Oncologists' perceptions of tumor genomic profiling and barriers to communicating secondary hereditary risks to African American cancer patients.

BACKGROUND: Tumor genomic profiling (TGP) identifies targets for precision cancer treatments, but also secondary hereditary risks. Oncologists are poorly trained to communicate the results of TGP, especially among patients with lower health literacy, poorer genetics knowledge, and higher mistrust. African American (AA) patients are especially vulnerable to poor understanding due to significant cancer disparities and lower uptake of TGP. The goal of this research is to inform the development of an internet-based brief educational support for oncologists to prepare them to provide better decisional support related to TGP for their AA cancer patients. METHODS: This mixed-methods study used semi-structured interviews of oncologists to inform development of an online survey with a convenience sample of US-based oncologists (n = 50) to assess perceptions of the challenges of TGP and communicating results to AA patients. RESULTS: Most interviewed oncologists felt it was important to consider racial/cultural differences when communicating about hereditary risks. Cost, family dynamics, discrimination concerns, and medical mistrust were identified as particularly salient. Survey respondents' views related to AAs and perceptions of TGP were strongly associated with years since completing training, with recent graduates expressing stronger agreement with statements identifying barriers/disadvantages to TGP for AA patients. CONCLUSIONS: Oncologists who had more recently completed training expressed more negative perceptions of TGP and more perceived challenges in communicating about TGP with their AA patients. Focused training for oncologists that addresses barriers specific to AAs may be helpful in supporting improved communication about TGP and improved decisional support for AA patients with cancer considering TGP to evaluate their tumors.

Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States.

Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.

Peer advice for women living with HIV in the Southern USA.

Peer advice can provide emotional, social and practical assistance for the sustained self-management of chronic conditions. For stigmatised diseases such as HIV, finding support can be challenging. Women living with HIV in the Southern USA are additionally impacted upon by region-specific barriers such as stigma, poverty and limited access to services. The effectiveness of peer advice has been studied, yet little is known about the advice shared amongst women living with HIV. Therefore, we aimed to qualitatively explore the context and content of the advice participants offered to other women. With the assistance of a Community Clinician Advisory Board, women were recruited from across the US Centers for Disease Control and Prevention South Census Region. In-depth interviews were conducted with (N = 40) participants, aged 23 to 72 years (M = 51.2). Qualitative inductive thematic analysis was used to explore both the solicited and unprompted advice shared during individual interviews. Analysis of interview transcripts revealed three advice themes: Consistency in disease management Practical, non-medical advice; and Emotional and social support. The findings are valuable in shaping future peer-delivered programmes and interventions to enhance HIV care engagement, medication adherence, and the well-being of women living with HIV in the Southern USA.

Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2-9 Years.

This research describes the development and preliminary feasibility of iByte4Health, a mobile health (mHealth) obesity prevention intervention designed for parents with a low-income of children 2-9 years of age. Study 1 (n = 36) presents findings from formative work used to develop the program. Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program.

Oncologists' Perceptions of Tumor Genomic Profiling and the Communication of Test Results and Risks.

Tumor genomic profiling (TGP) identifies genetic targets for precision cancer treatments. The complexity of TGP can expose gaps in oncologists' skills, complicating test interpretation and patient communication. Research on oncologists' use and perceptions of TGP could inform practice patterns and training needs. To study this, a sample of oncologists was surveyed to assess TGP use, perceptions, and perceived skills in TGP interpretation/communication, especially in communication of hereditary risks. Genomic self-efficacy and TGP knowledge were also assessed. The goal sample (n = 50) was accrued from 12/2019 to 1/2020. Respondents were primarily medical oncologists (78%) with >10 (mean 17.7) years of practice experience. TGP use was moderate/high (median 50 [range 2-398]) tests/year. Most oncologists reported informal/no training in interpretation (72%) or communication (86%) of TGP results and risks. Genomic self-efficacy was high and was associated with higher use of TGP (p = 0.047). Perceptions of the benefits and limitations of TGP were mixed: heterogeneity was seen by years of experience, TGP use, and knowledge. Most participants agreed that additional training in TGP communication was needed, especially in communication of hereditary risks, and that an online training tool would be useful (86%). We conclude that oncologists are frequently using TGP despite having mixed views about its utility and not feeling prepared to communicate risks to patients. Oncologists receive little education in interpreting TGP or communicating its results and risks, and would value training in this area.

Prospective assessment of contralateral prophylactic mastectomy decision-making in women with average risk: an application of perceptual mapping.

Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions.

Developing the "Control Identity" Typology to Create More Effective Testicular Health Promotional Messaging.

Testicular self-examination (TSE) promotional interventions historically operate without a theoretical framework, which negatively influences their effectiveness. As TSE is critical to the early detection of testicular cancer, this behavior is an essential component to improving overall male well-being. To address this need, the Control Identity personality typology was developed to assist in creating more effective TSE promotional interventions. Four outcome control dispositions were defined a priori based on the dimensions of illusions of control and locus of control. An original 41-item survey, the Control Identity Assessment Scale, was used to assess perceived vulnerability, value of health promotion, and health outcome control among a convenience sample of 300 university males aged 18 to 35 years via a cross-sectional research design. Factor and cluster analyses were employed to extract salient factors in the data and to identify subgroups within the sample. A consistent five-factor structure matrix (~70% explained variance) served as the foundation from which a k-means cluster analysis was employed to classify four types of individuals. Significant differences were detected between clusters on primary variables, including behavioral intentions to conduct TSE. The Control Identity typology aims to provide the needed mechanism for health practitioners to create more effective preventive health messaging to promote TSE. Future implications on employing this typology to segment audiences in order to increase overall effectiveness are offered. Application of this typology could ultimately lead to increasing TSE knowledge retention, behavioral intentions, actual performance, and adherence.

Correlates to Human Papillomavirus Vaccination Status and Willingness to Vaccinate in Low-Income Philadelphia High School Students.

BACKGROUND: Little is known about the correlates of human papillomavirus (HPV) vaccination or willingness to be vaccinated in urban, minority adolescents. METHODS: Using responses to the 2013 Youth Risk Behavior Survey in Philadelphia, a random sample of high schools provided weighted data representing 20,941 9th to 12th graders. Stratified by either having had or willingness to have the vaccine, bivariate analysis with sexual behavior, preventive health behaviors, mental health, substance use, and demographic characteristics were examined and then multivariable regression models were developed to estimate significant correlates. RESULTS: Respondents were 52.3% female, 84.4% non-White, and 65.9% ≥16 years; 43% reported having had the HPV vaccine, and of those not vaccinated, 66% reported willingness to be vaccinated. Logistic regression models indicate that females (odds ratio [OR] = 3.12, p < .01) and those reporting human immunodeficiency virus (HIV) testing (OR = 2.10, p < .01) were more likely to be vaccinated. Those reporting condom use during last intercourse (OR = 0.40; p = .05) and current marijuana use (OR = 0.37; p = .03) were less likely to indicate willingness to be vaccinated. CONCLUSIONS: Important areas for intervention include addressing misconceptions or feelings of "immunity," especially for those using condoms. Understanding the correlation between HIV testing and HPV vaccination is also an important intervention opportunity for schools hoping to increase adolescent vaccination rates.

A comprehensive review of school-based body mass index screening programs and their implications for school health: do the controversies accurately reflect the research?

BACKGROUND: Whereas legislation for body mass index (BMI) surveillance and screening programs has passed in 25 states, the programs are often subject to ethical debates about confidentiality and privacy, school-to-parent communication, and safety and self-esteem issues for students. Despite this debate, no comprehensive analysis has been completed that compares and contrasts how these issues differentially affect schools, parents, and students. METHODS: A keyword search from electronic databases and a review of state legislation related to BMI surveillance and screening were used to identify relevant literature and data focused on surveillance and screening policies, BMI report cards, and parental perceptions of BMI screenings and their child's weight status [corrected]. RESULTS: This article addresses the gap of previous literature by outlining the ethical considerations and implications that BMI screening programs and report cards have for schools, parents, and students, and links these with outcome studies to address whether these controversies are supported by research. CONCLUSIONS: Despite the controversies surrounding these programs, this review shows that they can be valuable for all parties and demonstrates BMI screening programs to be vital to the development of robust school-based obesity prevention programs and promotion of healthy lifestyles in schools.

Minority HIV patients' perceptions of barriers and facilitators to participation in clinical research.

HIV clinical trials play an essential role in producing new HIV medications, developing guidelines for the appropriate timing of antiretroviral treatment, and evaluating behavioral interventions that aim to increase the quality of life of HIV-infected individuals. It is critical to have participation from all demographic groups, yet minorities are disproportionately underrepresented in HIV clinical research. This study assessed HIV+ minority patient perceptions of the barriers and benefits of participating in HIV clinical trials in an HIV clinic of a large, urban teaching hospital. Twenty-six, age-eligible (18-65), minority patients were recruited and participated in three focus groups, separated by clinical research participation status. Results suggest differences in perceptions between those who had and had not participated. Facilitators for those who had participated included doctor recommendation and receiving extra medical attention. Those who had not participated indicated disclosure of HIV status, fear of losing the stability that their current medication regimen provided, distrust of the medical system and doubt about the origin of HIV were major deterrents of participation. Both groups indicated a need to better educate minority patients about what clinical research is and its benefits. To increase minority participation, it is vital to examine the perceptions of minority HIV-infected patients and develop culturally competent, developmentally appropriate messages that address these barriers.

Resident physicians' perceptions of barriers and facilitators to colorectal cancer screening for African Americans.

BACKGROUND: African Americans experience disproportionately higher morbidity and mortality from colorectal cancer (CRC), yet they complete screening at lower rates than Caucasians. While studies have identified barriers and facilitators to CRC screening among African Americans, no study has examined physician perceptions of these barriers. OBJECTIVE: The purpose of this study was to determine how resident physicians view barriers and facilitators to CRC screening among their African American patients, and to compare residents' perceptions with barriers and facilitators that have been reported in studies with African Americans. DESIGN: Both quantitative and qualitative data were obtained during in-depth interviews with 30 upper-year residents from an urban academic internal medicine program. RESULTS: Residents recognized the low levels of awareness of CRC that have been reported among African American patients. The most common barriers reported by residents were lack of knowledge, fears, personal/social circumstances, and colonoscopy-specific concerns. Residents reported a need for increased education, increased public awareness, and easier scheduling as facilitators for screening. Residents failed to appreciate some key perceptions held by African Americans that have been documented to either impede or facilitate CRC screening completion, particularly the positive beliefs that could be used to overcome some of the perceived barriers. CONCLUSIONS: Residents may be missing opportunities to more effectively communicate about CRC screening with their African American patients. Residents need more explicit education about African Americans' perceptions to successfully promote screening behaviors in this high-risk population.

Increasing colorectal cancer screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians.

Colorectal cancer (CRC) screening remains significantly underutilized by African Americans despite their increased risk compared to whites. The purpose of this article is to review recent research on patterns of screening, perceptions of CRC screening methods and outcomes of seven intervention trials specifically designed to increase screening among African Americans in light of the recommendation of the American College of Gastroenterologists to make colonoscopy the screening method of choice for this population. This review shows that progress has been made in understanding the complexity of perceived barriers to CRC screening among African Americans. Interventions that used community-based education targeting individuals and clinically based education targeting clinicians showed modest increases in screening rates. Targeting entire communities did not show significant results. However, because intervention studies use not only different types of interventions but different screening outcome measures, results are not easily comparable. While there is growing evidence that interventions can increase the use of fecal occult blood test (FOBT), it is not yet known if similar interventions can increase rates of screening colonoscopy. Clinicians, patients and policymakers also need to consider the array of social, cultural and financial issues associated with CRC screening in African-American communities.