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Vadaparampil ST, Fuzzell LN, Brownstein NC, Fontenot HB, Lake P, Michel A, McIntyre M, Whitmer A, Perkins RB. A cross-sectional survey examining clinician characteristics, practices, and attitudes associated with adoption of the 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines. Cancer 2023; 129:2671-2684. [PMID: 37221653 DOI: 10.1002/cncr.34838] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) risk-based management consensus guidelines are the most recent national guidelines for the management of abnormal cervical cancer screening tests. These guidelines benefit patients by concentrating testing and treatment in those at highest cervical cancer risk. Adoption of guidelines often occurs slowly, with few studies examining the factors associated with guideline-adherent management of abnormal results. METHODS To elucidate the factors associated with the use of the 2019 ASCCP guidelines among clinicians who perform cervical cancer screening, physicians and advanced practice professionals who perform cervical cancer screening were cross-sectionally surveyed. Clinicians responded to screening vignettes with differing recommendations for management between the 2019 and prior management guidelines. Screening vignette 1 involved reduction of invasive testing on a low-risk patient; screening vignette 2 involved increased surveillance testing on a high-risk patient. Binomial logistic regression models determined the factors associated with the use of the 2019 guidelines. RESULTS A total of 1251 clinicians participated from across the United States. For screening vignettes 1 and 2, guideline-adherent responses were given by 28% and 36% of participants, respectively. Management recommendations differed by specialty and were incorrect in different situations: there was inappropriate invasive testing by obstetrics and gynecology physicians (vignette 1) and inappropriate discontinuation of screening by family and internal medicine physicians (vignette 2). Regardless of their chosen response, over half erroneously believed they were guideline adherent. CONCLUSIONS Many clinicians who believe they are following appropriate guidelines may not realize their management strategy is inconsistent with the 2019 guidelines. Education initiatives tailored to clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms. PLAIN LANGUAGE SUMMARY The 2019 American Society for Colposcopy and Cervical Pathology risk-based management consensus guidelines are the most recent national guidelines for abnormal cervical cancer screening test management. We surveyed over 1200 obstetrics and gynecology (OB/GYN), family medicine, and internal medicine physicians and advanced practice providers about their screening and abnormal results follow-up practices in relation to guidelines. Few clinicians are following the 2019 guidelines. Management recommendations differed by clinician specialty and were incorrect in different situations: there was inappropriate invasive testing by OB/GYN physicians and inappropriate screening discontinuation by family and internal medicine physicians. Education tailored by clinician specialty could address the understanding of current guidelines, encourage the use of updated guidelines, maximize patient benefits, and minimize harms.
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Affiliation(s)
- Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Lindsay N Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Naomi C Brownstein
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Holly B Fontenot
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Paige Lake
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Alexandra Michel
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - McKenzie McIntyre
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ashley Whitmer
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Rebecca B Perkins
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
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Andrzejak SE, Lewis-Thames MW, Langston ME, Han Y, Khan S, Nettles DA, Fuzzell LN, Tingen MS, Moore JX. The Role of BMI in Allostatic Load and Risk of Cancer Death. Am J Prev Med 2023; 65:417-426. [PMID: 36889531 PMCID: PMC10440242 DOI: 10.1016/j.amepre.2023.03.002] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Obesity and proinflammatory conditions are associated with increased risks of cancer. The associations of baseline allostatic load with cancer mortality and whether this association is modified by body mass index (BMI) were examined. METHODS A retrospective analysis was performed in March-September 2022 using National Health and Nutrition Examination Survey years 1988 through 2010 linked with the National Death Index through December 31, 2019. Fine and Gray Cox proportional hazard models were stratified by BMI status to estimate subdistribution hazard ratios of cancer death between high and low allostatic load status (adjusted for age, sociodemographics, and health factors). RESULTS In fully adjusted models, high allostatic load was associated with a 23% increased risk of cancer death (adjusted subdistribution hazard ratio=1.23; 95% CI=1.06, 1.43) among all participants, a 3% increased risk of cancer death (adjusted subdistribution hazard ratio=1.03; 95% CI=0.78, 1.34) among underweight/healthy weight adults, a 31% increased risk of cancer death (adjusted subdistribution hazard ratio=1.31; 95% CI=1.02, 1.67) among overweight adults, and a 39% increased risk of death (adjusted subdistribution hazard ratio=1.39; 95% CI=1.04, 1.88) among obese adults, when compared to those with low allostatic load. CONCLUSIONS The risk of cancer death is highest among those with high allostatic load and obese BMI, but this effect was attenuated among those with high allostatic load and underweight/healthy or overweight BMI.
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Affiliation(s)
- Sydney E Andrzejak
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Marvin E Langston
- Department of Epidemiology & Population Health, Stanford University, Stanford, California
| | - Yunan Han
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Darryl A Nettles
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Lindsay N Fuzzell
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Martha S Tingen
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Justin X Moore
- Cancer Prevention, Control & Population Health, Medical College of Georgia, Georgia Cancer Center, Augusta University, Augusta, Georgia; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Kirtane K, Zhao Y, Amorrortu RP, Fuzzell LN, Vadaparampil ST, Rollison DE. Demographic disparities in receipt of care at a comprehensive cancer center. Cancer Med 2023; 12:13687-13700. [PMID: 37114585 PMCID: PMC10315757 DOI: 10.1002/cam4.5992] [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: 10/18/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND National Cancer Institute cancer centers (NCICCs) provide specialized cancer care including precision oncology and clinical treatment trials. While these centers can offer novel therapeutic options, less is known about when patients access these centers or at what timepoint in their disease course they receive specialized care. This is especially important since precision diagnostics and receipt of the optimal therapy upfront can impact patient outcomes and previous research suggests that access to these centers may vary by demographic characteristics. Here, we examine the timing of patients' presentation at Moffitt Cancer Center (MCC) relative to their initial diagnosis across several demographic characteristics. METHODS A retrospective cohort study was conducted among patients who presented to MCC with breast, colon, lung, melanoma, and prostate cancers between December 2008 and April 2020. Patient demographic and clinical characteristics were obtained from the Moffitt Cancer Registry. The association between patient characteristics and the timing of patient presentation to MCC relative to the patient's cancer diagnosis was examined using logistic regression. RESULTS Black patients (median days = 510) had a longer time between diagnosis and presentation to MCC compared to Whites (median days = 368). Black patients were also more likely to have received their initial cancer care outside of MCC compared to White patients (odds ratio [OR] and 95% confidence interval [CI] = 1.45 [1.32-1.60]). Furthermore, Hispanics were more likely to present to MCC at an advanced stage compared to non-Hispanic patients (OR [95% CI] = 1.28 [1.05-1.55]). CONCLUSIONS We observed racial and ethnic differences in timing of receipt of care at MCC. Future studies should aim to identify contributing factors for the development of novel mitigation strategies and assess whether timing differences in referral to an NCICC correlate with long-term patient outcomes.
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Affiliation(s)
- Kedar Kirtane
- Department of Head and Neck‐Endocrine OncologyMoffitt Cancer CenterTampaFloridaUSA
- Office of Community OutreachEngagement, and Equity, Moffitt Cancer CenterTampaFloridaUSA
| | - Yayi Zhao
- Department of Cancer EpidemiologyMoffitt Cancer CenterTampaFloridaUSA
| | | | - Lindsay N. Fuzzell
- Department of Health Outcomes & BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | - Susan T. Vadaparampil
- Office of Community OutreachEngagement, and Equity, Moffitt Cancer CenterTampaFloridaUSA
- Department of Health Outcomes & BehaviorMoffitt Cancer CenterTampaFloridaUSA
| | - Dana E. Rollison
- Department of Cancer EpidemiologyMoffitt Cancer CenterTampaFloridaUSA
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Rivera Rivera J, Fuzzell LN, Garcia J, Rathwell J, Robinson EJ, Chavez M, Fulton H, Whitmer A, Mathew E, Giuliano AR, Vadaparampil ST. Development of a Patient Activation Toolkit for Hepatitis C Virus Testing. J Cancer Educ 2023; 38:931-939. [PMID: 35971055 PMCID: PMC10187067 DOI: 10.1007/s13187-022-02209-0] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 05/18/2023]
Abstract
We evaluated the acceptability of a patient activation toolkit for hepatitis C virus (HCV) testing amidst universal adult guidelines. We developed a patient-facing toolkit that included a letter to the patient from their healthcare provider, HCV factsheet, and question prompt list, which contained questions for their provider about HCV infection and testing. We conducted qualitative interviews with patients ages 18-78 (n = 17), using a semi-structured interview guide based on learner verification. We assessed attraction, comprehension, cultural-linguistic acceptability, self-efficacy, and persuasiveness of toolkit materials using direct content analysis. Participants reported materials were attractive, offering suggestions to improve readability. They reported some understanding of materials but requested use of less medical jargon, particularly for the factsheet. Participants discussed cultural acceptability and suggested ways to improve language inclusiveness and comfort with content, given stigma surrounding HCV risk factors. Participants reported that including a letter, factsheet, and QPL improved the persuasiveness of materials, and they conveyed their motivation to be tested for HCV. Results indicate preliminary acceptability for use of the patient activation toolkit, which will be refined based on participants' recommendations. Overall, this patient activation toolkit holds promise for increasing HCV testing rates.
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Affiliation(s)
- Jessica Rivera Rivera
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA.
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Jennifer Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Julie Rathwell
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Edmondo J Robinson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Digital Health, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Melody Chavez
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Hayden Fulton
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Ashley Whitmer
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Ebin Mathew
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, USA.
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Andrews JE, Applequist J, Ward HL, Fuzzell LN, Vadaparampil ST. Cancer-related information behavior among black and hispanics in an NCI-designated comprehensive cancer center catchment. Patient Educ Couns 2023; 114:107812. [PMID: 37257260 DOI: 10.1016/j.pec.2023.107812] [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] [Received: 08/18/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study aims to better understand health behaviors, particularly health information seeking, and how this impacts cancer care within underserved minority populations in a specific catchment area in Florida. METHODS We conducted an analysis of survey data from a 2019 community health survey conducted by the Moffit Cancer Center (MCC). We utilized the Comprehensive Model of Information Seeking (CMIS) as a framework and performed structural equation modeling (SEM) and related statistical analyses. RESULTS Our findings confirm that characteristics and demographics present a positive relationship to Online Health Information Seeking (OHIS). We also found that Utility had a negative significant relationship to OHIS. CONCLUSIONS We concluded that the CMIS is a useful framework for studying cancer-related information seeking, and that when properly executed in the confines of a study, can lend itself to in-depth statistical analyses as found in SEM. IMPLICATIONS The SEM revealed the CMIS to be promising with results in our analysis worthy of further investigation of cancer care and healthcare information access considering undeserved and minority populations. PRACTICE IMPLICATIONS Models such as the CMIS can be useful for understanding information seeking behaviors and to design information and communication interventions to improve access and health outcomes.
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Affiliation(s)
- James E Andrews
- School of Information, University of South Florida, Tampa, FL, USA.
| | | | - Heather L Ward
- School of Information, University of South Florida, Tampa, FL, USA
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Fuzzell LN, Dodd S, Hu S, Hinnant A, Lee S, Cameron G, Garbutt JM. An informed approach to the development of primary care pediatric firearm safety messages. BMC Pediatr 2022; 22:26. [PMID: 34996397 PMCID: PMC8740359 DOI: 10.1186/s12887-021-03101-4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Firearm ownership is prevalent in the US and many children spend time in areas where firearms are not stored safely. The AAP recommends firearm safety counseling at pediatric well-visits. METHODS We developed and tested six contextual messages to promote safe firearm storage based on: absence of harm, collective appeal to understanding child behavior, pediatrician's authority, evidence-based, fear appeal, and general safety considerations. One hundred four parents who keep firearms at home were recruited from Amazon Mechanical Turk Prime and viewed video messages and reported behavioral intentions and emotional reactions following each message. RESULTS All six contextual messages were perceived as important and believable and increased parents' intentions to follow safety advice provided, but also elicited negative emotions. The authority message elicited more negative emotions and resulted in lower intentions to follow safe storage advice. CONCLUSIONS Including firearm messages with other child safety advice merits further evaluation. Authority messages should be avoided.
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Affiliation(s)
- Lindsay N Fuzzell
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine in St. Louis, Campus Box 8116, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Sisi Hu
- School of Journalism, University of Missouri, Columbia, MO, USA
| | - Amanda Hinnant
- School of Journalism, University of Missouri, Columbia, MO, USA
| | - Sungkyoung Lee
- School of Journalism, University of Missouri, Columbia, MO, USA
| | - Glen Cameron
- School of Journalism, University of Missouri, Columbia, MO, USA
| | - Jane M Garbutt
- Department of Pediatrics, Washington University School of Medicine in St. Louis, Campus Box 8116, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
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Vadaparampil ST, Fuzzell LN, Rathwell J, Reich RR, Shenkman E, Nelson DR, Kobetz E, Jones PD, Roetzheim R, Giuliano AR. HCV testing: Order and completion rates among baby boomers obtaining care from seven health systems in Florida, 2015-2017. Prev Med 2021; 153:106222. [PMID: 32721414 PMCID: PMC7854771 DOI: 10.1016/j.ypmed.2020.106222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/20/2019] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
Many U.S. residents infected with hepatitis C virus (HCV) are baby boomers (born 1945-1965), who remain undiagnosed. Past CDC and USPSTF guidelines recommended one-time HCV testing for all baby boomers, with newer guidelines recommending universal screening for all adults. This retrospective cohort study examined electronic medical records for patient visits from 2015 to 2017 within the OneFlorida Data Trust and University of South Florida Health system. We assessed percentages of HCV tests ordered and completed across four age groups (those born before 1945, 1945-1965, 1966-1985, and after 1985). In 2019, we used logistic regression to examine factors associated with HCV test ordering and completion among baby boomers, including age, race, sex, number of primary care visits, HIV status, hepatitis diagnosis, and liver cancer history. All age groups had low rates of HCV test orders. 4.4% of baby boomers had a test ordered in 2015, and 6.7% in 2016. Of those, 94.5% and 89.7% completed testing, respectively. All other races/ethnicities had lower likelihood of testing completion than Whites (Blacks (aOR 0.82, 95%, CI 0.75-0.91); Asians (0.69, 0.52-0.92); Hispanics (0.29, 0.26-0.32)), although test orders were higher for Asians (1.48, 1.37-1.61) and Blacks (1.78, 1.73-1.82). Tests ordered (11.42, 10.94-11.92) and completed (2.25, 1.94-2.60) were more likely among those with hepatitis history. Test orders were more likely for HIV-positive patients (3.68, 3.45-3.93), but completion was less likely (0.67, 0.57-0.78). Interventions are needed to increase testing rates so that HCV infections are treated early, mitigating HCV-related morbidity and mortality, especially related to liver cancer.
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Affiliation(s)
- Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America.
| | - Julie Rathwell
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, United States of America; Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, United States of America
| | - Richard R Reich
- Department of Biostatistics, H. Lee Moffitt Cancer Center, United States of America
| | | | - David R Nelson
- Department of Medicine, University of Florida, United States of America
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States of America
| | - Patricia D Jones
- Department of Medicine, Gastroenterology and Hepatology, University of Miami Miller School of Medicine, United States of America
| | - Richard Roetzheim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, United States of America; University of South Florida, Department of Family Medicine, United States of America
| | - Anna R Giuliano
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, United States of America; Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, United States of America
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Fuzzell LN, Vadaparampil ST, Giuliano AR, Liu Y, Coghill AE. Patterns of HIV Self-Disclosure in the Oncology Setting. JNCI Cancer Spectr 2021; 5:pkab058. [PMID: 34350380 PMCID: PMC8328009 DOI: 10.1093/jncics/pkab058] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/13/2021] [Accepted: 05/13/2021] [Indexed: 11/14/2022] Open
Abstract
Higher rates of cancer treatment toxicity and uniquely poor outcomes following a cancer diagnosis have been reported for persons living with HIV (PLWH). This highlights the importance of active HIV status ascertainment in the oncology setting. Self-disclosure of HIV via electronic questionnaire at patient intake is a low-cost option that has not been thoroughly evaluated. We examined 10 years (2009-2019) of patient intake questionnaire data at Moffitt Cancer Center. Self-disclosure of an HIV diagnosis was not uniform, with 36.1% (n = 299, 95% confidence interval [CI] = 32.8% to 39.4%) of 828 patients disclosing. Identification of HIV through this method was highest for anal cancer patients (66.7%, 95% CI = 57.8% to 74.7%). Self-disclosure among patients with hematopoietic malignancies, the most common diagnosis among PLWH at our institution, was lower (19.4%, 95% CI = 14.6% to 25.0%). Patient characteristics associated with HIV self-disclosure included cancer site, natal gender, and race and ethnicity. Findings highlight gaps to motivate future efforts to increase HIV ascertainment prior to initiating cancer care.
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Affiliation(s)
- Lindsay N Fuzzell
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Susan T Vadaparampil
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Yifen Liu
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Anna E Coghill
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.,Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Fuzzell LN, Perkins RB, Christy SM, Lake PW, Vadaparampil ST. Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups. Prev Med 2021; 144:106400. [PMID: 33388330 DOI: 10.1016/j.ypmed.2020.106400] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/09/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.
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Affiliation(s)
- Lindsay N Fuzzell
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America.
| | - Rebecca B Perkins
- Boston University School of Medicine, 85 E. Concord St., Boston, MA 02118, United States of America
| | - Shannon M Christy
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America
| | - Paige W Lake
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America
| | - Susan T Vadaparampil
- Moffitt Cancer Center, Department of Health Outcomes & Behavior, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Dr. Tampa, FL 33612, United States of America; University of South Florida, College of Medicine, 12901 Bruce B Downs Blvd., Tampa, FL 33612, United States of America.
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Fuzzell LN, Fraenkel L, Stark SL, Seehra SS, Nelson C, Keleman A, Politi MC. A Mixed Methods Study Exploring Older Womens' Attitudes Toward Osteoporosis Medications: Adapting a Health Communication Framework. Womens Health Rep (New Rochelle) 2020; 1:102-113. [PMID: 32617530 PMCID: PMC7325487 DOI: 10.1089/whr.2019.0014] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Bisphosphonates (BPs) can reduce fracture risk for adults with osteoporosis (OP), but they have rare risks, complicating decision making. Guided by an established health decision and communication framework, we explored older women's feelings and positions toward taking BPs. Materials and Methods: Using a mixed-methods design, we interviewed women >65 years of age who had never taken BPs. After learning about BPs, participants responded to items about their feelings toward medication benefits/risks. They then identified their overall position toward taking BPs (corresponding to Unquestioning Acceptors, Cautious Acceptors, Hesitants, Probable Refusers, and Definite Refusers). We analyzed data using qualitative content analysis and summarized quantitative data with descriptive statistics. Results: Thirty women participated. Acceptors (N = 17, 56.6%) worried about OP-related fractures. Hesitant participants (N = 12, 40%) worried about BP risks, yet expressed openness toward medications if given opportunities to gather information and talk to clinicians. One Refuser expressed distrust in clinicians and pharmaceuticals. Conclusions: Understanding women's positions toward BPs might improve decision-making processes for OP treatment. Clinicians could tailor communication based on patients' identified BP position. Acceptors might be comfortable with succinct conversations describing medications. Hesitant patients might need more information from resources such as decision aids. Building trust with patients questioning BPs can support future conversations.
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Affiliation(s)
- Lindsay N Fuzzell
- Department of Surgery, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA.,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Liana Fraenkel
- Department of Rheumatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Susan L Stark
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Sarabjeet S Seehra
- Applied Health Behavior, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Christine Nelson
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Audrey Keleman
- Department of Occupational Therapy, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA
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Politi MC, Goodwin CM, Kaphingst KA, Wang X, Fagerlin A, Fuzzell LN, Philpott-Streiff SE. How Do Subjective Health Literacy Measures Work in Young Adults? Specifying "Online" or "Paper-Based" Forms Impacts Results. MDM Policy Pract 2020; 5:2381468320924672. [PMID: 32529034 PMCID: PMC7263163 DOI: 10.1177/2381468320924672] [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] [Received: 01/28/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose. There is no gold-standard health literacy measure. The Single Item Literacy Screener (SILS) and Subjective Literacy Screener (SLS) ask people to self-report ability to understand health information. They were developed in older adults, before common use of electronic health information. This study explored whether the SILS and SLS related to objective literacy, numeracy, and comprehension among young adults, and whether specifying "online" or "paper-based" wording affected these relationships. Methods. Eligible individuals (18-35 years of age, English-speaking, US residents) from an online survey company were randomized to 1) original measures; 2) measures adding "paper-based" to describe health information/forms; or 3) measures adding "online" to describe health information/forms. We examined how each measure related to e-Health Literacy (eHEALS), subjective numeracy (SNS), objective numeracy (ONS), and comprehension of a short passage. Results. A total of 848/1342 respondents correctly answered attention-checks and were analyzed. The validated SILS related to comprehension (P = 0.003), eHEALS (P = 0.04), and ONS (P < 0.001) but not SNS (P = 0.44). When adding "paper-based," SILS related to eHEALS (P < 0.001) and ONS (P = 0.003) but did not relate to comprehension (P = 0.25) or SNS (P = 0.35). When adding "online," SILS related to comprehension (P < 0.001), eHEALS (P < 0.001), ONS (P = 0.005), and SNS (P = 0.03). The validated SLS related to comprehension (P < 0.001), eHEALS (P < 0.001), ONS (P < 0.001), and SNS (P < 0.001). When adding "paper-based," the SLS only related to eHEALS (P = <0.001) and comprehension (P = 0.03) but did not relate to ONS (P = 0.13) or SNS (P = 0.33). When adding "online," the SLS related to comprehension (P < 0.001), eHEALS (P < 0.001), and SNS (P = 0.03) but not ONS (P = 0.06). Conclusions. Young adults might interpret subjective health literacy measures differently when prompted to think about electronic or paper-based information. Researchers should consider clearer instructions or modified wording when using these measures in this population.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Courtney M Goodwin
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Xuechen Wang
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Sydney E Philpott-Streiff
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Fuzzell LN, Richards MJ, Fraenkel L, Stark SL, Politi MC. What information can the lay public find about osteoporosis treatment? A descriptive study coding the content and quality of bisphosphonate information on the internet. Osteoporos Int 2019; 30:2299-2310. [PMID: 31297567 PMCID: PMC6885753 DOI: 10.1007/s00198-019-05008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/15/2019] [Accepted: 05/02/2019] [Indexed: 01/28/2023]
Abstract
UNLABELLED Despite its effectiveness, bisphosphonate use for osteoporosis is low. We assessed bisphosphonate information on the internet and found the most commonly listed benefits/risks were bone density loss, gastrointestinal issues, and jaw necrosis, that risk quantification was rare, and information quality varied. Findings underscore the importance of clinical communication about bisphosphonates. INTRODUCTION The US Preventative Services Task Force recommends osteoporosis screening and treatment with bisphosphonates in high-risk populations. However, bisphosphonate use among individuals with osteoporosis remains low. The content and quality of information from outside sources may influence individuals' bisphosphonate decisions. Therefore, we sought to assess the content and quality of osteoporosis treatment information available to the public by conducting an internet search and coding available bisphosphonate information. METHODS Eleven search terms about osteoporosis and bisphosphonates were entered into four search engines. Two raters assessed websites for information about bisphosphonates, whether and how benefits and side effects were described and quantified, contraindications, and dosing instructions. Coders also assessed website interface and slant/balance of information. RESULTS One thousand four hundred seventy-three websites were identified. Two hundred twenty-seven websites met inclusion criteria and were coded. The most common bisphosphonate benefit described was prevention of bone density loss (77.1% of websites). The most common side effects described were gastrointestinal problems (66.1%) and jaw osteonecrosis (58.6%). Most websites did not quantify bisphosphonate benefits (78.0%) or side effects (82.4%). Complementary/integrative health websites (p < .001) and pharmaceutical litigation websites (p < .001) were more often slanted against taking bisphosphonates, compared to all websites coded. General medical knowledge websites were more balanced than other websites (p = .023). CONCLUSIONS The quality of bisphosphonate information on the internet varies substantially. Providers counseling patients about osteoporosis treatment should inquire about patients' baseline bisphosphonate knowledge. Providers can complement accurate information and address potential bisphosphonate misconceptions.
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Affiliation(s)
- L N Fuzzell
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - M J Richards
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - L Fraenkel
- School of Medicine, Department of Rheumatology, Yale University, New Haven, CT, USA
| | - S L Stark
- School of Medicine, Department of Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - M C Politi
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
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Shields CG, Fuzzell LN, Christ SL, Matthias MS. Patient and provider characteristics associated with communication about opioids: An observational study. Patient Educ Couns 2019; 102:888-894. [PMID: 30552013 PMCID: PMC6491239 DOI: 10.1016/j.pec.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/19/2018] [Revised: 11/16/2018] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Our objective is to examine the relationship of patient and provider characteristics and communication with chronic non-cancer pain and opioid management in primary care. METHOD We conducted an observational study using audio-recorded primary care appointments (up to 3/patient) and self-reported assessments of primary care providers (PCPs) and patients. We coded visit transcripts for 1) opioid and pain management talk and 2) mental health and opioid safety talk. RESULTS Eight PCPs and 30 patients had complete data for 78 clinic visits. PCPs and patients engaged in more opioid and pain management talk when patients reported greater pain catastrophizing and PCPs reported higher psychosocial orientation. PCPs and patients engaged in talk about mental health and opioid safety when patients reported greater anxiety, higher working alliance with their PCP, and when PCPs reported higher burnout. PCPs' negative attitudes about opioids were associated with fewer discussions about mental health and opioid safety. CONCLUSIONS Our results should facilitate design of interventions that improve communication and, ultimately, pain outcomes for patients. PRACTICE IMPLICATIONS Clinicians can use our results to increase patient engagement in discussions about opioid use and pain management or mental health and safety discussions.
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Affiliation(s)
- Cleveland G Shields
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA.
| | - Lindsay N Fuzzell
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Sharon L Christ
- Purdue University, Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue University, Purdue Center for Cancer Research, West Lafayette, IN, USA; Purdue University, Department of Statistics, West Lafayette, IN, 47906, USA
| | - Marianne S Matthias
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
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Fuzzell LN, LaJoie AS, Smith KT, Philpott SE, Jones KM, Politi MC. Parents' adherence to pediatric health and safety guidelines: Importance of patient-provider relationships. Patient Educ Couns 2018; 101:1570-1576. [PMID: 29731179 PMCID: PMC6057837 DOI: 10.1016/j.pec.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 02/16/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine 1) parent-provider communication about pediatric health/safety guidelines, 2) trust in child's provider, 3) comfort discussing guidelines, 4) agreement with guideline advice, 5) self-efficacy following guidelines, and their impact on guideline adherence. METHOD 256 parents of children ages 0-6 completed an online survey about sunscreen use, newborn Vitamin K injections, influenza vaccination, routine vaccination, car seats, infant safe sleep, furniture anchoring, large trampoline use, and firearm safety. Multivariable models regressed: 1) communication about each guideline on parents' corresponding guideline adherence; 2) trust, comfort discussing guidelines, agreement with guideline advice, self-efficacy, on parents' total guideline adherence. RESULTS Communication about furniture anchoring (OR = 2.26), sunscreen (OR = 5.28), Vitamin K injections (OR = 3.20), influenza vaccination (OR = 13.71), routine vaccination (OR = 6.43), car seats (OR = 6.15), and infant safe sleep (OR = 3.40) related to corresponding guideline adherence (ps < 0.05). Firearm safety communication was not related to adherence (OR = 1.11, n.s.). Trampoline communication related to lower likelihood of trampoline guideline adherence (OR = 0.24, p = 0.001). Agreement with guideline advice (β = 0.35), trust (β = 0.34), self-efficacy (β = 0.45), comfort discussing guidelines (β = 0.35) positively related to total guideline adherence (ps < 0.001). CONCLUSION Findings underscore the importance of provider communication about health/safety guidelines. PRACTICE IMPLICATIONS Providers should respectfully engage and build relationships with parents to support health/safety guideline adherence.
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Affiliation(s)
- Lindsay N Fuzzell
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA.
| | - A Scott LaJoie
- University of Louisville, Public Health and Information Sciences, Louisville, KY, USA
| | - Kyle T Smith
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Sydney E Philpott
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
| | - Katherine M Jones
- Washington University in St. Louis, School of Medicine, Department of Pediatrics, St. Louis, MO, USA
| | - Mary C Politi
- Washington University in St. Louis, School of Medicine, Division of Public Health Sciences, St. Louis, MO, USA
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