Effect of patient navigation on satisfaction with cancer-related care.

PURPOSE: Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care. METHODS: Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment. RESULTS: Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p > 0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care. CONCLUSIONS: PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN. TRIAL REGISTRATIONS: clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.

Assessing Health Literacy in Deaf American Sign Language Users.

Communication and language barriers isolate Deaf American Sign Language (ASL) users from mass media, health care messages, and health care communication, which, when coupled with social marginalization, places them at a high risk for inadequate health literacy. Our objectives were to translate, adapt, and develop an accessible health literacy instrument in ASL and to assess the prevalence and correlates of inadequate health literacy among Deaf ASL users and hearing English speakers using a cross-sectional design. A total of 405 participants (166 Deaf and 239 hearing) were enrolled in the study. The Newest Vital Sign was adapted, translated, and developed into an ASL version (ASL-NVS). We found that 48% of Deaf participants had inadequate health literacy, and Deaf individuals were 6.9 times more likely than hearing participants to have inadequate health literacy. The new ASL-NVS, available on a self-administered computer platform, demonstrated good correlation with reading literacy. The prevalence of Deaf ASL users with inadequate health literacy is substantial, warranting further interventions and research.

Emergency Department utilization among Deaf American Sign Language users.

BACKGROUND: Deaf American Sign Language (ASL) users comprise a linguistic minority population with poor health care access due to communication barriers and low health literacy. Potentially, these health care barriers could increase Emergency Department (ED) use. OBJECTIVE: To compare ED use between deaf and non-deaf patients. METHOD: A retrospective cohort from medical records. The sample was derived from 400 randomly selected charts (200 deaf ASL users and 200 hearing English speakers) from an outpatient primary care health center with a high volume of deaf patients. Abstracted data included patient demographics, insurance, health behavior, and ED use in the past 36 months. RESULTS: Deaf patients were more likely to be never smokers and be insured through Medicaid. In an adjusted analysis, deaf individuals were significantly more likely to use the ED (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.11-3.51) over the prior 36 months. CONCLUSION: Deaf American Sign Language users appear to be at greater odds for elevated ED utilization when compared to the general hearing population. Efforts to further understand the drivers for increased ED utilization among deaf ASL users are much needed.

Do clinicians recommend aspirin to patients for primary prevention of cardiovascular disease?

BACKGROUND: The United States Preventive Services Task Force (USPSTF) released updated guidelines in 2009 recommending aspirin to prevent myocardial infarction among at-risk men and stroke among at-risk women. OBJECTIVE: Our aim was to examine clinician aspirin recommendation among eligible persons based on cardiovascular risk scores and USPSTF cutoffs. DESIGN: We used across-sectional analysis of a current nationally representative sample. PARTICIPANTS: Participants were aged 40 years and older, and in the National Health and Nutrition Examination Survey (NHANES) (2011-2012). MAIN MEASURES: We determined aspirin eligibility for cardiovascular disease (CVD) prevention for each participant based on reported and assessed cardiovascular risk factors. We assessed men's risk using a published coronary heart disease risk calculator based on Framingham equations, and used a similar calculator for stroke to assess risk for women. We applied the USPSTF risk cutoffs for sex and age that account for offsetting risk for gastrointestinal hemorrhage. We assessed clinician recommendation for aspirin based on participant report. RESULTS: Among men 45-79 years and women 55-79 years, 87 % of men and 16 % of women were potentially eligible for primary CVD aspirin prevention. Clinician recommendation rates for aspirin among those eligible were low, 34 % for men and 42 % for women. Rates were highest among diabetics (63 %), those 65 to 79 years (52 %) or those in poor health (44 %). In contrast, aspirin recommendation rates were 76 % for CVD secondary prevention. After accounting for patient factors, particularly age, eligibility for aspirin prevention was not significantly associated with receiving a clinician's recommendation for aspirin (AOR 0.99 %; CI 0.7-1.4). CONCLUSIONS: Despite an "A recommendation" from the USPSTF for aspirin for primary prevention of CVD, the majority of men and women potentially eligible for aspirin did not recall a clinical recommendation from their clinician.

Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis.

PURPOSE: Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS: We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS: Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS: Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.

Clinician-targeted intervention and patient-reported counseling on physical activity.

INTRODUCTION: Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. METHODS: Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre-post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians' counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. RESULTS: Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0-15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. CONCLUSION: A clinician training intervention showed mixed results for 5As physical activity counseling.

Physical activity counseling intervention at a federally qualified health center: improves autonomy-supportiveness, but not patients' perceived competence.

OBJECTIVE: To assess the effect of a pilot intervention to promote clinician-patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians' autonomy-supportiveness. METHODS: Family medicine clinicians (n=13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up. RESULTS: Patients (n=326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68-4.06, p=0.03). There was no significant change in patient perceived competence for physical activity. CONCLUSIONS: A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity. PRACTICE IMPLICATIONS: Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians.

Do better-rated navigators improve patient satisfaction with cancer-related care?

Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care. The sample included 1,593 adults (85.8% with abnormal cancer screening and 14.2% with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator scale. We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care (PSCC) scale. We controlled for patient and site characteristics using backward selection logistic regression analyses. Among patients with abnormal screening, having a better-rated navigator was associated with higher score on the PSCC (p < 0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.05-1.82]. Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR, 3.06; 95% CI, 1.56-6.0). Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care.

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers.

BACKGROUND: Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. METHODS/DESIGN: The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. DISCUSSION: The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). TRIAL REGISTRATION: Clinical Trials Identifier: NCT01485627.

Low education as a risk factor for undiagnosed angina.

BACKGROUND: Early awareness, recognition, and treatment of angina can help prevent or delay an acute myocardial infarction and potentially delay death. A patient's educational level may affect a physician's diagnosis of angina and/or a patient's symptom recognition. The objective of this study was to determine whether low education is a risk factor for undiagnosed angina. METHODS: This was a cross-sectional observational study based on data from the National Health and Nutrition Examination Survey 2001 to 2008, providing a nationally representative sample of adults ≥40 years of age with angina based on physician diagnosis, presence of angina symptoms based on the Rose Questionnaire, or both. Educational attainment (high school or less vs more than high school) was the independent variable of interest. Undiagnosed angina (angina symptoms in the absence of angina diagnosis) was the dependent variable. We used logistic regression to control for age, sex, race/ethnicity, income, and health care visit during the past year. RESULTS: Low education was associated with undiagnosed angina (odds ratio: 1.43; 95% confidence interval: 1.01-2.03). Other undiagnosed angina predictors included being female, being black, and having no health care visit during the past year. CONCLUSIONS: Low education is associated with undiagnosed angina. These results underscore the need for providers to ask about angina symptoms and confirm patients' understanding of their angina diagnosis among those with low education.

Prevalence of self-reported memory problems in adult cancer survivors: a national cross-sectional study.

PURPOSE: Cancer and its treatments can impair cognitive function, especially memory, leading to diminished quality of life. Prevalence studies of cancer treatment-related memory impairment have not been conducted in the adult-onset cancer population. METHODS: To determine the prevalence of self-reported memory (SRM) problems in people with and without a history of cancer, we analyzed data from a large, nationally representative sample of the civilian, noninstitutionalized US population. Participants answered the yes-or-no question, "Are you limited in any way because of difficulty remembering or because you experience periods of confusion?" Age, sex, race/ethnicity, education, poverty, and general health were controlled. RESULTS: The sample (N = 9,819) consisted of 4,862 men and 4,957 women age 40 years and older. There were 1,938 blacks, 5,552 whites, 1,998 Hispanics, and 331 participants categorized as other race/multiracial. Of these, 1,305 reported a history of cancer; 8,514 did not. Memory problems were self-reported more often by participants with a history of cancer (14%) than by those without (8%). Having had cancer was independently associated with SRM impairment (adjusted odds ratio, 1.4; 95% CI, 1.08 to 1.83). Other predictors of memory impairment were age, lower education, lower income, and poorer general health (P < .01 for all). Participants with cancer had a 40% greater likelihood of reporting memory problems relative to those without cancer. CONCLUSION: Cancer history independently predicted SRM impairment. Prevalence of SRM impairment in people with a history of cancer/cancer treatment is substantial and increasing. Health care providers should assess and be ready to treat memory impairment in patients with a history of cancer.

Cross-cultural validation of a Patient Satisfaction with Interpersonal Relationship with Navigator measure: a multi-site patient navigation research study.

BACKGROUND: Patient navigators are trained to help patients effectively access and use healthcare resources in order to facilitate timely completion of recommended cancer screening, diagnostic care, and treatment. Patient navigators provide logistic, instrumental, and psychosocial support to cancer patients. Yet few studies have examined patient-navigator relationships, particularly for Spanish-speaking patients with low English proficiency. We aimed to validate a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I-Sp) scale. METHODS: We translated and back-translated the PSN-I into Spanish and administered the resulting PSN-I-Sp to 222 Spanish-fluent participants. We conducted a principal components analysis and assessed Cronbach's coefficient alpha (α) to evaluate the latent structure and the internal consistency of the PSN-I-Sp. We also completed correlation analyses to examine divergence and convergence of the PSN-I-Sp with the Spanish version of the Patient Satisfaction with Cancer-Related Care (PSCC-Sp) and the patients' demographics. RESULTS: The principal components analysis revealed a one-dimensional PSN-I-Sp measure that explained 82.0% of the variance. The reliability assessment revealed high internal consistency (α = 0.97). The PSN-I-Sp demonstrated good face validity and adequate convergent and divergent characteristics as indicated by a moderate correlation with scores on the PSCC-Sp (all ps < 0.0001) and a non-statistically significant correlation with marital status (all p > 0.05). CONCLUSION: The PSN-I-Sp is a valid and internally consistent measure of satisfaction with interpersonal relationship with a patient navigator for Spanish-speaking participants.

Psychometric development and reliability analysis of a patient satisfaction with interpersonal relationship with navigator measure: a multi-site patient navigation research program study.

BACKGROUND: Patient navigation (PN) is a method for addressing racial-ethnic and socioeconomically based disparities in cancer-related care. Patient navigators provide logistic and emotional support to underserved patients to facilitate successful completion of diagnostic and treatment care. Yet, little is known about patient satisfaction with the relationship with a navigator due to a dearth of instruments measuring satisfaction. OBJECTIVE: The objective of this study was to validate the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) measure for patients undergoing diagnostic and/or therapeutic cancer care. METHODS: We administered the PSN-I to 783 participants from the nine different sites of the National Cancer Institute sponsored Patient Navigation Research Program. We evaluated the latent structure and internal consistency of the PSN-I using principal components analysis (PCA) and Cronbach coefficient alpha (α), respectively. We used correlation analyses to examine divergence and convergence of the PSN-I with the Patient Satisfaction with Cancer-related Care (PSCC), the Rapid Estimate of Adult Literacy in Medicine (REALM) Long Form, and patients' demographics. RESULTS: The PCA revealed a coherent set of items that explicates 76.6% of the variance in PSN-I. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The PSN-I had good face validity as well as convergent and divergent validities as indicated by moderate correlations with score on the PSCC (all ps < 0.0001) and non-significant correlations with primary language, marital status, and scores on the REALM Long Form (all ps > 0.05). CONCLUSION: The PSN-I is a valid and suitable measure of satisfaction with a patient navigator for the present sample.

Psychometric validation and reliability analysis of a Spanish version of the patient satisfaction with cancer-related care measure: a patient navigation research program study.

BACKGROUND: Patient satisfaction (PS), a key measure of quality of cancer care, is a core study outcome of the multi-site National Cancer Institute-funded Patient Navigation Research Program. Despite large numbers of underserved monolingual Spanish speakers (MSS) residing in USA, there is no validated Spanish measure of PS that spans the whole spectrum of cancer-related care. The present study reports on the validation of the Patient Satisfaction with Cancer Care (PSCC) measure for Spanish (PSCC-Sp) speakers receiving diagnostic and therapeutic cancer-related care. METHODS: Original PSCC items were professionally translated and back translated to ensure cultural appropriateness, meaningfulness, and equivalence. Then, the resulting 18-item PSCC-Sp measure was administered to 285 MSS. We evaluated latent structure and internal consistency of the PSCC-Sp using principal components analysis (PCA) and Cronbach coefficient alpha (α). We used correlation analyses to demonstrate divergence and convergence of the PSCC-Sp with a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I-Sp) measure and patients' demographics. RESULTS: The PCA revealed a coherent set of items that explicates 47% of the variance in PS. Reliability assessment demonstrated that the PSCC-Sp had high internal consistency (α = 0.92). The PSCC-Sp demonstrated good face validity and convergent and divergent validities as indicated by moderate correlations with the PSN-I-Sp (p = 0.003) and nonsignificant correlations with marital status and household income (all p(s) > 0.05). CONCLUSION: The PSCC-Sp is a valid and reliable measure of PS and should be tested in other MSS populations.

Vitamin D and racial disparity in albuminuria: NHANES 2001-2006.

BACKGROUND: National data show unexplained racial disparity in albuminuria. We assessed whether low serum vitamin D status contributes to racial disparity in albuminuria. METHODS: We examined the association between race and albuminuria (spot urinary albumin/creatinine ratio (ACR) ≥30) among non-Hispanic black and white nonpregnant adults who were free of renal impairment in the National Health and Nutrition Examination Survey (NHANES) from 2001-2006. We conducted analyses without and with serum 25(OH)D. We adjusted for age, sex, education level, smoking, body mass index (BMI), diabetes, diagnosis of hypertension, and use of antihypertensive medication. RESULTS: Albuminuria was present in 10.0% of non-Hispanic blacks and 6.6% in non-Hispanic whites. Being black (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.23-1.73) was independently associated with albuminuria. There was a graded, inverse association between 25(OH)D level and albuminuria. Notably, the association between race and albuminuria was no longer significant (OR 1.19; 95% CI 0.97-1.47) after accounting for participants' serum 25(OH)D. Similar results were observed when participants with macroalbuminuria (ACR ≥300 mg/g) or elevated parathyroid hormone (>74 pg/ml) were excluded or when a continuous measure of 25(OH)D was substituted for the categorical measure. There were no interactions between race and vitamin D status though racial disparity in albuminuria was observed among participants with the highest 25(OH)D levels . CONCLUSION: Suboptimal vitamin D status may contribute to racial disparity in albuminuria. Randomized controlled trials are needed to determine whether supplementation with vitamin analogues reduces risk for albuminuria or reduce racial disparity in this outcome.

Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?

BACKGROUND: Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether changes in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making. METHODS: The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables. RESULTS: Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to 1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to 1.74). CONCLUSION: Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.

Do navigators' estimates of navigation intensity predict navigation time for cancer care?

Patient navigation requires that patient load be equitably distributed. We examined whether navigators could predict the relative amount of time needed by different patients for navigation. Analysis of 139 breast and colorectal cancer patients randomized to the navigation arm of a trial evaluating the effectiveness of navigation. Navigators completed a one-item scale estimating how much navigation time patients were likely to require. Participants were mostly females (89.2%) with breast cancer (83.4%); barriers to cancer care were insurance difficulties (26.6%), social support (18.0%), and transportation (14.4%). Navigator baseline estimates of navigation intensity predicted total navigation time, independent of patient characteristics. The total number of barriers, rather than any specific type of barrier, predicted increased navigator time, with a 16% increase for each barrier. Navigators' estimate of intensity independently predicts navigation time for cancer patients. Findings have implications for assigning navigator case loads.

Structural and reliability analysis of a patient satisfaction with cancer-related care measure: a multisite patient navigation research program study.

BACKGROUND: Patient satisfaction is an important outcome measure of quality of cancer care and 1 of the 4 core study outcomes of the National Cancer Institute (NCI)-sponsored Patient Navigation Research Program to reduce race/ethnicity-based disparities in cancer care. There is no existing patient satisfaction measure that spans the spectrum of cancer-related care. The objective of this study was to develop a Patient Satisfaction With Cancer Care measure that is relevant to patients receiving diagnostic/therapeutic cancer-related care. METHODS: The authors developed a conceptual framework, an operational definition of Patient Satisfaction With Cancer Care, and an item pool based on literature review, expert feedback, group discussion, and consensus. The 35-item Patient Satisfaction With Cancer Care measure was administered to 891 participants from the multisite NCI-sponsored Patient Navigation Research Program. Principal components analysis (PCA) was conducted for latent structure analysis. Internal consistency was assessed using Cronbach coefficient alpha (α). Divergent analysis was performed using correlation analyses between the Patient Satisfaction With Cancer Care, the Communication and Attitudinal Self-Efficacy-Cancer, and demographic variables. RESULTS: The PCA revealed a 1-dimensional measure with items forming a coherent set explaining 62% of the variance in patient satisfaction. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The Patient Satisfaction With Cancer Care demonstrated good face validity, convergent validity, and divergent validity, as indicated by moderate correlations with subscales of the Communication and Attitudinal Self-Efficacy-Cancer (all P < .01) and nonsignificant correlations with age, primary language, marital status, and scores on the Rapid Estimate of Adult Literacy in Medicine Long Form (all P > .05). CONCLUSIONS: The Patient Satisfaction With Cancer Care is a valid tool for assessing satisfaction with cancer-related care for this sample.

Blood lead levels in relation to cognitive function in older U.S. adults.

Studies suggest that cumulative exposure to lead, as measured in the bone, is associated with accelerated cognitive decline at older age. It is presently unclear, however, whether current blood lead levels (BLLs) are adversely related to cognitive functioning in older adults. We evaluated BLLs in relation to cognition in the continuous National Health and Nutrition Examination Survey (NHANES). The current study was limited to adults age 60 and older. We examined two measures of cognitive functioning: self-reported functional limitation due to difficulty remembering or periods of confusion (NHANES 1999-2008; n=7277) and performance on the Digit Symbol Substitution Test (DSST; NHANES 1999-2002; n=2299). We evaluated quintiles of BLL (<1.30, 1.79-<2.30, 2.30-<3.20, and ≥3.20µg/dL) in relation to cognitive functioning using logistic (functional limitation) and linear (DSST scores) regression in SUDAAN, adjusting for age, sex, race, poverty-income ratio, education, and self-reported general health status. BLLs were not associated with self-reported confusion or memory problems in crude and adjusted analyses, with adjusted odds ratios and 95% confidence intervals (CI) of 1.0 (ref.), 0.9 (CI=0.7-1.3), 0.8 (CI=0.6-1.2), 1.0 (CI=0.7-1.3), 1.0 (CI=0.7-1.4), respectively, in increasing quintiles. Similarly, there was no clear association between performance on the DSST and BLL after accounting for all covariates. Our findings add to the inconsistent evidence regarding the association between concurrent BLLs and cognitive function in older adults. Early-life or long-term, accumulated lead exposures may be etiologically more relevant to accelerated cognitive decline at older age.

A population-based assessment of blood lead levels in relation to inflammation.

BACKGROUND: Some experimental and observational research suggests that inflammation may be an important mediator of lead toxicity. However, lead-induced inflammation has not been well-studied in non-occupationally exposed populations. METHODS: Using data for 9,145 individuals >or=40 years of age from the National Health and Nutrition Examination Survey 1999-2004, we assessed the association between blood lead levels (BLLs) and C-reactive protein (CRP), fibrinogen, and white blood cell (WBC) count via ordinal logistic regression. We also examined the interaction between BLL and gender in relation to the inflammatory markers. RESULTS: No evidence for an association between lead exposure and inflammatory markers was observed with odds ratios around or below the null. Although men but not women appeared to be at increased risk of lead-induced inflammation, no consistent dose-response patterns were observed across BLL quintiles. CONCLUSION: Inflammation does not appear to be an important mediator of lead toxicity.