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Gadd N, Lee S, Sharman MJ, Obamiro K. Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review. Prev Med Rep 2024; 39:102653. [PMID: 38384964 PMCID: PMC10879007 DOI: 10.1016/j.pmedr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.
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Affiliation(s)
- Nicola Gadd
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Simone Lee
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
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Wang SM, Njoroge MW, Mundy LR, Sergesketter AR, Stukes B, Shammas RL, Langdell HC, Geng Y, Hollenbeck ST. Evaluating Disparities in Pathways to Breast Reconstruction. J Reconstr Microsurg 2023; 39:671-680. [PMID: 37023769 DOI: 10.1055/s-0043-1764486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction. METHODS All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity. RESULTS A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age (p < 0.001) and nonprivate insurance (p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion (p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) ≥ 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women (p = 0.27). CONCLUSION Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.
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Affiliation(s)
- Sabrina M Wang
- Duke University School of Medicine, Durham, North Carolina
| | | | - Lily R Mundy
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Amanda R Sergesketter
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Bryanna Stukes
- Duke University School of Medicine, Durham, North Carolina
| | - Ronnie L Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Hannah C Langdell
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | | | - Scott T Hollenbeck
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
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Syvyk S, Roberts SE, Finn CB, Wirtalla C, Kelz R. Colorectal cancer disparities across the continuum of cancer care: A systematic review and meta-analysis. Am J Surg 2022; 224:323-331. [PMID: 35210062 DOI: 10.1016/j.amjsurg.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/27/2022] [Accepted: 02/16/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Disparate colorectal cancer outcomes persist in vulnerable populations. We aimed to examine the distribution of research across the colorectal cancer care continuum, and to determine disparities in the utilization of Surgery among Black patients. METHODS A systematic review and meta-analysis of colorectal cancer disparities studies was performed. The meta-analysis assessed three utilization measures in Surgery. RESULTS Of 1,199 publications, 60% focused on Prevention, Screening, or Diagnosis, 20% on Survivorship, 15% on Treatment, and 1% on End-of-Life Care. A total of 16 studies, including 1,110,674 patients, were applied to three meta-analyses regarding utilization of Surgery. Black patients were less likely to receive surgery, twice as likely to refuse surgery, and less likely to receive laparoscopic surgery, when compared to White patients. CONCLUSIONS Since 2011, the majority of research focused on prevention, screening, or diagnosis. Given the observed treatment disparities among Black patients, future efforts to reduce colorectal cancer disparities should include interventions within Surgery.
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Affiliation(s)
- Solomiya Syvyk
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA
| | - Sanford E Roberts
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin B Finn
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; NewYork-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, New York, NY, USA
| | - Chris Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia PA, USA; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Short- and Long-Term Outcomes following Severe Traumatic Lower Extremity Reconstruction: The Value of an Orthoplastic Limb Salvage Center to Racially Underserved Communities. Plast Reconstr Surg 2021; 148:646-654. [PMID: 34432698 DOI: 10.1097/prs.0000000000008277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous studies have demonstrated that nonwhite race and disadvantaged socioeconomic status negatively impact outcomes following lower extremity reconstruction. The authors sought to characterize differences in outcomes between racial groups in patients necessitating traumatic lower extremity reconstruction at an orthoplastic limb salvage center. METHODS A retrospective review between 2002 and 2019 was conducted of patients who underwent free flap lower extremity reconstruction at an orthoplastic limb salvage center. Patient demographics were identified, and permanent addresses were used to collect census data. Short-term complications and long-term functional status were recorded. RESULTS One hundred seventy-three patients underwent lower extremity reconstruction and met inclusion criteria. Among all three groups, African American patients were more likely to be single (80 percent African American versus 49 percent Caucasian and 29.4 percent other; p < 0.05) and had significantly lower rates of private insurance compared with Caucasian patients (25 percent versus 56.7 percent; p < 0.05). African American patients demonstrated no significant differences in total flap failure (4.9 percent versus 8 percent and 5.6 percent; p = 0.794), reoperations (10 percent versus 5.8 percent and 16.7 percent; p = 0.259), and number of readmissions (2.4 versus 2.0 and 2.1; p = 0.624). Chronic pain management (53.3 percent versus 44.2 percent and 50 percent; p = 0.82), full weight-bearing status (84.2 percent versus 92.7 percent and 100 percent; p = 0.507), and ambulation status (92.7 percent versus 100 percent and 100 percent; p = 0.352) were similar among groups. CONCLUSIONS Outcomes are equivalent between racial groups presenting to an orthoplastic limb salvage center for lower extremity reconstruction. The postoperative rehabilitation strategies, follow-up, and overall support that an orthoplastic limb salvage center ensures may lessen the impact of socioeconomic disparities in traumatic lower extremity reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Butler PD, Morris MP, Momoh AO. Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation. Ann Surg Oncol 2021; 28:6099-6108. [PMID: 34287788 DOI: 10.1245/s10434-021-10487-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
For many women, breast reconstruction is an essential component of the breast cancer care continuum after mastectomy. Despite postmastectomy breast reconstruction now being a standard of care, numerous studies over the past decade have documented persistent racial disparities in breast reconstruction rates, physician referral patterns, and patient knowledge of their reconstructive options. These disparities have disproportionately impacted women of color-most specifically, African American women. Recent data have revealed racial differences in patient comorbidities, informed decision-making satisfaction, and clinical outcomes after breast reconstruction. Explicitly, African American women have significantly more risk factors for complications and less baseline knowledge regarding reconstructive options than white women. With a recent heightened attention focused on social determinants of health, studies designed to improve these racial differences have demonstrated promising results through educational outreach to underserved communities, implementation of tailored legislation promoting inclusion, diversity, and equity, and encouragement of additional recruitment of ethnically underrepresented-in-medicine surgeons. This study uses a targeted review of the literature to provide a summary of racial disparities in breast reconstruction for African American women, with our perspective on opportunities for improvement.
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Affiliation(s)
- Paris D Butler
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Martin P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Familusi O, Rios-Diaz AJ, Tilahun ED, Cunning JR, Broach RB, Brooks AD, Guerra CE, Butler PD. Post-mastectomy breast reconstruction: reducing the disparity through educational outreach to the underserved. Support Care Cancer 2020; 29:1055-1063. [DOI: 10.1007/s00520-020-05589-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022]
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Shin HY, Kim KY, Kang P. Concept analysis of community health outreach. BMC Health Serv Res 2020; 20:417. [PMID: 32404160 PMCID: PMC7222455 DOI: 10.1186/s12913-020-05266-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background The definition of community health outreach to promote the health of vulnerable populations depends heavily on the particulars of the given health project and community. There is no consistency in the definitions attached to the concept itself. Our study aimed to clarify the general definition of community health outreach to facilitate its understanding and use. Methods Walker and Avant’s (2010) method of concept analysis was used to understand community health outreach. A total of 45 articles were included in the analysis after having searched for text on database portals like PubMed, Scopus, CINAHL complete and EMBASE published between 2010 and 2018. Results The defining attributes of the concept of community health outreach were purposive, temporary, mobile and collaboration with community. The antecedents were population facing health risks and awareness of health risks. The consequences were increased accessibility and health promotion. Conclusion This study proposed the definition of community health outreach as a temporary, mobile project that involves the collaboration of a community to undertake its purposeful health intervention of reaching a population facing health risks. This definition provides a general understanding of the outreach undertaken by health workers and enables the strong connection between health professionals and community residents.
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Affiliation(s)
- Hye Young Shin
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 10408, Gyeonggi-do, Republic of Korea.,College of Nursing, Baekseok Culture University, 1 Baekseokdaehak-ro, Dongnam-gu, Cheonan-si, 31065, Chungcheongnam-do, Republic of Korea
| | - Ka Young Kim
- Department of Nursing, College of Nursing, Gachon University, 191 Hambakmoeiro, Yeonsu-gu, Incheon, 21936, Republic of Korea.
| | - Purum Kang
- College of Nursing, Woosuk University, 443 Samnye-ro, Samnye-eup, Wanju, Jeonbuk, 55338, Republic of Korea.
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Rogers CR, Rovito MJ, Hussein M, Obidike OJ, Pratt R, Alexander M, Berge JM, Dall'Era M, Nix JW, Warlick C. Attitudes Toward Genomic Testing and Prostate Cancer Research Among Black Men. Am J Prev Med 2018; 55:S103-S111. [PMID: 30670195 PMCID: PMC6352989 DOI: 10.1016/j.amepre.2018.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/18/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Black men are diagnosed with prostate cancer at nearly twice the rate of white men and are underrepresented in prostate cancer research, including validation studies of new clinical tools (e.g., genomic testing). Because healthcare system mistrust has contributed to these disparities for centuries, black men may be less inclined to pursue novel testing, and identification of facilitators to their participation in prostate cancer research studies remains warranted. METHODS A community-engaged approach involving a partnership with a community organization was used to conduct seven focus groups in Minnesota, Alabama, and California to explore black men's attitudes toward prostate cancer research participation and genomic testing for prostate cancer. Data were collected and analyzed from April 2015 to April 2017. RESULTS Identified genomic testing barriers included a lack of terminology understanding, healthcare system mistrust, reluctance to seek medical care, and unfavorable attitudes toward research. Facilitators included family history, value of prevention, and the desire for health education. Lack of prostate cancer knowledge, prostate-specific antigen testing confusion, healthcare system distrust, and misuse of personal health information were barriers to research study participation. Some black men were motivated to participate in research if it was seen as constructive and transparent. CONCLUSIONS Disparities for black men can both motivate and disincentivize participation depending upon a positive or negative view of research. Confusion over prostate cancer clinical care has fueled some mistrust among black men affecting both clinical care and research participation. With increased education, health literacy, and assurances of research integrity and transparency, black men may be more willing to participate in prostate cancer testing and research. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Charles R Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Michael J Rovito
- Department of Health Professions, University of Central Florida, Orlando, Florida
| | - Musse Hussein
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mark Alexander
- Health and Wellness Committee, 100 Black Men of America, Inc., Oakland, California
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Marc Dall'Era
- Department of Urology, University of California, Davis, Sacramento, California
| | - Jeffrey W Nix
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher Warlick
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
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