"The promise of community-based advocacy and education efforts for increasing cancer clinical trials accrual".

Only 3% of cancer patients participate in cancer clinical trials (CCTs). A number of barriers to participation, particularly for minority groups, can be addressed through community-focused education and advocacy efforts. Working with community partnerships, a pilot program sought to change knowledge, attitudes, and role behaviors among community leaders, primary care providers (PCPs), and clinical researchers about CCTs, to increase patient awareness of and participation in CCTs. A mixed method evaluation utilized quantitative analysis of surveys administered to participants during the program period (2006-2008) and qualitative data from interviews with key participants. Programmatic efforts were effective in increasing knowledge and training community leaders and PCPs to disseminate messages about clinical trials, and ultimately increasing patient inquiries about local trials. Training improved cultural competency skills among clinical researchers to recruit and retain CCT participants. Partnerships fostered new processes and structures to facilitate CCT participation in their communities. Clinical trials education and advocacy efforts through community partnerships have an important role in enhancing clinical trial access and in increasing clinical trial participation. Oncologists' involvement in and leadership of such partnerships are critical to promoting CCT accrual, particularly for minority groups.

Insurance status and the use of guideline therapy in the treatment of selected cancers.

PURPOSE: This study estimates the impact of type of insurance coverage on the receipt of guideline therapy in a population-based sample of cancer patients treated in the community. PATIENTS AND METHODS: Patients (n = 7,134) from the National Cancer Institute's Patterns of Care studies who were newly diagnosed with 11 different types of cancer were analyzed. The definition of guideline therapy was based on the National Comprehensive Cancer Network treatment recommendations. Insurance status was categorized as a mutually exclusive hierarchical variable (no insurance, any private insurance, any Medicaid, Medicare only, and all other). Multivariate analyses were used to examine the association between insurance and receipt of guideline therapy. RESULTS: Adjusting for clinical and nonclinical variables, insurance status was a modest, although statistically significant, determinant of receipt of guideline therapy, with 65% of the privately insured patients receiving recommended therapy compared with 60% of patients with Medicaid. Seventy percent of the uninsured patients received guideline therapy, which was nonsignificantly different compared with private insurance. When stratified by race, insurance was a statistically significant predictor of the receipt of guideline therapy only for non-Hispanic blacks. CONCLUSION: Overall, levels of guideline treatment were lower than expected and particularly low for patients with Medicaid or Medicare only. The use of guideline therapy for ovarian and cervical cancer patients and for patients with rectal cancers was unrelated to type of insurance. Of particular concern is the significantly lower use of guideline therapy for non-Hispanic black patients with Medicaid. After adjusting for other factors, only half of these patients received guideline therapy.

Measuring sustained mammography use by urban African-American women.

Although the numbers of African-American women who are 'ever' screened for breast cancer has increased, sustaining regular screening over a lifetime remains a problem. Face-to-face interviews about breast cancer screening were conducted with 576 African-American women from an east coast city. The well-screened index measuring adherence to breast cancer screening guidelines was developed and tested. This index incorporated a woman's past and present use of mammography plus her future intent to be screened. Respondents were dichotomized into well-screened and not well-screened groups. Social and psychological factors associated with sustained screening as measured by this index were then explored. In bivariate analyses, education, health insurance, usual source of care, chronicity and preference for provider ethnicity and gender were significantly different for the two groups. In the multivariate model, women who were well-screened were significantly more likely to report recent physician contact, Pap smear, dental visit, history of breast problems, and beliefs that screening should be done annually and that early detection improves outcomes. Women reporting poor health were less likely to be well-screened. The well-screened index can potentially be used for assessment by clinicians and for program evaluation; however further validation studies need to be conducted. Despite limited resources, the majority of these urban African-American women are building lifetime patterns of regular breast cancer screening. Focused efforts are needed to achieve sustained screening patterns in the 25% who are not regularly screened.

Oncology Nursing Society year 2004 research priorities survey.

PURPOSE/OBJECTIVES: To determine the Oncology Nursing Society (ONS) research priorities for 2005-2008 for oncology nursing across the entire scope of cancer care, including prevention, detection, treatment, survivorship, and palliative care. DESIGN: Descriptive, cross-sectional survey. SAMPLE: Stratified into two groups: random sample of general membership (N = 2,205; responses = 287, or 13%) and all ONS active members in the United States with doctoral degrees (N = 627, responses = 144, or 23%); overall response rate was 15%. METHODS: The 2000 survey was revised and updated. Postcards were mailed to the original sample (N = 1,605) prior to the launch of the online survey, inviting participation via an online or paper-and-pencil survey. An e-mail announcement of the survey was launched one week later, followed by reminders the following week. Because of low response rates, a second sample (N = 600) was selected and contacted. MAIN RESEARCH VARIABLES: 117 topic questions divided into seven categories. Several items were new or reworded. FINDINGS: The top 20 research priorities included 12 of the top 20 items found in the 2000 survey; 8 topics were new to the top 20. Priority topics were distributed across six of seven categories. When general membership results were compared to the doctoral sample, 10 topics were among the top 20 for both groups. Nine topics were top priorities in the 2000 (researcher) and 2004 (doctorally prepared) surveys. CONCLUSIONS: Response rates to the electronic survey were lower than for previous paper-and-pencil surveys, but an adequate response was obtained. Rank order of mean importance ratings was determined by narrow differences in scores. The general membership and doctorally prepared samples showed similarities as well as differences in results. IMPLICATIONS FOR NURSING: The 2004 survey results will inform the 2005 research agenda and assist the ONS Foundation and other funding organizations in distributing research funds.