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Platter HN, Ezeani A, Hyams T, Huang GC, Vanderpool RC, Klein WM. Abstract PO-017: The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The disruption of routine cancer screening during the COVID-19 pandemic is a public health priority given documented delays in the diagnosis and treatment of screening-eligible cancers, and future impacts on cancer mortality. Furthermore, COVID-19 has disproportionately affected historically underrepresented populations such as the Hispanic community, who already experience lower cancer screening rates compared to non-Hispanic whites. The purpose of this study was to examine inquiries about cancer screening among Spanish-speaking general public users before and during COVID-19, using data from the National Cancer Institute's Cancer Information Service (CIS). For this analysis, we examined cancer screening inquiries before (February 2019-March 2020) and during (March 2020-January 2021) COVID-19 among Spanish-speaking general public users. We analyzed CIS point of access (email, LiveHelp, social media, telephone), subjects of interaction, and referrals. Cancer sites with low cell sizes (e.g., lung) were combined into the category “other.” We conducted Chi-squared tests to compare counts for cancer screening inquiries before and during COVID-19 across these variables. There were 47.3% (n=691) cancer screening inquiries among English-speaking users before COVID-19 and 52.7% (n=770) during COVID-19. In comparison, among the 300 cancer screening inquiries from Spanish speakers, there were 57% (n=171) before COVID-19 compared to 43% (n=129) during COVID-19. There was a significant difference in patterns between these two groups (p<.002). Cancer site inquiries among Spanish speakers included breast (n=66), general (n=108), and 17 other cancers combined (n=126). The proportion of breast and general cancer inquiries from Spanish speakers increased during COVID-19 compared to pre-COVID (p<.001), whereas other cancer inquiries decreased. Additionally, Spanish-speaking telephone-based inquiries increased during COVID-19 whereas all other points of access decreased (p<.001); subjects of interaction regarding general cancer questions increased, but those on finding healthcare services, screening tests, and other subjects decreased (p<.01); and there was an increase in referrals to national/community organizations and to the CDC National Breast and Cervical Cancer Early Detection Program, although referrals to healthcare providers and other sources decreased during COVID-19 (p<.001). We found that COVID-19 was associated with a significant decrease in cancer screening inquiries among Spanish speakers compared to English speakers using the CIS, with changes in point of access, referrals, subject of interaction, and cancer site for Spanish-speaking CIS users. It is critical to evaluate how these changes in information-seeking may affect screening behaviors post-COVID in Hispanic communities and may potentially widen existing disparities that have worsened during COVID-19. Despite overall inquiry reductions, there was an increase in some cancer screening referrals, hopefully resulting in increased screening behavior among Spanish-speaking CIS users.
Citation Format: Heather N. Platter, Adaora Ezeani, Travis Hyams, Grace C. Huang, Robin C. Vanderpool, William M.P. Klein. The association of COVID-19 and cancer screening inquiries among Spanish speakers: An examination of NCI Cancer Information Service data [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-017.
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Boyd P, Murray AB, Hyams T, Sleight AG, Moser RP, Arndt J, Czajkowski SM, Hall K. Neuroticism, cancer mortality salience, and physician avoidance in cancer survivors: Proximity of treatment matters. Psychooncology 2021; 31:641-648. [PMID: 34747095 DOI: 10.1002/pon.5850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine if the relationship between neuroticism and physician avoidance/physician visit concerns are mediated by perceptions that cancer is associated with death ("cancer mortality salience"; CMS) for cancer survivors to inform public health interventions and tailored health communications. METHODS Cancer survivors comprised 42.3% of the total sample (n = 525). Participants completed a 4-item neuroticism scale, 4-item cancer perceptions scale, and 4-item physician avoidance and concerns scale. Multiple linear regression models were used to assess relationships among variables for cancer survivors and separately for those without a history of cancer. RESULTS Neuroticism was positively associated with CMS for cancer survivors, b = 0.26, (p < 0.001), and those without cancer, b = 0.22, (p < 0.001). There was an association between neuroticism and physician avoidance among cancer survivors with temporally distant treatment courses after controlling for CMS, b = 0.56 (p = 0.006), but not for those currently or recently having had undergone treatment (p = 0.949). There was also an indirect relationship between neuroticism and physician visit concerns that was mediated by CMS for cancer survivors, b = 0.07, CI = [0.03, 0.13], but this relationship was again driven by cancer survivors with more distal treatment courses. CONCLUSIONS High neuroticism in cancer survivors is associated with physician avoidance and physician visit concerns when treatment is temporally distant. Interventions aimed at decoupling the association between cancer and death can help increase the willingness of cancer survivors to attain cancer care follow-ups and healthcare more generally.
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Affiliation(s)
- Patrick Boyd
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Ashley B Murray
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Travis Hyams
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Alix G Sleight
- Department of Physical Medicine & Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Jamie Arndt
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Susan M Czajkowski
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Kara Hall
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Mueller NM, Hyams T, King-Marshall EC, Curbow BA. Colorectal cancer knowledge and perceptions among individuals below the age of 50. Psychooncology 2021; 31:436-441. [PMID: 34546622 DOI: 10.1002/pon.5825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/06/2021] [Accepted: 09/09/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) rates are increasing in individuals below the age of 50 and this trend has been projected to continue for the foreseeable future. Health officials are calling for increased awareness of rising rates in affected populations to promote discussion and early detection. METHODS In May 2018, we surveyed an online purposive sample of adults below the age of 50 (N = 624). We conducted an exploratory analysis examining knowledge of current CRC screening guidelines, knowledge of available CRC screening methods, perceived risk of CRC, and perceived importance of screening for CRC by gender, race, and previous CRC screening activity. RESULTS The sample was 56% female, averaged 36 years of age, largely identified as Caucasian (84%), married (48%), and well educated (70% with some college or a college degree). 36% correctly identified the current age of recommended CRC screening initiation. Few (8%) correctly identified all CRC screening options presented. Genetics was thought to be the most relevant determinant of CRC. African American or black participants perceived themselves to be at lower risk of CRC, while women rated the importance of screening significantly lower than men. CONCLUSION We identified a lack of CRC knowledge in individuals below the age of 50. Interventions should correct perceptions of risk of CRC and highlight the importance of screening. Complete knowledge of the range of screening options may reduce barriers to screening while a greater knowledge of modifiable risk factors of CRC can promote healthy behaviors.
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Affiliation(s)
- Nora M Mueller
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Evelyn C King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Barbara A Curbow
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
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Hyams T, Golden B, Sammarco J, Sultan S, King-Marshall E, Wang MQ, Curbow B. Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process. BMC Health Serv Res 2021; 21:754. [PMID: 34325701 PMCID: PMC8320058 DOI: 10.1186/s12913-021-06705-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/18/2020] [Accepted: 06/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual's preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. METHODS Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. RESULTS Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. CONCLUSIONS We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.
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Affiliation(s)
- Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA. .,Division of Cancer Control and Population Sciences, Office of the Director, National Cancer Institute, Bethesda, USA.
| | - Bruce Golden
- Department of Decision, Operations, and Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, USA
| | - John Sammarco
- Definitive Business Solutions, Inc., 11921 Freedom Drive, Suite 550, Reston, VA, 20190, USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, USA
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Hyams T, Mueller N, Curbow B, King-Marshall E, Sultan S. Screening for colorectal cancer in people ages 45-49: research gaps, challenges and future directions for research and practice. Transl Behav Med 2021; 12:198-202. [PMID: 34184736 DOI: 10.1093/tbm/ibab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Travis Hyams
- National Cancer Institute, Division of Cancer Control and Population Sciences, Office of the Director, Rockville, MD, USA.,Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Nora Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
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Brown AGM, Hyams T, Brown AN, Nicastro H, Pratt CA. News from NHLBI: Nutrition Research at the National Heart, Lung, and Blood Institute and Future Opportunities. J Nutr 2021; 151:598-604. [PMID: 33561207 PMCID: PMC8189012 DOI: 10.1093/jn/nxaa413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nutrition plays a major role in the prevention and treatment of cardiovascular and other chronic diseases; hence, nutrition research is a priority for the National Heart, Lung, and Blood Institute (NHLBI). The purpose of this analysis is to describe the scope of NHLBI-funded extramural nutrition research grants over the past decade and offer insights into future opportunities for nutrition research relevant to NHLBI's mission. METHODS Data were extracted using the Research, Condition, and Disease Categorization spending categories from the publicly available NIH Research Portfolio Online Reporting Tool Expenditures and Results. New 2018 and 2019 grants were coded into categories and mapped to the 2016 NHLBI Strategic Vision priorities. RESULTS Approximately 90% of nutrition research funds supported extramural grants, particularly through investigator-initiated R series grants (69.6%). Of these, 19.8% were classified as clinical trials. Consistent nutrition-related topics, including physical activity, weight loss, fatty acids, metabolic syndrome, childhood obesity, and other topics such as gut microbiota, arterial stiffness, sleep duration, and meal timing, emerged in 2014-2019. Mapping of the NHLBI Strategic Vision objectives revealed that 32% of newly funded grants focused on pathobiological mechanisms important to the onset and progression of heart, lung, blood, and sleep disorders, with opportunities including developing novel diagnostic and therapeutic strategies and clinical and implementation science research. DISCUSSION The findings show the breadth of NHLBI-funded nutrition research and highlight potential research opportunities for nutrition scientists.
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Affiliation(s)
| | - Travis Hyams
- Present address for TH: National Cancer Institute, 9609 Medical Center Dr, Rockville, MD 20850
| | - Alanna N Brown
- Present address for ANB: Spelman College, 350 Spelman Ln SW, Atlanta, GA 30314
| | - Holly Nicastro
- Present address for HN: National Institute of National Institute of Diabetes and Digestive and Kidney Diseases, 31 Center Dr, Bethesda, MD 20892
| | - Charlotte A Pratt
- Clinical Applications and Preventions Branch, Division of Cardiovascular Science, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
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Bowen DJ, Hyams T, Laurino M, Woolley T, Cohen S, Leppig KA, Jarvik G. Development of FamilyTalk: an Intervention to Support Communication and Educate Families About Colorectal Cancer Risk. J Cancer Educ 2020; 35:470-478. [PMID: 30737640 PMCID: PMC6688969 DOI: 10.1007/s13187-019-1484-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
IFamily members of individuals with colorectal cancer (CRC) may be at increased risk of developing the disease. However, the majority of CRC can be prevented through colonoscopy screening and family members may not be aware if they are recommended to pursue earlier screening because of their family history of CRC. As such, tools must be developed to effectively communicate potential changes to the recommended age for colonoscopy screening and other important CRC-related information to family members. We modified and adapted a successful intervention for families with melanoma to be appropriate for families with CRC to increase communication and screening in family members. The multistep process included the following: (1) developing a paper version of the intervention, (2) piloting the paper version among families with CRC, (3) developing the web-based version, and (4) testing the intervention for usability. Qualitative data was collected and analyzed for pilot testing. Usability testing utilized both qualitative and quantitative data. Patients with CRC liked the paper version and had multiple suggestions, including adding a better introduction, sections on genetics and family history, and clearer communication assistance. The web-based tool was well received and improved upon the linear book format with links, better section instructions, and more proactive communication tools for families. These processes produced materials that satisfied individuals from various families with assistance and support for communicating about CRC. Evaluating the effects of the tools in rigorous research projects is the next step.
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Affiliation(s)
- Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Box 357120, Seattle, WA, 98195, USA.
| | - Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Mercy Laurino
- Genetics and Cancer Prevention Programs, Seattle Cancer Care Alliance, Seattle, WA, USA
| | | | - Stacey Cohen
- Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Gail Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
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Hyams T, Curbow B, Christie J, Mueller N, King-Marshall E, Sultan S, George TJ. Providers' Perceptions of Barriers to Optimal Communication With Patients During the Postcolonoscopy Experience. J Patient Exp 2018; 5:272-278. [PMID: 30574547 PMCID: PMC6295812 DOI: 10.1177/2374373518759548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Colonoscopy screening is an effective method of detecting and preventing colorectal cancer. Standard procedure for most colonoscopies (98%) is to use conscious sedation, which can cause short-term cognitive impairment postprocedure, including communication difficulties. In this study, we explored providers' (gastroenterology doctors and nurses) perceptions of the barriers to optimal communication with patients immediately following colonoscopy. METHODS We conducted interviews with 61 providers across 5 clinical configurations. Interviews were transcribed and coded with NVivo version 11 software. RESULTS Themes emerged regarding barriers to optimal provider-patient communication postcolonoscopy: patient barriers (sedation and patient characteristics), caregiver barriers, and system characteristics. CONCLUSIONS Providers' perceived barriers to communication are an important topic to study. They endorsed, in particular, interventions that target the postcolonoscopy time frame when patients may still be sedated, but providers must convey important discharge and follow-up instructions.
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Affiliation(s)
- Travis Hyams
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Juliette Christie
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Nora Mueller
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Shahnaz Sultan
- Department of Medicine, University of Florida, Gainesville, FL, USA
- North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Thomas J George
- Department of Medicine, University of Florida, Gainesville, FL, USA
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Bowen DJ, Hyams T, Goodman M, West KM, Harris‐Wai J, Yu J. Systematic Review of Quantitative Measures of Stakeholder Engagement. Clin Transl Sci 2017; 10:314-336. [PMID: 28556620 PMCID: PMC5593160 DOI: 10.1111/cts.12474] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 01/23/2023] Open
Affiliation(s)
- DJ Bowen
- University of WashingtonSeattleWashingtonUSA
| | - T Hyams
- University of WashingtonSeattleWashingtonUSA
| | - M Goodman
- College of Global Public HealthNew York UniversityNew YorkNew YorkUSA
| | - KM West
- University of WashingtonSeattleWashingtonUSA
| | - J Harris‐Wai
- University of CaliforniaSan FranciscoCaliforniaUSA
| | - J‐H Yu
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
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Hyams T, Bowen DJ, Condit C, Grossman J, Fitzmaurice M, Goodman D, Wenzel L, Edwards KL. Views of Cohort Study Participants about Returning Research Results in the Context of Precision Medicine. Public Health Genomics 2016; 19:269-75. [PMID: 27553645 DOI: 10.1159/000448277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 07/11/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The practice of biorepository-based genetics research raises questions related to what ethical obligations researchers have to their participants. It is important to explore and include the thoughts of current biorepository participants as we move forward with this type of research. METHODS Thirty participants (17 cancer patients, 7 cancer-free controls, and 6 relatives) were drawn from the Northwest Cancer Genetics Registry and participated in qualitative interviews lasting between 45 and 90 min. Topics explored in this study include which types of genetic test results participants of large biorepositories expect and would like to receive from research analyzing their samples, as well as thoughts on best practice for conducting this type of research. RESULTS Cancer cases, controls, and first-degree relatives have differing views on what results they would like to receive from biorepository-based research. Participants across all groups attempted to balance the costs and benefits of returning individual research results. DISCUSSION In the wake of precision medicine, it is important to describe the range of ways participants in large biorepositories both think and talk about the utilization of their specimens for genetics research.
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Affiliation(s)
- Travis Hyams
- Institute for Public Health Genetics, University of Washington, Seattle, Wash., USA
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Abstract
The growth of managed care in the United States has been paralleled by a rising tide of anti-managed care sentiment. The "managed care problem" is understood generally as the need to protect individuals against large companies that care more about their bottom line than about people. The premise of the BEST (Best Ethical Strategies for Managed Care) project is that the "managed care problem" is best understood as an ethical problem--a conflict of values that arises as the country changes from a patient-centered to a population-centered approach to health care. The BEST project team worked with nine managed care organizations to identify their most intractable problems. The team redefined these problems in terms of ethical dilemmas, then studied each organization in search of innovative, exemplary approaches. These exemplary approaches are being shared publicly with the aim that they be adapted and adopted by other organizations facing similar difficulties and by regulators and legislators hoping to improve the health care system.
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