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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Healthcare Predictors of Information Dissemination About Genetic Risks

Objectives

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

Methods

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

Results

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

Conclusion

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

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

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

Citation Format: Agnieszka M. Mynarska, Shaila M. Strayhorn, Tynetta Hill-Muhammad, Nyahne Q. Bergeron, Desmona C. Strahan, Stephanie L. Jara, Nancy Rayas, Anita Rong, Misael Villegas, Dana Villines, Karriem S. Watson, Aditya Khanna, Yamilé Molina. An exploration of patient navigation on various outcomes of African American breast cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-062.

Abstract A040: “Don’t tell anybody I have breast cancer, they gonna tell everybody! I don’t want my business in the street”: Patterns of secrecy regarding breast cancer among African American breast cancer survivors

Introduction: African American women suffer disproportionately from breast cancer relative to other women. One potential contributing historic and cultural factor regards a need for privacy and non-disclosure of disease experiences. This study was a first step to characterize the diffusion of personal breast cancer information throughout African American women’s social networks. Methods: This is a secondary analysis of the Offering African Survivors Increased Support (OASIS) study, which compares the survivorship experiences of women who were/were not navigated throughout diagnosis and treatment. To be eligible, participants had to be: 1) diagnosed within 2011-2014 at Advocate Health in Chicago, IL; 2) female; 3) 18 years or older; and, 4) African American. Trained interviewers conducted 60-90 minute interviews in participants’ homes, libraries, or office spaces, wherein they administered a modified version of Burt’s General Social Survey instrument regarding communication during breast cancer diagnosis and treatment. Results: Approximately 27% of our 33 participants were 50-74 years old, 39% had a bachelor’s degree or greater level of education, and 76% were retired. Overall, 157 family and friends identified as individuals with whom survivors were close during the period of diagnosis/treatment. Survivors disclosed their breast cancer diagnosis to 81% of these individuals, of which 81% were female, 31% were relatives, and 44% communicated with survivors on a daily basis. Qualitative analysis suggest: 1) disclosure was not aligned with fear of disease or a lack of self-assurance/ideology as a strong black woman; rather, disclosure was rooted in societal norms and acceptance of vulnerabilities of black women. Qualitative findings also suggested this disclosure led to a syndrome of silence and level of secrecy too difficult to unravel, fostering a lifetime of secrecy. Conclusion: Our preliminary data have important implications regarding how rising breast cancer incidence rates and breast cancer interventions for African Americans may not necessarily result in increased community knowledge and exchange of evidence-based, personally experienced information about breast cancer. Ongoing analyses will explicitly identify family and friends who were not engaged about breast cancer and reasons for non-disclosure.

Citation Format: Desmona C Strahan, Nyahne Bergeron, Shaila Strayhorn, Aditya Khanna, Dana Villines, Karriem S WatsonY, Yamilé Molina. “Don’t tell anybody I have breast cancer, they gonna tell everybody! I don’t want my business in the street”: Patterns of secrecy regarding breast cancer among African American breast cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A040.