Preventive oncology & epidemiology最新文献

Background: The Colorectal Cancer Control Program (CRCCP) funds recipients to partner with primary care clinics to adopt and sustain evidence-based interventions (EBIs) that increase CRC screening. This qualitative study explored how CRCCP recipients support their clinic partners to sustain EBI implementation.

Materials and methods: Two waves of data collection - including 27 key informant interviews and 4 validation focus groups with CRCCP recipients - explored recipients' preparation for partnering with potential clinics and supporting EBI implementation and sustainment. Thematic analysis identified support strategies used throughout the CRCCP lifespan.

Result: To prepare for partnerships with clinics, recipients assessed organizational characteristics (leadership support, staffing, and data capacity) to determine readiness for implementing and sustaining EBIs. Recipients then: provided funding for implementation support, and ongoing training and technical assistance; established a clinic-level screening champion; and integrated EBIs into clinic workflows. Some recipients continue to partner with clinics after EBIs are sustained to monitor CRC screening rates and fund follow-up colonoscopies.

Discussion: Study findings indicate that assessing organizational characteristics to determine readiness and providing funding and ongoing technical assistance are practical approaches to support CRC EBI sustainment. Results can inform program and partnership planning among CRCCP recipients and other cancer screening and chronic disease prevention programs.

Introduction: We identified potential approaches to address barriers to colorectal cancer (CRC) screening in rural communities of award recipients from the Centers for Disease Control and Prevention's Colorectal Cancer Control Program (CRCCP).

Methods: Nine program managers and directors discussed approaches to address barriers to CRC screening. The programs served areas with rural communities and tribal reservations. Participants participated in five monthly web-based meetings and completed questionnaires regarding the use and usefulness of approaches. We conducted two focus groups with award recipients' partners to validate the approaches.

Results: Participants indicated that patient reminders, small media, and translated materials were useful in increasing uptake. There were six approaches that all programs used and agreed were useful for providers, including creating standard operating procedures and promoting stool-based testing. There was more variation on usefulness at the health system level, but all programs used and agreed standing orders for stool-based tests were useful.

Discussion: Through discussions, questionnaires, and focus groups with participants, we found that many of the approaches to overcoming barriers in rural areas focused on aiding patients in accessing screening and automating procedures to mitigate the impacts of staff and provider turnover. Further evaluation can determine effective, sustainable and cost-effective approaches.

Objective: Dental clinic oropharyngeal human papillomavirus (HPV) patient education remains understudied. Using a descriptive analysis approach, this study aimed to understand Appalachian Ohio dental clinics' provider knowledge on HPV, structural compositions for education, patient education approaches, and demographics.

Methods: Surveyed Appalachian Ohio general and pediatric dentists responded to HPV education attitude statements and estimated their HPV vaccine recommendation frequency. Staff completed environmental scans about staff composition, structural capacity for general education, and HPV educational efforts and materials. Descriptive analyses were compared by clinic type.

Results: All dentists (n=14) believed patients were at-risk for HPV-related cancers and most (≥64%) agreed that the HPV vaccine was safe and effective. Most felt unprepared to educate patients on HPV (64%) and few frequently recommended the HPV vaccine (14%). No clinic shared materials with patients despite most having sufficient display space (75% for ≥2 material types). Older dentist clinics were more actively engaged in HPV education, made more vaccine recommendations, and had more capacity for additional education; younger dentist clinics had more personnel that were more confident in their communication skills and the HPV vaccine.

Conclusions: Appalachian dentists rarely educated patients about the HPV. Targeted educational materials and training are needed to support these providers in providing this vital information.

Background: Health insurance education could mitigate financial toxicity experienced by young adult (YA) cancer survivors by increasing confidence when navigating cancer care costs. This paper describes the protocol in a randomized controlled trial (RCT) to test a virtual patient navigation program designed to help YA cancer survivors understand their health insurance.

Methods: This is a two-arm, multi-site (Huntsman Cancer Institute, Intermountain Health) RCT wherein intervention participants receive four sessions with a patient navigator (PN) and a booklet on insurance; usual care receives the booklet. We will enroll 300 YA cancer survivors (n=200 intervention; n=100 usual care) diagnosed with breast, testicular, lymphoma, sarcoma, colorectal, melanoma, or thyroid cancer between the ages of 26 and 39, who have completed treatment in the past two years. All participants will complete three surveys: enrollment, 6 months, and 12 months; medical records/insurance claims data will be collected out to 18-month follow-up. Recruitment began in the fall of 2023 and is expected to last approximately 2.5 years. The primary efficacy outcomes include improvement in health insurance literacy and financial toxicity at 6 months. Secondary outcomes include adherence to cancer surveillance guidelines at 18 months. We will also conduct cost-effectiveness and budget impact analyses.

Discussion: Anticipated results from this trial could identify key information that YA cancer survivors need to improve health insurance literacy and survivorship care.

Background: Community cancer centers face challenges in accessing cancer data and communicating health information to patients and community members due to limited tools and resources. The CancerClarity app, recognized at the 2023 Catchment Area Data Conference Hackathon, addresses this need by integrating data visualization with Artificial intelligence (AI)-driven narrative generation. Converting quantitative cancer statistics to narrative descriptions using large language models (LLMs) may help cancer centers communicate complex cancer data more effectively to diverse stakeholders.

Methods: The CancerClarity app employs LLM prompting within the R Shiny web framework, sourcing data from Cancer InFocus. It offers users an interactive exploration of cancer incidence, mortality, and health determinants across U.S. counties.

Results: The CancerClarity app integrates LLM via its application programming interface (API) for real-time, linguistically tailored narratives, making cancer data accessible to a broad audience. The app offers cancer centers a cost-effective solution to swiftly identify their catchment areas and assess the cancer burden within the populations they serve.

Discussion: By enhancing public health decision-making through AI-driven narratives, the app underscores the critical role of effective communication in public health. Future enhancements include the integration of Retrieval Augmented Generation (RAG) for improved AI responses and evidence-based public health guidance.

Despite advances in the early detection and treatment of breast cancer (BC), inequity persists, and the BC mortality rate remains approximately 40% higher among Black and African American (B/AA) women compared to White (W) women. In response to The University of Kansas Cancer Center's Catchment Area Steering Committee identified priorities, the Breast Cancer Health Equity Task Force (BCHETF) leveraged data-driven insights to develop targeted interventions that promote BC prevention and early detection among B/AA women. By synthesizing data, we mapped census tracts with high B/AA population density to identify targeted areas to focus screening and outreach efforts with an evidence-based intervention (EBI). The BCHETF and researchers are also engaged in ongoing projects to explore patient-level experiences of BC care among B/AA women through focus groups and address provider-level gaps in the delivery of BC risk assessment and screening with telementoring and practice facilitation. Targeting efforts through data visualization has been helpful, but limitations remain. Here, we describe the BCHETFs concerted and ongoing efforts to address BC health disparities among B/AA women, facilitate improvements in BC screening access and outcomes, and promote health equity for all.

Background: The Together for Health-Virginia (T4H-VA) Research Program aimed to advance cancer prevention, education, and outreach in Virginia. Creating a representative and inclusive cohort is critical to the program's mission and quality of outcomes. The T4H-VA Research Program utilized a multi-modal sampling approach to improve population health assessment. The current study describes the technology-based, non-probability platform developed for this purpose and compares differences between the probability-based (mail-based) and non-probability-based (e-cohort) methods with respect to participant demographics, health characteristics, and health information and technology use.

Methods: T4H-VA is a research registry focusing on 54 counties within the Massey Comprehensive Cancer Center (MCCC) catchment area in Richmond, VA. Adult residents proficient in English were eligible. For the probability-based sampling, surveys were mailed to residents within the catchment area. For the non-probability sampling, an online study platform was developed and surveys were completed through the web/mobile app.

Results: Both cohorts fell short of recruitment goals. The study yielded 1158 participants (M=57, SD=16 years; 55.0% female; 72.1% White); 899 (77.6%) were sampled through the probability, mail-based approach. Participants who identified as "other" race were significantly less likely to be sampled by the non-probability method. Significant differences emerged, including health protective (greater moderate and high physical activity) and risk factors (greater alcohol consumption and personal history of cancer) in the non-probability, e-cohort relative to the probability sample. E-Cohort participants were significantly more likely to report using electronic health records.

Discussion: Overall difficulties in recruiting were caused, at least in part, by the onset of the COVID-19 pandemic and related factors. The e-cohort, which used exclusively digital recruitment strategies, fell significantly short of recruitment goals. This suggests in-person and mail-based strategies remain important for recruitment. Moreover, instead of favoring a singular approach, a combined approach to survey sampling may capitalize on the strengths of each sampling mode to increase diversity in sociodemographic and health risk characteristics.

To evaluate the association of neighborhood level economic, environmental, and social indicators with lung cancer (LC) incidence and mortality. Data for adult incident LC cases in Allegheny County, Pennsylvania, diagnosed between 2015-2019 were obtained from Pennsylvania cancer registry. Cases were summarized at census-tract level. Publicly available data on neighborhood deprivation index (NDI), built environment, and racial isolation at census-tracts were linked to cases. Poisson regression was used to compute relative risk (RR) for LC incidence and mortality, adjusting for covariates. A total of 3256 LC cases were included in the analyses. About 68% were ≥65 years, 54% female, 14% Black or African American, and 63% deceased. Results of the multivariable model found that increasing quintiles (Q) of NDI were significantly associated with increasing risk of LC incidence and mortality. The RRs (95% confidence interval) of LC incidence for Q2, Q3, Q4 and Q5 were 1.36 (1.21-1.52), 1.55 (1.40-1.72), 1.68 (1.51-1.87), 2.08 (1.82-2.38), respectively, compared with Q1 (P trend <0.01). The corresponding RRs for LC mortality were 1.46 (1.27-1.68), 1.63 (1.42-1.88), 1.74 (1.51-2.01), 2.04 (2.02-2.88) (P trend <0.01). Targeted interventions for LC prevention and early detection in high NDI neighborhoods may be more effective to reduce LC health disparities.

Background: Data dashboards that can communicate complex and diverse catchment area data effectively can transform cancer prevention and care delivery and strengthen community engagement efforts. Engaging stakeholders in data dashboard development, by seeking their inputs and collecting feedback, has the potential to maximize user-centeredness.

Objective: To describe a systematic, stakeholder-driven, and theory-based approach for developing catchment area data visualization tools for cancer centers.

Methods: Cancer-relevant catchment area data were identified from national- and state-level data sources (including cancer registries, national surveys, and administrative claims databases). A prototype tool for data visualization was designed, developed, and tested based on the OPT-In [Organize, Plan, Test, Integrate] framework. A working group of multi-disciplinary experts collected stakeholder feedback through formative assessment to understand data and design preferences. Thematic areas, data elements, and the composition and placement of data visuals in the prototype were identified and refined by working group members. Visualizations were rendered in Tableau^© and embedded in a public-facing website. A mixed-method approach was used to assess the understandability and actionability of the tool and to collect open-ended feedback that informed action items for improvisation.

Results: We developed a visualization dashboard that illustrates cancer incidence and mortality, risk factor prevalence, healthcare access, and social determinants of health for the Hollings Cancer Center catchment area. Color-coded maps, time-series plots, and graphs illustrate these catchment area data. A total of 21 participants representing key stakeholders [general audience (n=4), community advisory board members and other representatives (n=7), and researchers (n=10)] were identified. The understandability and actionability scores exceeded the minimum (80%) threshold. Themes that emerged from qualitative data suggest that additional changes to the tool such as a warm color palette, data source transparency, and the addition of analytical features (data overlaying and area-resolution selection) would further enhance the tool. Integration of communication efforts and messages within a broader context is in progress.

Discussion: A catchment area data resource developed through a systematic, stakeholder-driven, and theory-based approach can meet (and surpass) benchmarks for understandability and actionability, and lead to an overall positive response from stakeholders. Creating channels for advocacy and forming community partnerships will be the next step necessary to promote policies and programs for improving cancer outcomes in the catchment areas.

Background: Distributing CRC screening through pharmacies, a highly accessible health service, may create opportunities for more equitable access to CRC screening. However, providing CRC screening in a new context introduces a substantial implementation challenge.

Methods: We conducted 23 semi-structured interviews with community pharmacists practicing in Washington state and North Carolina about distributing fecal immunochemical tests (FIT) to patients in the pharmacy. The Consolidated Framework for Implementation Research (CFIR) was used to guide analysis.

Results: Pharmacists believed that delivering FITs was highly compatible with their environment, workflow, and scope of practice. While knowledge about FIT eligibility criteria varied, pharmacists felt comfortable screening patients. They identified standardized eligibility criteria, patient-facing educational materials, and continuing education as essential design features. Pharmacists proposed adapting existing pharmacy electronic health record systems for patient reminders/prompts to facilitate FIT completion. While pharmacists felt confident that they could discuss test results with patients, they also expressed a need for stronger communication and care coordination with primary care providers.

Discussion: When designing a pharmacy-based CRC screening program, pharmacists desired programmatic procedures to fit their current knowledge and context. Findings indicate that if proper attention is given to multi-level factors, FIT delivery can be extended to pharmacies.