ABSTRACT
Background: The successful use of hormone therapy (HT) has contributed to improved 5-year cause-specific breast cancer survival rates, and evidence shows that long-term use produces a larger reduction in recurrence and mortality, with nearly 50% reduction in breast cancer mortality during the second decade after diagnosis. Despite the proven benefits, hormone therapy adherence is suboptimal (less than 80% of daily doses taken), and about 33% of women who are prescribed HT do not take their medication as prescribed and are at increased risk of disease recurrence and increased mortality. Smartphone ownership has increased substantially over the past decade, providing an extraordinary opportunity for innovation in the delivery of tailored interventions to improve patients' adherence to hormonal therapy. Purpose: We present preliminary results of a pilot study that involves a theory-based, culturally tailored, interactive mobile app + patient navigation to improve adherence to HT among breast cancer patients attending the breast clinic at the Mays Cancer Center (MCC). Methods: This is a 2-group parallel, randomized control trial that is currently recruiting 120 breast cancer patients and randomly assigning them to the intervention (60) or the control (60) group. The intervention group receives two components: 1) the HT Helper phone app;and 2) assistance from a patient navigator who will provide educational, psychosocial support and reinforcement, address common barriers, and facilitate the interaction with the medical team as needed. The control group receives the usual care and information provided by the MCC's breast clinic to patients undergoing HT. The app and navigation support are based in Social Cognitive Theory and principles of motivational interviewing. Results: Due to the COVID-19 pandemic, we were forced to suspend the start of the intervention until May 2021. We have recruited 27 patients and will present a general description of participants and preliminary results of the 3- month follow-up. This theory-based intervention will empower patients' self-monitoring and management. It will facilitate patient education, identification/reporting of side effects, delivery of self-care advice, and simplify communication between the patient and the oncology team. Conclusions: The anticipated outcome is a scalable, evidence-based, and easily disseminated intervention with potentially broad use to patients using HT and other oral anticancer agents. The ultimate goal of this innovative multi-communication intervention is to improve overall survival and life expectancy, enhance quality of life, reduce recurrence, and decrease healthcare costs.
ABSTRACT
Promoting coronavirus vaccination is deterred by misinformation, ranging from elaborate conspiracy theories about sinister purposes to exaggeration of side effects, largely promulgated by social media. In this pilot study, we tested the effects of different messages on actions leading to vaccination. Two theory-based advertisements were produced for Facebook, which provided video testimonials from peer role models recommending vaccination and its benefits while providing psychological inoculation through the models' acknowledging misinformation, rejecting it and receiving the vaccine. These ads were paid to appear on Facebook users' feeds in rural counties in South Texas, along with a generic vaccine promotion ad from the CDC without peer models or psychological inoculation. Ad viewers could click a link to 'find a vaccine near you'; these responses served as the outcome variable for assessing experimental effects. Ads featuring peer modeling with psychological inoculation yielded a significantly higher rate of positive responses than CDC ads (30.5 versus14.9/1000 people reached in English and 49.7 versus 31.5/1000 in Spanish; P < 0.001 for both English and Spanish rate comparisons). This provides useful pilot data supporting the hypothesis that theory-based communication, i.e. peer modeling with psychological inoculation, may be more effective than more traditional forms of advertising for promoting coronavirus vaccination.
Subject(s)
Coronavirus , Social Media , Advertising , Humans , Pilot Projects , Vaccination/psychologyABSTRACT
Context: Coronavirus disease (COVID-19) clinical manifestations are mainly respiratory, although cardiac complications are being reported. However, specific information about the clinical characteristics and in-hospital outcomes of patients with myocarditis associated with COVID-2019 is limited. Aim: The aim is to describe the clinical characteristics and outcomes of patients with acute myocarditis associated with COVID-19. Methods: The study consisted of a systematic review of all available case reports. Systematic searches were conducted using MEDLINE (PubMed interface) LILACS and Scielo to identify studies from December 2019 to 11 July 2020 involving adult patients with acute myocarditis associated with COVID-19. Results: Twenty patients were included. The median age was 49 years (interquartile range [IQR] 32.25-69), and 60% were male. Ten patients presented ST-segment elevation on the ECG. All patients had elevated serum levels of troponin T or I, N-terminal pro-brain natriuretic peptide (median 3436 ng/L, IQR 1315-12054) and C-reactive protein (median 33 mg/L, IQR 18-94). Interleukin-6 was measured in three patients, presenting elevated values as well. Left ventricular ejection fraction (LVEF) was severely impaired in 60% of the patients. Half of the patients received corticosteroids, 43.7% antivirals and 31.3% hydroxychloroquine. Moreover, 15.8% of patients underwent mechanical circulatory support. Most patients (90.9%) recovered heart function with LVEF above 40%. In-hospital mortality rate was 15.8%, the main cause of death being bacterial septic shock (75%). Conclusion: Several cases of coronavirus-related myocarditis have been reported. The clinical presentation was heterogeneous. The vast majority of patients were treated with steroids and antivirals. Most patients recovered cardiac function;however, mortality was relatively high.