Within- and between-group heterogeneity in cultural models of emotion among people of European, Asian, and Latino heritage in the United States

Research on cultural variation in emotion values and beliefs has usually explained this variation in terms of individualism and collectivism, typically comparing European American against East Asian cultural contexts. This study examined emotion model variability across as well as within cultural contexts in a large sample of young adults of Latino heritage along with people of European and East Asian heritage. Using latent class analysis, we characterized and predicted endorsement of emotion models, distinguishing emotion ideals (the emotions one desires) from beliefs about injunctive norms for emotion (the emotions one believes are appropriate). Students from three universities in different regions of the United States (N = 1,618; 490 of European heritage, 463 of Asian heritage, 665 of Latino heritage) provided data on the desirability and appropriateness of experiencing 19 specific emotions in daily life, as well as their U.S. cultural orientation and sociodemographic characteristics. Four distinct classes/models of emotion desirability and four classes/models of emotion appropriateness emerged. Latent class regression demonstrated that endorsement of emotion models was systematically related to heritage group membership and mainstream cultural orientation. Findings suggest meaningful within-group heterogeneity in emotion models and highlight the ways in which emotion models among people of Latino heritage are both similar to and distinct from models among people of European and Asian heritage. By developing a more nuanced understanding of between- and within-group variation in emotion models and highlighting the Latin American form of collectivism as in need of further research, this study advances cultural psychology, affective science, and their integration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Demand for and Occurrence of Medication Cost Conversations: A Narrative Review

High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations (n = 7 articles) but only 23% reported having held a cost conversation across six specialties (n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.

Addressing multilevel barriers to clinical trial participation among Black and White men with prostate cancer through the PACCT study

BACKGROUND

Cancer clinical trial participation is low and inequitable. Partnering Around Cancer Clinical Trials (PACCT) addressed systemic and interpersonal barriers through an observational study of eligibility and an intervention to improve patient-physician communication and trial invitation rates.

METHODS

Physicians at two comprehensive cancer centers and Black and White men with prostate cancer participated. Patients were followed for 2 years to determine whether they became potentially eligible for an available therapeutic trial. Potentially eligible patients were randomized to receive a trials-focused Question Prompt List or usual care. Patient-physician interactions were video-recorded. Outcomes included communication quality and trial invitation rates. Descriptive analyses assessed associations between sociodemographic characteristics and eligibility and effects of the intervention on outcomes.

RESULTS

Only 44 (22.1%) of participating patients (n = 199) became potentially eligible for an available clinical trial. Patients with higher incomes were more often eligible (>$80,000 vs. <$40,000, adjusted OR = 6.06 [SD, 1.97]; $40,000-$79,000 vs. <$40,000, adjusted OR = 4.40 [SD, 1.81]). Among eligible patients randomized to the intervention (n = 19) or usual care (n = 25), Black patients randomized to the intervention reported participating more actively than usual care patients, while White intervention patients reported participating less actively (difference, 0.41 vs. -0.34). Intervention patients received more trial invitations than usual care patients (73.7% vs. 60.0%); this effect was greater for Black (80.0% vs. 30.0%) than White patients (80.0% vs. 66.7%).

CONCLUSIONS

Findings suggest the greatest enrollment barrier is eligibility for an available trial, but a communication intervention can improve communication quality and trial invitation rates, especially for eligible Black patients.

PACCT: An intervention to improve communication quality and clinical trial invitations for Black and White men with prostate cancer

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Background: Cancer clinical trial enrollment rates are low, with Black individuals especially underrepresented. We tested Partnering Around Cancer Clinical Trials (PACCT), a multi-level intervention designed to improve patient-physician communication and increase trial invitations among Black and White men with prostate cancer. This study reports only on PACCT Phase 1, the patient-focused intervention, because data collection for PACCT Phase 2, the physician-focused intervention, was halted by the COVID-19 pandemic. Methods: Black and White men with prostate cancer and their physicians were invited to participate. Patients were tracked <two years for trial eligibility, with eligible patients randomized to usual care or intervention. Intervention patients received a brochure that included text promoting patient-physician partnerships and a trials-focused Question Prompt List to encourage them to participate actively in clinic visits, such as by asking questions or stating concerns. Patient-physician visits with eligible patients were video-recorded. After the visits, communication (i.e., patient active participation and physician patient-centered communication) was assessed via patient self-report and observer ratings of video-recordings. Medical chart abstractions determined trial invitations. Univariable logistic mixed-effects models nesting patients within physicians tested intervention effects by race on communication and trial invitation. Results: Among 199 participants (91 Black; 108 White), 22% (n = 44; 20 Black, 24 White) became eligible for a trial and received the intervention (n = 19) or usual care (n = 25). Regarding communication, Black intervention patients reported participating more actively than those in usual care (difference = 0.41, 95% CI -0.27-1.08), while White intervention patients reported participating less actively than those in usual care (difference = -0.34, 95% CI -0.72-0.05). No differences in observer ratings of active participation or self-report or observer ratings of physician communication were found. Regarding trial invitations, findings were nonsignificant, but showed more intervention patients (74%) than usual care patients (60%) received invitations (logOR = 1.97, 95% CI -0.30 to 4.24), with Black intervention patients having higher odds of receiving invitations (80%) than White intervention patients (67%) (logOR = 3.84, 95% CI -0.92 to 8.59 vs. logOR = -0.14, 95% CI -4.61 to 4.50). Conclusions: Few patients (22%, n = 44) were eligible for a trial during PACCT Phase 1. Despite this small sample, the PACCT intervention showed promise in increasing the level of active participation among Black patients and in increasing clinical trial invitations for Black and White patients. Future research should test this intervention in a larger sample and in combination with the physician-focused intervention. Clinical trial information: NCT02906241.

PACCT: An intervention to improve communication quality and clinical trial invitations for Black and White men with prostate cancer

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Background: Cancer clinical trial enrollment rates are low, with Black individuals especially underrepresented. We tested Partnering Around Cancer Clinical Trials (PACCT), a multi-level intervention designed to improve patient-physician communication and increase trial invitations among Black and White men with prostate cancer. This study reports only on PACCT Phase 1, the patient-focused intervention, because data collection for PACCT Phase 2, the physician-focused intervention, was halted by the COVID-19 pandemic. Methods: Black and White men with prostate cancer and their physicians were invited to participate. Patients were tracked <two years for trial eligibility, with eligible patients randomized to usual care or intervention. Intervention patients received a brochure that included text promoting patient-physician partnerships and a trial-focused Question Prompt List to encourage them to participate actively in clinic visits, such as by asking questions or stating concerns. Patient-physician visits with eligible patients were video-recorded. After the visits, communication (i.e., patient active participation and physician patient-centered communication) was assessed via patient self-report and observer ratings of video-recordings. Medical chart abstractions determined trial invitations. Univariable logistic mixed-effects models nesting patients within physicians tested intervention effects by race on communication and trial invitation. Results: Among 199 participants (91 Black; 108 White), 22% (n = 44; 20 Black, 24 White) became eligible for a trial and received the intervention (n = 19) or usual care (n = 25). Regarding communication, Black intervention patients reported participating more actively than those in usual care (difference = 0.41, 95% CI -0.27-1.08), while White intervention patients reported participating less actively than those in usual care (difference = -0.34, 95% CI -0.72-0.05). No differences in observer ratings of active participation or self-report or observer ratings of physician communication were found. Regarding trial invitations, findings were nonsignificant, but showed more intervention patients (74%) than usual care patients (60%) received invitations (logOR = 1.97, 95% CI -0.30 to 4.24), with Black intervention patients having higher odds of receiving invitations (80%) than White intervention patients (67%) (logOR = 3.84, 95% CI -0.92 to 8.59 vs. logOR = -0.14, 95% CI -4.61 to 4.50). Conclusions: Few patients (22%, n = 44) became eligible for a trial during PACCT Phase 1. Despite this small sample, the PACCT intervention showed promise in increasing active participation among Black patients and in increasing clinical trial invitations for both Black and White patients. Future research should test this intervention in a larger sample and in combination with the physician-focused intervention. Clinical trial information: NCT02906241.

Development and pilot test of a physician-focused cancer clinical trials communication training intervention

Objective

We describe the development and pilot test of a physician-focused, web-based training module designed to improve physician communication related to clinical trials in a diverse cancer patient population.

Methods

Researchers and stakeholders developed the training module, which included a video explaining patient-centered communication strategies for discussing trials, and re-enactments of actual clinical interactions. For the pilot test, the module was provided to physician participants in the Partnering Around Cancer Clinical Trials (PACCT) trial at two major urban cancer centers. Questionnaires assessed change in beliefs, behavioral attitudes, knowledge and comfort; and perceptions of the module.

Results

Nineteen physicians participated in the pilot test. Most were experienced in discussing trials. Assessments of change were mixed regarding beliefs; they showed marginal improvement in attitudes, and significant improvement in knowledge, but no change in comfort. Feedback on the module was favorable.

Conclusions

This stakeholder-developed physician communication training module was acceptable and effective, albeit in this small and highly-experienced physician sample. Future research should determine its effectiveness on communication in clinical settings.

Innovation

This is the first physician training module to focus on communicating about clinical trials in a diverse patient population. It offers a web-based format and re-enactments of naturally-occurring clinical interactions.

Trial Registration Number: NCT02906241

Understanding engagement behaviors and rapport building in tobacco cessation telephone counseling: An analysis of audio-recorded counseling calls

INTRODUCTION

Though telephone counseling is a modality commonly used to promote health behavior change, including tobacco cessation, specific counselor and participant behaviors that indicate engagement and therapeutic alliance remain poorly characterized in the literature. We sought to explore smokers' and counselors' engagement and rapport-building behaviors in telephone counseling for smoking cessation and patterns of these behaviors by smokers' psychiatric symptoms.

METHODS

The study team transcribed, audio-recorded tobacco cessation counseling calls for the presence of engagement and rapport-building behaviors among recently hospitalized participants enrolled in a smoking cessation randomized controlled trial (RCT). The study used baseline data from the RCT to explore frequencies of counselors' and smokers' behaviors among smokers who had reported more (vs. fewer) symptoms of depression (PHQ8 ≥ 10) or anxiety (GAD7 ≥ 10) at study entry.

RESULTS

Participants (n = 37) were mostly female (23/37), White (26/37), with a median age of 58. At study entry while hospitalized, moderate-to-severe symptoms of depression (18/37) and anxiety (22/37) were common. Participant-led engagement behaviors included referencing past quit attempts, asking questions, elaborating response to yes/no questions, expressing commitment to behavior change, and assigning importance to nonautomated calls. Counselor-led behaviors included building off prior interaction, empathy, normalizing challenges, reframing and summarizing, validating achievements, and expressing shared experience. Both participants and counselors engaged via general discussion and humor. Participant-led engagement behaviors appeared more often in call transcripts among patients with higher baseline depression and anxiety symptoms compared to those with lower symptom scores.

CONCLUSIONS

This study classified participant-led, counselor-led, and shared engagement behaviors during tobacco cessation counseling calls. Increased engagement via telephone counseling may be important for individuals with psychiatric symptoms identified at the start of treatment.

Evidence-based smoking cessation treatment: a comparison by healthcare system

BACKGROUND

A systems-level approach to smoking cessation treatment may optimize healthcare provider adherence to guidelines. Institutions such as the Veterans Health Administration (VHA) are unique in their systematic approach, but comparisons of provider behavior in different healthcare systems are limited.

METHODS

We surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated VHA in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (exposure: AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment (delivery of counseling plus smoking cessation medication or referral) at least once in the past 12 months (composite outcome). Multivariable logistic regression with adjustment for specialty was performed in 2017-2019.

RESULTS

Of 625 healthcare providers surveyed, 407 (65%) responded, and 366 (59%) were analyzed. Most respondents practiced at the AHC (273[75%] vs VHA 93[25%]) and were general internists (215[59%]); pulmonologists (39[11%]); hematologists/oncologists (69[19%]); and gynecologists (43[12%]). Most respondents (328[90%]) reported the primary outcome. The adjusted odds of evidence-based smoking cessation treatment were higher among VHA vs. AHC healthcare providers (aOR = 4.3; 95% CI 1.3-14.4; p = .02). Health systems differed by provision of individual treatment components, including smoking cessation medication use (98% VHA vs. 90% AHC, p = 0.02) and referral to smoking cessation services (91% VHA vs. 65% AHC p = 0.001).

CONCLUSIONS

VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers. Healthcare systems' prioritization of and investment in smoking cessation treatment is critical to improving providers' adherence to guidelines.

Willingness to Discuss Clinical Trials Among Black vs White Men With Prostate Cancer

Importance

Black individuals are underrepresented in cancer clinical trials.

Objective

To examine whether Black and White men with prostate cancer differ in their willingness to discuss clinical trials with their physicians and, if so, whether patient-level barriers statistically mediate racial differences.

Design, Setting, and Participants

This cross-sectional survey study used baseline data from Partnering Around Cancer Clinical Trials, a randomized clinical trial to increase Black individuals' enrollment in prostate cancer clinical trials. Data were collected from 2016 through 2019 at 2 National Cancer Institute-designated comprehensive cancer centers; participants were Black and White men with intermediate-risk to high-risk prostate cancer. In mediation analysis, path models regressed willingness onto race and each potential mediator, simultaneously including direct paths from race to each mediator. Significant indirect effect sizes served as evidence for mediation.

Exposures

Race was the primary exposure. Potential mediators included age, education, household income, perceived economic burden, pain/physical limitation, health literacy, general trust in physicians, and group-based medical suspicion.

Main Outcomes and Measures

The primary outcome was the answer to a single question: "If you were offered a cancer clinical trial, would you be willing to hear more information about it?"

Results

A total of 205 participants were included (92 Black men and 113 White men), with a mean (range) age of 65.7 (45-89) years; 32% had a high school education or lower, and 27.5% had a household income of less than $40 000. Most (88.3%) reported being definitely or probably willing to discuss trials, but White participants were more likely to endorse this highest category of willingness than Black participants (82% vs 64%; χ22 = 8.81; P = .01). Compared with White participants, Black participants were younger (F1,182 = 8.67; P < .001), less educated (F1,182 = 22.79; P < .001), with lower income (F1,182 = 79.59; P < .001), greater perceived economic burden (F1,182 = 42.46; P < .001), lower health literacy (F1,184 = 9.84; P = .002), and greater group-based medical suspicion (F1,184 = 21.48; P < .001). Only group-based medical suspicion significantly mediated the association between race and willingness to discuss trials (indirect effect, -0.22; P = .002).

Conclusions and Relevance

In this study of men with prostate cancer, most participants were willing to discuss trials, but Black men were significantly less willing than White men. Black men were more likely to believe that members of their racial group should be suspicious of the health care system, and this belief was associated with lower willingness to discuss trials. Addressing medical mistrust may improve equity in clinical research.

Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos

Background

With the rapid advances in gene technologies in recent years, the potential benefits of precision medicine (PM) may spread unevenly to disadvantaged populations, such as Hispanics/Latinos.

The objective of this study was to explore patient-level barriers and facilitators to dissemination and adoption of PM among Hispanics/Latinos, including knowledge and awareness.

Methods

Self-identified Hispanics/Latinos from diverse countries in Latin America (N = 41) participated in the study. Using a cross-sectional observational qualitative research design, six focus groups and a demographic questionnaire were collected in English and Spanish. Qualitative content analysis was utilized to code the transcripts and identify emerging themes.

Results

Hispanics/Latinos never heard of and had no knowledge about PM. Barriers to dissemination and adoption of PM included lack of health insurance, financial burden, participants’ immigration status, distrust of government, limited English proficiency, low literacy levels, cultural norms, fear about genetic testing results, lack of transportation, newness of PM, and lack of information about PM. Facilitators included family support; information provided in Spanish; use of plain language and graphics; assistance programs for uninsured; trust in physicians, healthcare staff, well-known hospitals, academic institutions, and health care providers and community organization as sources of reliable information; personal motivation, and altruism or societal benefit.

Conclusions

Culturally-and linguistically-tailored, low-literacy educational material about PM should be created in English and Spanish. Future research should examine provider-level and system-level barriers and facilitators to implementation and adoption of PM among Hispanic/Latino patients.

Who emphasizes positivity? An exploration of emotion values in people of Latino, Asian, and European heritage living in the United States

Emotion values vary within and between individualistic and collectivistic cultural contexts. The form of collectivism prevalent in Latin America emphasizes simpatía, a cultural model that stresses the relational benefits of positivity but also the costs of negativity. This model was predicted to engender a pattern of emotion values distinct from that of the more commonly studied collectivist group, people of Asian heritage (PAH), among whom an emphasis on moderating positive and negative emotions is typically observed, and from people of European heritage (PEH), among whom authenticity in emotions is typically valued. College students of Latino (n = 659), Asian (n = 446), and European (n = 456) heritage living in the United States completed a study examining positive and negative emotion values. Mixed-model analysis of variance that included interactions among culture, emotion valence (positive, negative), value type (desirability, appropriateness), and response type (experience, expression) suggested distinct patterns of emotion values across groups. People of Latino heritage (PLH) rated positive emotions as more desirable and appropriate to experience and express than PAH (ps < .001) but less desirable and appropriate to experience and express than PEH (ps ≤ .001). PLH also rated negative emotions as more undesirable (ps < .001) but similarly inappropriate to experience and express (ps > .05) compared with PAH and as similarly undesirable (ps > .05) but more inappropriate to experience (p < .001) compared with PEH. The emotion-value pattern that emerged was largely consistent with simpatía for PLH and provides new evidence of similarity and variation in emotion values in three distinct contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

eHealth Activity among African American and White Cancer Survivors: A New Application of Theory

eHealth is a promising resource for cancer survivors and may contribute to reducing racial disparities in cancer survivorship. This research applies the Unified Theory of Acceptance and Use of Technology (UTAUT) to examine eHealth activity among African American (AfAm) and White cancer survivors. In a population-based sample of AfAm and White survivors (n = 300), a Poisson regression tested whether UTAUT constructs (facilitating conditions, social influence, perceived ease of use, perceived usefulness) and beliefs about security/trustworthiness of eHealth were associated with the number of eHealth activities respondents had used. To test whether the effects varied across racial groups, interactions between each of these five facets and survivor race were included in the model. The model adjusted for demographic characteristics, cancer history, and internet access and use. Across racial groups, facilitating conditions (IRR = 1.44, 95%CI [1.17, 1.77]) and perceived usefulness (IRR = 1.16, 95%CI [1.08, 1.24]) were associated with increased eHealth activity. A marginally significant interaction between race and perceived ease of use (IRR = 1.17, 95%CI [0.99, 1.39]) indicated this perception was associated with decreased eHealth activity for White but not AfAm survivors. A significant interaction between race and perceived security/trustworthiness (IRR = 1.16, 95%CI [1.02, 1.32]) indicated this perception was associated with increased eHealth activity for AfAm but not White survivors. Social influence was not associated with eHealth use for either group (IRR = 1.07, 95%CI [0.98, 1.16]). Interventions targeting attitudes about eHealth may encourage its adoption and use. Furthermore, eHealth tools intended for use among AfAm cancer survivors should ensure they are secure and emphasize trustworthiness to intended users.

Smartphone apps for cancer: A content analysis of the digital health marketplace

Objective

The purpose of this study was to examine the state of smartphone applications for cancer intended for the general public with a focus on interactive features, content sources, and application developer affiliations. The level of health provider involvement in screening or appraising application content was also assessed.

Methods

A total of 123 apps were identified for analysis from two major mobile application marketplaces (Apple iTunes = 40; Google Play = 83). Application characteristics were collected, analyzed, and reported. These included the mobile platform, cost, application developer affiliation, date of last update, purpose of application, content sources, and interactive features.

Results

In the study sample, 50% of the applications focused on general information for cancer (62/123). Next, this was followed by applications for breast cancer (15%, 19/123) and skin cancer (7%, 8/123). Only 10% of application descriptions (12/123) identified sources for application content. Interactive features included the ability to monitor symptoms, side effects, treatments, and chronic pain (20%, 25/123). Only 3% of the applications (4/123) stated content had been evaluated by health providers.

Conclusions

This study contributes an updated analysis of applications for cancer available in the digital health marketplace. The findings have implications for information quality and supportive resources for cancer care. More transparent information about content sources, organizational affiliations, and level of health provider oversight in screening application content is warranted. Recommendations for improving the quality of cancer applications are also offered.

Unpacking Trial Offers and Low Accrual Rates: A Qualitative Analysis of Clinic Visits With Physicians and Patients Potentially Eligible for a Prostate Cancer Clinical Trial

PURPOSE

Cancer clinical trial accrual rates are low, and information about contributing factors is needed. We examined video-recorded clinical interactions to identify circumstances under which patients potentially eligible for a trial at a major cancer center were offered a trial.

METHODS

We conducted a qualitative directed content analysis of 62 recorded interactions with physicians (n = 13) and patients with intermediate- or high-risk prostate cancer (n = 43). Patients were screened and potentially eligible for a trial. We observed and coded the interactions in 3 steps: (1) classification of all interactions as explicit offer, offer pending, trial discussed/not offered, or trial not discussed; (2) in interactions with no explicit offer, classification of whether the cancer had progressed; (3) in interactions classified as progression but no trial offered, identification of factors discussed that may explain the lack of an offer.

RESULTS

Of the 62 interactions, 29% were classified as explicit offer, 12% as offer pending, 18% as trial discussed/not offered, and 39% as trial not discussed. Of those with no offer, 57% included information that the cancer had not progressed. In 68% of the remaining interactions with patients whose cancer had progressed but did not receive an offer, reasons for the lack of offer were identified, but in 32%, no explanation was provided.

CONCLUSION

Even in optimal circumstances, few patients were offered a trial, often because their cancer had not progressed. Findings support professional recommendations to broaden trial inclusion criteria. Findings suggest accrual rates should reflect the proportion of eligible patients who enroll.

Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy

BACKGROUND

Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients' use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized.

OBJECTIVE

This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized.

METHODS

We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods-preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)-controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers' use of EMRs explained disparities.

RESULTS

From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers' use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models.

CONCLUSIONS

Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients' use of messaging.

Attitudes toward Precision Treatment of Smoking in the Southern Community Cohort Study

BACKGROUND

Precision interventions using biological data may enhance smoking treatment, yet are understudied among smokers who are disproportionately burdened by smoking-related disease.

METHODS

We surveyed smokers in the NCI-sponsored Southern Community Cohort Study, consisting primarily of African-American, low-income adults. Seven items assessed attitudes toward aspects of precision smoking treatment, from undergoing tests to acting on results. Items were dichotomized as favorable (5 = strongly agree/4 = agree) versus less favorable (1 = strongly disagree/2 = disagree/3 = neutral); a summary score reflecting generalized attitudes was also computed. Multivariable logistic regression tested independent associations of motivation (precontemplation, contemplation, and preparation) and confidence in quitting (low, medium, and high) with generalized attitudes, controlling for sociodemographic factors and nicotine dependence.

RESULTS

More than 70% of respondents endorsed favorable generalized attitudes toward precision medicine, with individual item favorability ranging from 64% to 83%. Smokers holding favorable generalized attitudes reported higher income and education (P < 0.05). Predicted probabilities of favorable generalized attitudes ranged from 63% to 75% across motivation levels [contemplation vs. precontemplation: adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI), 1.36-3.25, P = 0.001; preparation vs. precontemplation: AOR = 1.83, 95% CI, 1.20-2.78, P = 0.005; contemplation vs. preparation: AOR = 1.15, 95% CI, 0.75-1.77, P = 0.52] and from 59% to 78% across confidence (medium vs. low: AOR = 1.91, 95% CI, 1.19-3.07, P = 0.007; high vs. low: AOR = 2.62, 95% CI, 1.68-4.10, P < 0.001; medium vs. high: AOR = 0.73, 95% CI, 0.48-1.11, P = 0.14).

CONCLUSIONS

Among disproportionately burdened community smokers, most hold favorable attitudes toward precision smoking treatment. Individuals with lower motivation and confidence to quit may benefit from additional intervention to engage with precision smoking treatment.

IMPACT

Predominantly favorable attitudes toward precision smoking treatment suggest promise for future research testing their effectiveness and implementation.

eHealth Engagement as a Response to Negative Healthcare Experiences: Cross-Sectional Survey Analysis

Background

eHealth provides individuals with new means of accessing health information and communicating with providers through online channels. Prior evidence suggests that patients use eHealth to find information online when they receive care that is low in patient centeredness. However, it is unclear how other problems with the healthcare-delivery system motivate the use of eHealth, how these problems relate to different kinds of eHealth activities, and which populations are most likely to use eHealth when they receive low-quality care.

Objective

We aimed to determine how two types of negative care experiences—low patient centeredness and care coordination problems—motivate the use of different eHealth activities, and whether more highly educated individuals, who may find these tools easier to use, are more likely to use eHealth following negative experiences than less highly educated individuals.

Methods

Using nationally representative data from the 2017 Health Information National Trends Survey, we used factor analysis to group 25 different eHealth activities into categories based on the correlation between respondents’ reports of their usage. Subsequently, we used multivariate negative binomial generalized linear model regressions to determine whether negative healthcare experiences predicted greater use of these resulting categories. Finally, we stratified our sample based on education level to determine whether the associations between healthcare experiences and eHealth use differed across groups.

Results

The study included 2612 individuals. Factor analysis classified the eHealth activities into two categories: provider-facing (eg, facilitating communication with providers) and independent (eg, patient-driven information seeking and communication with non-providers). Negative care experiences were not associated with provider-facing eHealth activity in the overall population (care coordination: P=.16; patient centeredness: P=.57) or among more highly educated respondents (care coordination: P=.73; patient centeredness: P=.32), but respondents with lower education levels who experienced problems with care coordination used provider-facing eHealth more often (IRR=1.40, P=.07). Individuals engaged in more independent eHealth activities if they experienced problems with either care coordination (IRR=1.15 P=.01) or patient-centered communication (IRR=1.16, P=.01). Although care coordination problems predicted independent eHealth activity across education levels (higher education: IRR=1.13 P=.01; lower education: IRR=1.19, P=.07), the relationship between low perceived patient centeredness and independent activity was limited to individuals with lower education levels (IRR=1.25, P=.02).

Conclusions

Individuals use a greater number of eHealth activities, especially activities that are independent of healthcare providers, when they experience problems with their healthcare. People with lower levels of education seem particularly inclined to use eHealth when they have negative healthcare experiences. To maximize the potential for eHealth to meet the needs of all patients, especially those who are traditionally underserved by the healthcare system, additional work should be performed to ensure that eHealth resources are accessible and usable to all members of the population.

The influence of affective behavior on impression formation in interactions between black cancer patients and their oncologists

OBJECTIVE

Black patients and their physicians tend to form relatively negative impressions of each other, and these may contribute to racial disparities in health outcomes. The current research tested the hypothesis that the interaction between positive and negative affective behavior predicts the most positive impressions in clinic visits between Black patients and their oncologists.

METHOD

Naïve coders rated patients' and oncologists' positive and negative affective behavior in thin slices from 74 video recorded clinic visits. We examined whether (a) physician positive affect, negative affect, or their interaction predicted patients' perceptions of patient-centeredness, trustworthiness, and confidence in recommended treatments and (b) patient positive affect, negative affect, or their interaction predicted physicians' perceptions of patient cognitive ability, likelihood of treatment adherence, and likelihood of treatment tolerance. We also tested whether affective behavior mediated relationships between race-related attitudes and post-visit impressions or influenced post-visit impressions independently of attitudes.

RESULTS

When oncologists displayed relatively high levels of both positive and negative affect, patients were more confident in recommended treatments but did not rate physicians higher in patient centeredness or trustworthiness. When patients expressed relatively high levels of positive and negative affect, oncologists perceived patients to be higher in cognitive ability and more likely to adhere to treatment recommendations, but no more likely to tolerate treatments. Affective behavior influenced impressions independently of race-related attitudes.

CONCLUSIONS

Positive and negative affective behaviors jointly contribute to impression formation in clinic visits between Black patients and oncologists, and may have implications for patient treatment and outcomes in this underserved patient population.

Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials

Background

Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients’ decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial.

Methods/design

Data collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients’ understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes.

Discussion

PACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers.

Trial registration

Clinical Trials.gov registration number: NCT02906241 (September 8, 2016).

The impact of Black cancer patients' race-related beliefs and attitudes on racially-discordant oncology interactions: A field study

OBJECTIVE

Both physician and patient race-related beliefs and attitudes are contributors to racial healthcare disparities, but only the former have received substantial research attention. Using data from a study conducted in the Midwestern US from 2012 to 2014, we investigated whether 114 Black cancer patients' existing race-related beliefs and attitudes would predict how they and 18 non-Black physicians (medical oncologists) would respond in subsequent clinical interactions.

METHOD

At least two days before interacting with an oncologist for initial discussions of treatment options, patients completed measures of perceived past discrimination, general mistrust of physicians, and suspicion of healthcare systems; interactions were video-recorded. Measures from each interaction included patients' verbal behavior (e.g., level of verbal activity), patients' evaluations of physicians (e.g., trustworthiness), patients' perceptions of recommended treatments (e.g., confidence in treatment), physicians' evaluations of patient personal attributes (e.g., intelligence) and physicians' expectations for patient treatment success (e.g., adherence).

RESULTS

As predicted, patients' race-related beliefs and attitudes differed in their associations with patient and physician responses to the interactions. Higher levels of perceived past discrimination predicted more patient verbal activity. Higher levels of mistrust also predicted less patient positive affect and more negative evaluations of physicians. Higher levels of suspicion predicted more negative evaluations of physicians and recommended treatments. Stronger patient race-related attitudes were directly or indirectly associated with lower physician perceptions of patient attributes and treatment expectations.

CONCLUSION

Results provide new evidence for the role of Black patients' race-related beliefs and attitudes in racial healthcare disparities and suggest the need to measure multiple beliefs and attitudes to identify these effects.

Their Hands Have Lost Their Bones: Exploring Cultural Scripts in Two West African Affect Lexica

Previous research has indicated the importance of embodiment in West African emotion lexica. The current study aims to explore the pervasiveness of this cultural script through the analysis of the emotional lexica of two West African languages (Ga and Ewe) from Southern Ghana that have been featured minimally in previous emotion research. The analysis indicated that embodiment was an important cultural script in both affective lexica. However, interpersonal representations of emotions were also present. Further, emotion words in the two languages differed in the more specific loci of emotions.