Fatalism Revisited: Further Psychometric Testing Across Two Studies.

Cancer fatalism may impact outcomes, particularly for African American (AA) women with breast cancer (BrCa). We examined the psychometrics of the modified Powe Fatalism Inventory in sample of AA women with BrCa from two studies. Only the predetermination and God's will items satisfy the conditions to be classified as a strong subscale. Our analysis identified that five items had strong psychometric properties for measuring fatalism for AA women with BrCa. However, these items do not include all the defining attributes of fatalism. A strong measure of fatalism strengthens our understanding of how this concept influences AA patient outcomes.

Health Information Seeking Among Rural African Americans, Caucasians, and Hispanics: It Is Built, Did They Come?

This cross-sectional study examines health information-seeking behaviors and access to and use of technology among rural African Americans, Caucasians, and Hispanics. There was a low level of health information seeking across the sample. Few used smartphones or tablets and did not endorse receiving health information from their health care provider by e-mail. Printed materials remained a source of health information as did friends and family. Information should be shared using multiple platforms including more passive methods such as television and radio. More research is needed to ensure the health literacy, numeracy, and ability to navigate the online environment.

Social support provided by and strain experienced by African-American cancer caregivers.

BACKGROUND: Cancer is the second most common condition among people over 50, behind only dementia, associated with caregiving. As treatments improve, the number of cancer caregivers will increase. However, there is limited research about African-American cancer caregivers (AACCs). PURPOSE: The purpose of this mixed methods study is to describe (1) the types of social support provided by and (2) the levels of strain reported by AACCs. METHODS: Cancer patients from a regional safety net hospital nominated family caregivers who helped them after their cancer diagnosis. Consented caregivers were interviewed in the waiting room while the patient received treatment or later by phone using the Modified Caregiver Strain Index (MCSI), five structured interview questions, and demographic questions-20 min. Responses to the interview questions were processed using Miles and Huberman's content analysis guide. Descriptive statistics for demographics and the MCSI were performed using SPSS. RESULTS: Of the 45 AACCs, 64 % had medical conditions. Caregivers reported patients' pain (31 %), stress (9 %), and nausea (7 %) as the most common symptoms. AACCs most commonly provided instrumental (67 %) or emotional (42 %) support; spiritual (20 %) and informational (20 %) support were less common. CONCLUSION: Emphasis is needed in providing care assistance information to the AACCs to ensure effective support for their loved ones. This study highlights areas of support where assistance can be useful among AACCs.

Partnering against cancer today: a blueprint for coordinating efforts through communication science.

One of the hallmarks of the communication revolution over the past decade has been its support for participation, whether that be in the active engagement of patients searching the Web for answers to vital health questions, or in the collective energies of self-organizing communities through social media. At the same time, some of the major obstacles to achieving a full and equitable reach of evidence-based cancer control knowledge have been traced back to discontinuities in communication either within clinical care or the broader public awareness system. Communication scientists from the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society joined forces in 2010 to investigate ways in which communication science can be used to improve coordination and enhance participation in cancer control for the nation. From 2010 to 2013, the three organizations worked together in 1) convening two meetings designed to assess the status of funded research in communication science, 2) completing a systematic review of literature published over the previous 10 years, and 3) authoring a blueprint for coordinated efforts using the implications of communication science. The blueprint consists of three major goals: first, to identify high-yield targets of opportunity using the health impact pyramid articulated by Centers for Disease Control and Prevention Director, Thomas Frieden; second, to leverage opportunities within the new communication environment, including the opportunities catalyzed by national efforts to create an infrastructure for evidence implementation through health information technology; and third, to assist in coordinating efforts across collaborative entities through participative media.

Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project.

African Americans have higher rates of cardiovascular disease (CVD) and poorer outcomes compared to others. The American Diabetes Association and the National Diabetes Education Program have promoted use of the ABC approach (glycated hemoglobin A1c, blood pressure, cholesterol) for identifying and controlling the leading indicators of CVD risk. In the present study, researchers added a D factor, for depression, because this disorder is common and also predictive of CVD risk and of control of diabetes. Particularly among low-income African Americans, depression is frequently not targeted or treated. The current study tests the effectiveness of recruiting African Americans in churches and training community health workers (CHWs) to educate their peers about CVD and risk reduction. For the intervention group, CHWs participated in a 16-hour training session and delivered a 6-week tailored educational program with counseling sessions and demonstrations. The control group received a weekly lecture by clinical experts. The CHW active-learning intervention was more effective than lectures by clinical experts in increasing the knowledge of CVD risk. The only significant difference in clinical measures reflected a worsening of HbA1c levels in the control group; the CHW intervention group showed a slight improvement. Participants also learned self-management skills, such as taking blood pressure, measuring glucose, and reading labels. Nevertheless, more longitudinal research and a larger sample size are needed to confirm the impact of CHWs in community settings to change factors associated with CVD risk.

Complementary and alternative medicine (CAM) use among men with a history of prostate cancer.

Complementary and alternative medicine (CAM) has been commonly used among Americans; however, less is known about its use among men with a history of prostate cancer. This study used the 2002 National Health Interview Survey (NHIS) to explore the amount and type of CAM use among 218 Black and White men with a history of prostate cancer. Over 90% of men reported having ever used any form of CAM and most men used biologically-based and mind-body therapies. Nurses are in a unique position to discuss, to assess needs and practices, and perhaps, to act as intermediaries for physicians and other healthcare professionals and prostate cancer survivors who use CAM.

A review of intervention studies that seek to increase colorectal cancer screening among African-Americans.

OBJECTIVE: The purpose of this paper is to critically review intervention studies that aimed to increase African-Americans' participation in colorectal cancer (CRC) screening. DATA SOURCE: Potential studies were identified using a combination of key words in five computerized databases. STUDY INCLUSION AND EXCLUSION CRITERIA: Articles were selected if they met all of the inclusion criteria: (1) The study's purpose was to test an intervention to increase CRC screening. (2) At least 50% of the sample was African-American. (3) The study focused on individuals 50 years and older. (4) The study was published between 2000 and 2008. DATA EXTRACTION: Abstracts and reference lists were scanned to determine relevance and a copy of the article was obtained. DATA SYNTHESIS: Data from each study were extracted and placed in a matrix for synthesis. RESULTS: Interventions focused on recruitment from health care centers, churches, housing projects, and senior centers. Both direct and indirect strategies were used to identify the barriers to CRC screening. CONCLUSIONS: Findings suggest that interventions are most successful when they target individuals or communities, address known barriers to screening, deliver tailored messages, use multiple methods of message delivery, and are delivered over multiple time points.

Perceptions of support among older African American cancer survivors.

PURPOSE/OBJECTIVES: To explore the perceived social support needs among older adult African American cancer survivors. RESEARCH APPROACH: Qualitative design using grounded theory techniques. SETTING: Outpatient oncology clinics in the southeastern United States. PARTICIPANTS: Focus groups with 22 older adult African American cancer survivors. METHODOLOGIC APPROACH: Purposeful sampling technique was used to identify focus group participants. In-depth interviews were conducted and participants were interviewed until informational redundancy was achieved. MAIN RESEARCH VARIABLES: Social support needs of older adult African American patients with cancer. FINDINGS: Social support was influenced by (a) symptoms and treatment side effects, (b) perceptions of stigma and fears expressed by family and friends, (c) cultural beliefs about cancer, and (d) desires to lessen any burden or disruption to the lives of family and friends. Survivors navigated within and outside of their networks to get their social support needs met. In some instances, survivors socially withdrew from traditional sources of support for fear of being ostracized. Survivors also described feeling hurt, alone, and socially isolated when completely abandoned by friends. CONCLUSIONS: The support from family, friends, and fellow church members is important to positive outcomes among older African American cancer survivors. However, misconceptions, fears, and negative cultural beliefs persist within the African American community and negatively influence the social support available to this population. INTERPRETATION: Early identification of the factors that influence social support can facilitate strategies to improve outcomes and decrease health disparities among this population.

Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women.

African American women are more likely than any other racial or ethnic group to present with a later stage of breast cancer at initial diagnosis. Delay in breast cancer detection is a critical factor in diagnosis at a later stage. Available data indicate a delay of 3 months or more is a significant factor in breast cancer mortalty. Numerous factors have been reported as contributing to delay in time to seek medical care including religiosity, spirituality, and fatalistic beliefs. This study examined the influence of religiosity, spirituality, and cancer fatalism on delay in diagnosis and breast cancer stage in African American women with self-detected breast symptoms. A descriptive correlation, retrospective methodology using an open-ended questionnaire and three validated measurement scales were used: the Religious Problem Solving Scale (RPSS), the Religious Coping Activity Scale (RCAS) subscale measuring spiritually based coping, and the modified Powe Fatalism Inventory (mPFI). A convenience sample of 129 women ages between 30 and 84 years who self-reported detecting a breast symptom before diagnosis of breast cancer within the preceding 12 months were included in the study. Outcome variables were time to seek medical care and breast cancer stage. Other variables of interest included marital status, income, education, insurance status, and to whom the women spoke about their breast symptoms. Data were analyzed using descriptive statistics, logistic regression analysis, Pearson r correlations, Mann-Whitney U analysis, and Chi Square analysis. Participants were found to be highly religious and spiritual but not fatalistic. While most women delayed more than 3 months in seeking medical care, no associations were found between the three predictor variables and time to seek medical care. The median delay in time from self detection of a breast symptom to seeking medical care was 5.5 months. Women who were less educated, unmarried, and talked to God only about their breast change were significantly more likely to delay seeking medical care. An association was found between disclosing a breast symptom to God only and delay in seeking medical care. In contrast, women who had told a person about their breast symptom were more likely to seek medical care sooner. African American women who delayed seeking medical care for longer than 3 months were more likely to present with a later stage of breast cancer than women who sought care within 3 months of symptom discovery.

Religious beliefs and delay in breast cancer diagnosis for self-detected breast changes in African-American women.

African-American women have a one-third higher death rate from breast cancer. Delay in breast cancer detection is a significant factor in being diagnosed at a later stage. The objective of this research was to examine the relationship between religious beliefs and delay in diagnosis of breast cancer and breast cancer stage for self-detected breast symptoms. Participants ranged in age from 30 to 84 years, with a median age of 54 years. This was a descriptive, correlational study, which utilized an open-ended questionnaire. Statistically significant association was found between Time to Seek Medical Care and Stage of Breast Cancer at p = 0.001, with 67% of the participants (n = 87) presenting with > Stage I breast cancer, and with the mean time to seek medical care at 5.4 months. A statistically significant association was also found related to "did you tell anyone about the breast change"? (i. e., Yes, No, or Only Talked to God). Delay in time to seek medical care was significantly associated with only talking to God about the breast change at (p = 0.02). Telling someone about their breast symptom was also statistically significant at p = 0.01 for reducing delay.

Prostate-specific antigen test use and digital rectal examinations among African-American men, 2002-2006.

African-American men experience greater incidence and mortality from prostate cancer compared to White men as well as men from other groups. Few studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use in African-American men. This study examined use of the PSA test and DRE among African-American men over time and identified correlates associated with the use of these procedures. Overall trends for years 2002-2006 showed a significant decrease in recent PSA test use and DRE among African-American men in 2004 and 2006 compared to year 2002. Recent PSA test use and DRE were associated with several factors including older ages, being married, higher levels of education and income, and overweight and obese body mass index (BMI). PSA test use and DRE among African-American men should be monitored over time to find out if this pattern continues.

Comparing knowledge of colorectal and prostate cancer among African American and Hispanic men.

African American and Hispanic men are less likely to participate in prostate and colorectal cancer screening and have poorer outcomes from these diseases. Guided by the Patient/Provider/System Theoretical Model for Cancer Screening, this study compares the relationships among knowledge of prostate and colorectal cancer, perceptions of cancer fatalism, common sources of cancer information, and awareness of cancer resources screening between African American (n = 72) and Hispanic (n = 47) men who attend federally qualified health centers and a hospital-based primary care clinic in a southern state. African American men were older, had higher levels of education, and were more knowledgeable about cancer than Hispanic men were. However, Hispanic men were more fatalistic about cancer. Most men in both groups were more likely to get cancer information from the television and/or radio, with few accessing the Internet for this information. The men were not aware of many of the leading cancer-related organizations and programs. Nurses continue to play a critical role in patient education and enhancing screening rates. These findings suggest that culturally and educationally appropriate intervention strategies are needed to enhance knowledge and that the television/radio may be an effective medium for delivering these strategies.

Eliminating cancer-related disparities: how nurses can respond to the challenge.

OBJECTIVES: To review disparities in cancer incidence and mortality among several distinct population groups in the US and the challenges nurses face in eliminating these disparities. DATA SOURCES: Journal articles, books, and government reports. CONCLUSION: Despite the phenomenal progress in cancer detection and control, many populations in the US suffer needlessly and die from potentially curable cancers. IMPLICATIONS FOR NURSING PRACTICE: Nurses can address cancer care needs of population groups at increased risk for developing and/or dying from cancer.

Self-reported cancer screening rates versus medical record documentation: incongruence, specificity, and sensitivity for African American women.

PURPOSE/OBJECTIVES: To evaluate levels of incongruence, specificity, and sensitivity between self-reported screening and medical record documentation for breast, cervical, and colorectal cancer screening. DESIGN: Descriptive, quantitative. SETTING: Federally qualified health centers in the southeastern United States. SAMPLE: 116 African American women. The mean age was 35 years, and the mean educational level was 12.6 years. METHODS: Women were eligible to participate in the study if they were older than age 18 and able to understand English or Spanish. They were recruited from the waiting areas of health centers over a consecutive five-day period. MAIN RESEARCH VARIABLES: Self-reported rates of screening and screening rates documented in the medical record. FINDINGS: The level of incongruence between self-report and medical record documentation was more than 50% for some procedures. Rates of specificity were high, particularly over time. Rates of sensitivity were 33% or less. CONCLUSIONS: The women tended to overreport screenings in the past year when compared to medical records. The women and medical records indicated that the screenings had not been performed in the past two to five years or more than five years ago. IMPLICATIONS FOR NURSING: Nurses are in a unique position to educate women about cancer screening in a culturally and educationally appropriate way while ensuring that those conversations and procedures are documented in the medical record by all providers.

Physician-patient discussions with african american men about prostate cancer screening.

Prostate cancer is the second leading cancer killer in men. Men in general and African American men in particular face crucial decisions regarding prostate cancer screening and perhaps treatment for this disease. Major health organizations agree that men should discuss prostate cancer screening with their physicians or other health care professionals. The purpose of the study was to examine sociodemographic and other correlates of physician-patient discussions regarding the advantages and disadvantages of the prostate-specific antigen (PSA) test among African American men aged 40 or older. A majority of African American men reported having discussed the advantages and disadvantages of prostate cancer screening and/or testing with their physicians before ordering it, and physician-patient discussions about the PSA test were associated with increased screening in African American men. Inasmuch as African American men have greater prostate cancer incidence and mortality over other groups, future attempts should be made to find meaningful correlates of PSA screening and test use to help reduce the burden of this disease.

Spirituality among African American cancer survivors: having a personal relationship with God.

African American breast and prostate cancer survivors describe their personal relationship with God as very real, close, and intimate. During their cancer trajectory, God was there with them, healing, protecting, and in control of their lives. Participants believed that God provided types of support not available from family members or friends. In return, these participants dedicated their lives to God through service in their churches or through helping others. Findings can help healthcare professionals and others in clinical practice to understand the reliance that many African American cancer survivors have on their spirituality. These findings also suggest that many African Americans perceive their survival from cancer as a gift from God. Therefore, for them, finding a way to give back is an important component of their spirituality.

Attitudes and beliefs about smoking among African-American college students at historically black colleges and universities.

Smoking rates are lower among African Americans compared to Caucasians, but African Americans have higher lung cancer mortality. Guided by the Powe Fatalism Model, this descriptive study reports on attitudes and beliefs and predictors of lifetime cigarette smoking behaviors among students at historically black colleges and universities (HBCUs). Data were collected using the Attitudes and Beliefs about Perceived Consequences of Smoking Scale and a Demographic Data Questionnaire. The majority (N = 438) were female and single. More than 50% reported trying cigarettes in their lifetime and reported smoking a whole cigarette at age 15.5 years. Only 7.5% of the sample were lifetime smokers. The likelihood that a student would smoke was 15 times greater if their friends smoked and almost seven times greater if they were not members of a Greek organization compared to other students. Males associated smoking with self-confidence, endorsed the emotional benefits and influencing factors of smoking compared to females. Intervention efforts should focus on preventing the initiation of smoking as well as cessation efforts for students at HBCUs. Campus clubs and organizations can play a vital role in long-term changes in smoking behaviors for these students.

Quality of life of African American cancer survivors. A review of the literature.

African Americans are more likely to present with advanced stages of cancer at the time of diagnosis, and their survival rates continue to lag behind those of Caucasian survivors. Although the need to address the quality of life (QOL) of cancer survivors is well documented, little is known about the QOL of African American cancer survivors. A comprehensive literature search from 1990 to 2005 was conducted in 5 phases as outlined by Cooper. Inclusion criteria included the measurement of QOL as an outcome and the report and/or comparison of QOL for African Americans in the sample. The studies that met the criteria for inclusion focused on breast and prostate cancer. All were descriptive (quantitative or qualitative). Overall, the QOL of African American cancer survivors described in this research is poorer than for Caucasians, although in 1 study African American breast cancer survivors reported better emotional adjustment, sexual functioning, and lower symptom distress. Nonetheless, because of the limited and conflicting research as well as inconsistent measurements and methodologies, it is not possible to adequately describe the QOL of African American cancer survivors. Research is needed that uses consistent, culturally appropriate measures, theoretical frameworks, and definitions across studies. Cancer 2007. (c) 2006 American Cancer Society.