014] [Revised: 10/02/2015] [Accepted: 01/09/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Child Health Initiative for Lifelong Eating and Exercise is a multicomponent obesity-prevention intervention, which was evaluated among Head Start (HS) centers in American Indian and predominantly Hispanic communities in rural New Mexico. This study examines the intervention's foodservice outcomes: fruits, vegetables, whole grains, discretionary fats, added sugars, and fat from milk served in meals and snacks. METHODS Sixteen HS centers were randomized to intervention/comparison groups, following stratification by ethnicity and preintervention median body mass index of enrolled children. The foodservice component included quarterly trainings for foodservice staff about food purchasing and preparation. Foods served were evaluated before and after the 2-year intervention, in the fall 2008 and spring 2010. RESULTS The intervention significantly decreased fat provided through milk and had no significant effect on fruit, vegetables and whole-grain servings, discretionary fats, and added sugar served in HS meals and snacks. When effect modification by site ethnicity was examined, the effect on fat provided through milk was only found in American Indian sites. CONCLUSIONS Foodservice interventions can reduce the amount of fat provided through milk served in HS. More research is needed regarding the implementation of foodservice interventions to improve the composition of foods served in early education settings.
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Affiliation(s)
- Alexandra B Morshed
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899.
| | - Sally M Davis
- Department of Pediatrics, Director, Prevention Research Center, University of New Mexico, MSC 11 6145, Albuquerque, NM 87131.
| | - Patricia C Keane
- Department of Pediatrics, University of New Mexico Prevention Research Center, MSC 11 6145, Albuquerque, NM 87131.
| | - Orrin B Myers
- Department of Internal Medicine, University of New Mexico, MSC 10 5550, Albuquerque, NM 87131.
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131.
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Nedjat-Haiem FR, Carrion IV, Gonzalez K, Ell K, Thompson B, Mishra SI. Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication. Am J Hosp Palliat Care 2016; 34:308-317. [PMID: 26878869 DOI: 10.1177/1049909115627773] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 11/17/2022] Open
Abstract
Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.
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Affiliation(s)
- Frances R Nedjat-Haiem
- 1 School of Social Work, New Mexico State University, Las Cruces, NM, USA.,2 Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Iraida V Carrion
- 3 School of Social Work, University of South Florida, Tampa, FL, USA
| | - Krystana Gonzalez
- 1 School of Social Work, New Mexico State University, Las Cruces, NM, USA
| | - Kathleen Ell
- 4 School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Beti Thompson
- 5 School of Public Health, University of Washington, Seattle, WA, USA
| | - Shiraz I Mishra
- 6 School of Medicine, University of New Mexico, Albuquerque, NM, USA
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Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. The effectiveness of exercise interventions for improving health-related quality of life from diagnosis through active cancer treatment. Oncol Nurs Forum 2015; 42:E33-53. [PMID: 25542333 DOI: 10.1188/15.onf.e33-e53] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among adults scheduled to, or actively undergoing, cancer treatment. DATA SOURCES 11 electronic databases were searched through November 2011. In addition, the authors searched PubMed's related article feature, trial registries, and reference lists of included trials and related reviews. DATA SYNTHESIS 56 trials with 4,826 participants met the inclusion criteria. At 12 weeks, people exposed to exercise interventions had greater improvement in overall HRQOL, physical functioning, role functioning, social functioning, and fatigue. Improvement in HRQOL was associated with moderate-to-vigorous intensity exercise interventions. CONCLUSIONS Exercise can be a useful tool for managing HRQOL and HRQOL domains for people scheduled to, or actively undergoing, cancer treatment. More methodologically rigorous trials are needed to examine the attributes of exercise programs most effective for improving HRQOL. IMPLICATIONS FOR NURSING Evidence from this review supports the incorporation of exercise programs of moderate-to-vigorous intensity for the management of HRQOL among people scheduled to, or actively undergoing, cancer treatment into clinical guidelines through the Oncology Nursing Society's Putting Evidence Into Practice resources.
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Affiliation(s)
- Shiraz I Mishra
- Department of Pediatrics and Family and Community Medicine, University of New Mexico (UNM) Cancer Center in Albuquerque
| | - Roberta W Scherer
- Department of Epidemiology, The Johns Hopkins Center for Clinical Trials
| | - Claire Snyder
- Division of General Internal Medicine, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Paula Geigle
- Department of Neurology, University of Maryland Rehabilitation and Orthopaedic Institute in Baltimore
| | - Carolyn Gotay
- School of Population and Public Health, University of British Colombia, Vancouver, Canada
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Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncol Nurs Forum 2015; 41:E326-42. [PMID: 25355029 DOI: 10.1188/14.onf.e326-e342] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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]
Abstract
PURPOSE/OBJECTIVES To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment. DATA SOURCES 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources. DATA SYNTHESIS 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]). CONCLUSIONS Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who have completed treatment. Future research is needed to help understand specific attributes of exercise programs that are beneficial for improving HRQOL within and across cancer types. IMPLICATIONS FOR NURSING Evidence presented in this review supports the inclusion of exercise programs in clinical guidelines for the management of cancer survivors who have completed treatment, such as the Oncology Nursing Society's Putting Evidence Into Practice resource.
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Affiliation(s)
- Shiraz I Mishra
- Department of Pediatrics and Family and Community Medicine, University of New Mexico in Albuquerque
| | - Roberta W Scherer
- Center for Clinical Trials in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Claire Snyder
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore
| | - Paula Geigle
- Department of Neurology, University of Maryland School of Medicine, Baltimore
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Hoffman RM, Sussman AL, Getrich CM, Rhyne RL, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Murrietta AM, Saeed AI, Mishra SI. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography. Prev Chronic Dis 2015; 12:E108. [PMID: 26160294 PMCID: PMC4509091 DOI: 10.5888/pcd12.150112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. METHODS We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. RESULTS We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. CONCLUSION Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
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Affiliation(s)
- Richard M Hoffman
- University of New Mexico School of Medicine, University of New Mexico Cancer Center, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico
| | - Andrew L Sussman
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | | | - Robert L Rhyne
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Georgetown Lombardi Comprehensive Cancer Center and Georgetown University Medical Center, Washington, DC
| | | | | | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ali I Saeed
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131. . Dr Mishra is also affiliated with the University of New Mexico Cancer Center and the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Hoffman RM, Espey DK, Rhyne RL, Gonzales M, Rajput A, Mishra SI, Stone SN, Wiggins CL. Colorectal cancer incidence and mortality disparities in new Mexico. J Cancer Epidemiol 2014; 2014:239619. [PMID: 24527035 PMCID: PMC3910286 DOI: 10.1155/2014/239619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 12/31/2022] Open
Abstract
Background. Previous analyses indicated that New Mexican Hispanics and American Indians (AI) did not experience the declining colorectal cancer (CRC) incidence and mortality rates observed among non-Hispanic whites (NHW). We evaluated more recent data to determine whether racial/ethnic differences persisted. Methods. We used New Mexico Surveillance Epidemiology and End Results data from 1995 to 2009 to calculate age-specific incidence rates and age-adjusted incidence rates overall and by tumor stage. We calculated mortality rates using National Center for Health Statistics' data. We used joinpoint regression to determine annual percentage change (APC) in age-adjusted incidence rates. Analyses were stratified by race/ethnicity and gender. Results. Incidence rates continued declining in NHW (APC -1.45% men, -1.06% women), while nonsignificantly increasing for AI (1.67% men, 1.26% women) and Hispanic women (0.24%). The APC initially increased in Hispanic men through 2001 (3.33%, P = 0.06), before declining (-3.10%, P = 0.003). Incidence rates declined in NHW and Hispanics aged 75 and older. Incidence rates for distant-stage cancer remained stable for all groups. Mortality rates declined significantly in NHW and Hispanics. Conclusions. Racial/ethnic disparities in CRC persist in New Mexico. Incidence differences could be related to risk factors or access to screening; mortality differences could be due to patterns of care for screening or treatment.
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Affiliation(s)
- Richard M. Hoffman
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
- Medicine Service, New Mexico VA Health Care System, 1501 San Pedro Drive SE, Albuquerque, NM 87108, USA
- University of New Mexico Cancer Center, Albuquerque, NM 87106, USA
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - David K. Espey
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Robert L. Rhyne
- University of New Mexico Cancer Center, Albuquerque, NM 87106, USA
- Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Melissa Gonzales
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
- University of New Mexico Cancer Center, Albuquerque, NM 87106, USA
| | - Ashwani Rajput
- University of New Mexico Cancer Center, Albuquerque, NM 87106, USA
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Shiraz I. Mishra
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - S. Noell Stone
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Charles L. Wiggins
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
- University of New Mexico Cancer Center, Albuquerque, NM 87106, USA
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Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Clin Otolaryngol 2013. [PMID: 23164265 DOI: 10.1111/coa.2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Clin Otolaryngol 2013; 37:390-2. [PMID: 23164265 DOI: 10.1111/coa.12015] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Page-Reeves J, Mishra SI, Niforatos J, Regino L, Bulten R. An Integrated Approach to Diabetes Prevention: Anthropology, Public Health, and Community Engagement. Qual Rep 2013; 18:1-22. [PMID: 24490179 PMCID: PMC3905317] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diabetes is an enormous public health problem with particular concern within Hispanic communities and among individuals with low wealth. However, attempts to expand the public health paradigm to include social determinants of health rarely include analysis of social and contextual factors considered outside the purview of health research. As a result, conceptualization of the dynamics of diabetes health disparities remains shallow. We argue that using a holistic anthropological lens has the potential to offer insights regarding the nature of the interface between broader social determinants, health outcomes and health disparity. In a primarily Hispanic, immigrant community in Albuquerque, New Mexico, we conducted a mixed methods study that integrates an anthropological lens with a community engaged research design. Our data from focus groups, interviews, a survey and blood sampling demonstrate the need to conceptualize social determinants more broadly, more affectively and more dynamically than often considered. These results highlight a need to include, in addition to individual-level factors that are traditionally the focus of public health and more innovative structural factors that are currently in vogue, an in-depth, qualitative exploration of local context, social environment, and culture, and their interactions and intersectionality, as key factors when considering how to achieve change. The discussion presented here offers a model for culturally situated and contextually relevant scientific research. This model achieves the objectives and goals of both public health and anthropology while providing valuable insights and mechanisms for addressing health disparity such as that which exists in relation to diabetes among Hispanic immigrants in New Mexico. Such an approach has implications for how research projects are designed and conceptualizing social determinants more broadly. The discussion presented provides insights with relevance for both disciplines.
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Affiliation(s)
| | | | | | - Lidia Regino
- East Central Ministries, Albuquerque, New Mexico, USA
| | - Robert Bulten
- East Central Ministries, Albuquerque, New Mexico, USA
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Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev 2012; 2012:CD007566. [PMID: 22895961 PMCID: PMC7387117 DOI: 10.1002/14651858.cd007566.pub2] [Citation(s) in RCA: 360] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survivors experience numerous disease and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). Exercise interventions are hypothesized to alleviate these adverse outcomes. HRQoL and its domains are important measures for cancer survivorship. OBJECTIVES To evaluate the effectiveness of exercise on overall HRQoL and HRQoL domains among adult post-treatment cancer survivors. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, PEDRO, LILACS, SIGLE, SportDiscus, OTSeeker, and Sociological Abstracts from inception to October 2011 with no language or date restrictions. We also searched citations through Web of Science and Scopus, PubMed's related article feature, and several websites. We reviewed reference lists of included trials and other reviews in the field. SELECTION CRITERIA We included all randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing exercise interventions with usual care or other nonexercise intervention to assess overall HRQoL or at least one HRQoL domain in adults. Included trials tested exercise interventions that were initiated after completion of active cancer treatment. We excluded trials including people who were terminally ill, or receiving hospice care, or both, and where the majority of trial participants were undergoing active treatment for either the primary or recurrent cancer. DATA COLLECTION AND ANALYSIS Five paired review authors independently extracted information on characteristics of included trials, data on effects of the intervention, and assessed risk of bias based on predefined criteria. Where possible, meta-analyses results were performed for HRQoL and HRQoL domains for the reported difference between baseline values and follow-up values using standardized mean differences (SMD) and a random-effects model by length of follow-up. We also reported the SMDs between mean follow-up values of exercise and control group. Because investigators used many different HRQoL and HRQoL domain instruments and often more than one for the same domain, we selected the more commonly used instrument to include in the SMD meta-analyses. We also report the mean difference for each type of instrument separately. MAIN RESULTS We included 40 trials with 3694 participants randomized to an exercise (n = 1927) or comparison (n = 1764) group. Cancer diagnoses in study participants included breast, colorectal, head and neck, lymphoma, and other. Thirty trials were conducted among participants who had completed active treatment for their primary or recurrent cancer and 10 trials included participants both during and post cancer treatment. Mode of the exercise intervention included strength training, resistance training, walking, cycling, yoga, Qigong, or Tai Chi. HRQoL and its domains were measured using a wide range of measures.The results suggested that exercise compared with control has a positive impact on HRQoL and certain HRQoL domains. Exercise resulted in improvement in: global HRQoL at 12 weeks' (SMD 0.48; 95% confidence interval (CI) 0.16 to 0.81) and 6 months' (0.46; 95% CI 0.09 to 0.84) follow-up, breast cancer concerns between 12 weeks' and 6 months' follow-up (SMD 0.99; 95% CI 0.41 to 1.57), body image/self-esteem when assessed using the Rosenberg Self-Esteem scale at 12 weeks (MD 4.50; 95% CI 3.40 to 5.60) and between 12 weeks' and 6 months' (mean difference (MD) 2.70; 95% CI 0.73 to 4.67) follow-up, emotional well-being at 12 weeks' follow-up (SMD 0.33; 95% CI 0.05 to 0.61), sexuality at 6 months' follow-up (SMD 0.40; 95% CI 0.11 to 0.68), sleep disturbance when comparing follow-up values by comparison group at 12 weeks' follow-up (SMD -0.46; 95% CI -0.72 to -0.20), and social functioning at 12 weeks' (SMD 0.45; 95% CI 0.02 to 0.87) and 6 months' (SMD 0.49; 95% CI 0.11 to 0.87) follow-up. Further, exercise interventions resulted in decreased anxiety at 12 weeks' follow-up (SMD -0.26; 95% CI -0.07 to -0.44), fatigue at 12 weeks' (SMD -0.82; 95% CI -1.50 to -0.14) and between 12 weeks' and 6 months' (SMD -0.42; 95% CI -0.02 to -0.83) follow-up, and pain at 12 weeks' follow-up (SMD -0.29; 95% CI -0.55 to -0.04) when comparing follow-up values by comparison group.Positive trends and impact of exercise intervention existed for depression and body image (when analyzing combined instruments); however, because few studies measured these outcomes the robustness of findings is uncertain.No conclusions can be drawn regarding the effects of exercise interventions on HRQoL domains of cognitive function, physical functioning, general health perspective, role function, and spirituality.Results of the review need to be interpreted cautiously owing to the risk of bias. All the trials reviewed were at high risk for performance bias. In addition, the majority of trials were at high risk for detection, attrition, and selection bias. AUTHORS' CONCLUSIONS This systematic review indicates that exercise may have beneficial effects on HRQoL and certain HRQoL domains including cancer-specific concerns (e.g. breast cancer), body image/self-esteem, emotional well-being, sexuality, sleep disturbance, social functioning, anxiety, fatigue, and pain at varying follow-up periods. The positive results must be interpreted cautiously due to the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.
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Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 2012; 2012:CD008465. [PMID: 22895974 PMCID: PMC7389071 DOI: 10.1002/14651858.cd008465.pub2] [Citation(s) in RCA: 284] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with cancer undergoing active treatment experience numerous disease- and treatment-related adverse outcomes and poorer health-related quality of life (HRQoL). Exercise interventions are hypothesized to alleviate these adverse outcomes. HRQoL and its domains are important measures of cancer survivorship, both during and after the end of active treatment for cancer. OBJECTIVES To evaluate the effectiveness of exercise on overall HRQoL outcomes and specific HRQoL domains among adults with cancer during active treatment. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed MEDLINE, EMBASE, CINAHL, PsycINFO, PEDRO, LILACS, SIGLE, SportDiscus, OTSeeker, Sociological Abstracts from inception to November 2011 with no language or date restrictions. We also searched citations through Web of Science and Scopus, PubMed's related article feature, and several websites. We reviewed reference lists of included trials and other reviews in the field. SELECTION CRITERIA We included all randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials (CCTs) comparing exercise interventions with usual care or other type of non-exercise comparison intervention to maintain or enhance, or both, overall HRQoL or at least one distinct domain of HRQoL. Included trials tested exercise interventions that were initiated when adults with cancer were undergoing active cancer treatment or were scheduled to initiate treatment. DATA COLLECTION AND ANALYSIS Five paired review authors independently extracted information on characteristics of included trials, data on effects of the intervention, and assessed risk of bias based on predefined criteria. Where possible, we performed meta-analyses for HRQoL and HRQoL domains for the reported difference between baseline values and follow-up values using standardized mean differences (SMDs) and a random-effects model by length of follow-up. We also reported the SMD at follow-up between the exercise and control groups. Because investigators used many different HRQoL and HRQoL domain instruments and often more than one for the same domain, we selected the more commonly used instrument to include in the SMD meta-analyses. We also report the mean difference for each type of instrument separately. MAIN RESULTS We included 56 trials with 4826 participants randomized to an exercise (n = 2286) or comparison (n = 1985) group. Cancer diagnoses in trial participants included breast, prostate, gynecologic, hematologic, and other. Thirty-six trials were conducted among participants who were currently undergoing active treatment for their cancer, 10 trials were conducted among participants both during and post active cancer treatment, and the remaining 10 trials were conducted among participants scheduled for active cancer treatment. Mode of exercise intervention differed across trials and included walking by itself or in combination with cycling, resistance training, or strength training; resistance training; strength training; cycling; yoga; or Qigong. HRQoL and its domains were assessed using a wide range of measures.The results suggest that exercise interventions compared with control interventions have a positive impact on overall HRQoL and certain HRQoL domains. Exercise interventions resulted in improvements in: HRQoL from baseline to 12 weeks' follow-up (SMD 0.33; 95% CI 0.12 to 0.55) or when comparing difference in follow-up scores at 12 weeks (SMD 0.47; 95% CI 0.16 to 0.79); physical functioning from baseline to 12 weeks' follow-up (SMD 0.69; 95% CI 0.16 to 1.22) or 6 months (SMD 0.28; 95% CI 0.00 to 0.55); or when comparing differences in follow-up scores at 12 weeks (SMD 0.28; 95% CI 0.11 to 0.45) or 6 months (SMD 0.29; 95% CI 0.07 to 0.50); role function from baseline to 12 weeks' follow-up (SMD 0.48; 95% CI 0.07 to 0.90) or when comparing differences in follow-up scores at 12 weeks (SMD 0.17; 95% CI 0.00 to 0.34) or 6 months (SMD 0.32; 95% CI 0.03 to 0.61); and, in social functioning at 12 weeks' follow-up (SMD 0.54; 95% CI 0.03 to 1.05) or when comparing differences in follow-up scores at both 12 weeks (SMD 0.16; 95% CI 0.04 to 0.27) and 6 months (SMD 0.24; 95% CI 0.03 to 0.44). Further, exercise interventions resulted in a decrease in fatigue from baseline to 12 weeks' follow-up (SMD -0.38; 95% CI -0.57 to -0.18) or when comparing difference in follow-up scores at follow-up of 12 weeks (SMD -0.73; 95% CI -1.14 to -0.31). Since there is consistency of findings on both types of measures (change scores and difference in follow-up scores) there is greater confidence in the robustness of these findings.When examining exercise effects by subgroups, exercise interventions had significantly greater reduction in anxiety for survivors with breast cancer than those with other types of cancer. Further, there was greater reduction in depression, fatigue, and sleep disturbances, and improvement in HRQoL, emotional wellbeing (EWB), physical functioning, and role function for cancer survivors diagnosed with cancers other than breast cancer but not for breast cancer. There were also greater improvements in HRQoL and physical functioning, and reduction in anxiety, fatigue, and sleep disturbances when prescribed a moderate or vigorous versus a mild exercise program.Results of the review need to be interpreted cautiously owing to the risk of bias. All the trials reviewed were at high risk for performance bias. In addition, the majority of trials were at high risk for detection, attrition, and selection bias. AUTHORS' CONCLUSIONS This systematic review indicates that exercise may have beneficial effects at varying follow-up periods on HRQoL and certain HRQoL domains including physical functioning, role function, social functioning, and fatigue. Positive effects of exercise interventions are more pronounced with moderate- or vigorous-intensity versus mild-intensity exercise programs. The positive results must be interpreted cautiously because of the heterogeneity of exercise programs tested and measures used to assess HRQoL and HRQoL domains, and the risk of bias in many trials. Further research is required to investigate how to sustain positive effects of exercise over time and to determine essential attributes of exercise (mode, intensity, frequency, duration, timing) by cancer type and cancer treatment for optimal effects on HRQoL and its domains.
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Mishra SI, DeForge B, Barnet B, Ntiri S, Grant L. Social determinants of breast cancer screening in urban primary care practices: a community-engaged formative study. Womens Health Issues 2012; 22:e429-38. [PMID: 22841803 DOI: 10.1016/j.whi.2012.06.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND The recent decline in the breast cancer mortality rate can be attributed to intensive screening and early detection efforts. However, studies have documented a decline in self-reported recent mammography use and interventions to enhance mammography utilization have yielded modest improvements. To address the root causes of breast cancer disparities and improve mammography use, interventions need to address multiple layers of patient, provider, and health system factors. OBJECTIVE Using community-based participatory research principles, we sought to learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. METHODS We conducted five focus groups among 41 eligible women who were predominantly African American, recruited using nonprobability purposive sampling methods from urban community health centers in Baltimore, Maryland. Data are reported from three focus groups (n = 28) that provided usable data. We used the social determinants of health perspective to conduct a qualitative content analysis and interpretation of the data. RESULTS Major obstacles to obtaining a screening mammogram were individual-level (i.e., pain from the procedure) and structural-level factors (i.e., cost, geography, convenience). Strategies to overcome obstacles could include the creation of structural mechanisms whereby women can receive a host of services during one visit to a healthcare professional's office. Important promoters of screening behavior included social-level factors such as social support, hope, and positive treatment outcomes. CONCLUSION The social determinants of health perspective provided a unique perspective to frame barriers and promoters of mammography utilization and insights to develop interventions aimed at improving cancer control among women receiving care at urban primary care health centers.
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Affiliation(s)
- Shiraz I Mishra
- Department of Pediatrics and the Prevention Research Center, University of New Mexico, Albuquerque, NM, USA.
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Mishra SI, Gioia D, Childress S, Barnet B, Webster RL. Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions. Health Soc Work 2011; 36:249-258. [PMID: 22308877 PMCID: PMC3606079 DOI: 10.1093/hsw/36.4.249] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [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] [Indexed: 05/27/2023]
Abstract
This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These factors included medication side effects, fear of harm from medication, fear of dependence on medication, complex instructions, suboptimal communications with doctor, suspicion about doctors' and pharmaceutical companies' motives in prescribing medication, and the high cost ofmedications. Participants also identified motivators, both internal (self-initiated) and external (initiated by family, doctor, support groups),to ensure adherence to multiple medications. These motivators included self-discipline, sense of personal responsibility, faith, support from family members and doctors, and focused health education and self-management support. Three themes emerged that enhanced understanding of the complexity of adherence to multiple medications: (1) reaching one's own threshold for medication adherence, (2) lack of shared information and decision making, and (3) taking less than the prescribed medication. Further analysis of the data revealed that the patients perceived a lack of shared decision making in the management of their comorbid chronic conditions and their medication regimen.
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Affiliation(s)
- Shiraz I Mishra
- UNM Prevention Research Center, Albuquerque, NM 87131-0001, USA.
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Mishra SI, Luce PH, Baquet CR. Increasing pap smear utilization among Samoan women: results from a community based participatory randomized trial. J Health Care Poor Underserved 2010; 20:85-101. [PMID: 19711495 DOI: 10.1353/hpu.0.0160] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND We tested the effectiveness of a theory-guided, culturally tailored cervical cancer education program designed to increase Pap smear use among Samoan women residing in the U.S. Territory of American Samoa. METHODS We used a two-group, pretest-posttest design. The sample comprised 398 Samoan women age 20 and older recruited from Samoan churches. Women in the intervention group received a culturally tailored cervical cancer education program in three weekly sessions. The primary outcome was self-reported receipt of a Pap smear. RESULTS Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3-3.2, p < .01) as likely to self-report Pap smear use at the posttest. CONCLUSIONS The findings support the efficacy of the multifaceted, theory-guided, culturally tailored community-based participatory cervical cancer education program for Samoan women in effecting positive changes in Pap smear use and cervical cancer related knowledge and attitudes.
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Affiliation(s)
- Shiraz I Mishra
- Department of Family and Community Medicine, University of Maryland School of Medicine, University of Maryland Statewide Health Network, 401 W Redwood Street, Suite 100, Baltimore, MD 21201, USA.
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Baquet CR, Mishra SI, Weinberg AD. A descriptive analysis of state legislation and policy addressing clinical trials participation. J Health Care Poor Underserved 2010; 20:24-39. [PMID: 19711491 DOI: 10.1353/hpu.0.0156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This report describes state policy and legislation related to clinical trials participation and Maryland's model to enhance clinical trial availability and participation. METHODS Descriptive review of state policy and legislation related to coverage for clinical trials costs based on data from the National Cancer Institute (NCI) State Cancer Legislative Database, the American Cancer Society, and NCI; additionally, discussion of Maryland's comprehensive multilevel clinical trial model comprising policy initiatives, community engagement, research, education, and infrastructure support. RESULTS Twenty-four states have mandated clinical trial coverage through specific legislation or agreements since 1994. Covered benefits varied among the states. CONCLUSIONS Besides cost and insurance barriers, there is a need to address important patient, physician and researcher, and structural barriers to clinical trial participation. Maryland provides a comprehensive model to address the multi-faceted clinical trial participation determinants as it tracks state and federal policy, documents trial barriers, and conducts community education.
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Affiliation(s)
- Claudia R Baquet
- University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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