Anna M. McDaniel

Health Literacy and Its Association With the Use of Information Sources and With Barriers to Information Seeking in Clinic-Based Pregnant Women

We investigated health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women. The Short Test of Functional Health Literacy in Adults (STOFHLA) was used to measure health literacy in 143 English-speaking low-income pregnant women. About 15% of the participants demonstrated low health literacy. Participants with low health literacy were less likely to use the Internet and more likely to have self-efficacy barriers than participants with high health literacy. Interventions to promote information-seeking skills and Internet access are indicated for women with low health literacy.

Consumer health informatics: From genomics to population health

Innovations in health information technology have ushered in a new era of health care. The use of emerging information and communication technology to improve or enable health and health care is the central focus of consumer health informatics (CHI). Traditionally, CHI interventions to promote health and well-being have targeted the individual or family. Advances in genomic health and the emergence of public health informatics call for broadening the scope of CHI. The authors discuss CHI from the point-of-view of the consumer (e.g., from individuals to policy makers) and the level of health data from the subcellular (e.g., genetic or protein structures) to population (e.g., geographically-referenced information).

Differences in Circulating Endothelial Progenitor Cells among Childhood Cancer Survivors Treated with and without Radiation.

Radiation during childhood cancer treatment increases the propensity to atherosclerotic cardiovascular disease among adult survivors of childhood cancer. This is thought to be mediated through the damage to the underlying vascular endothelium. Endothelial progenitor cells (EPCs) involved in vascular endothelial repair after its damage may be affected by radiation therapy but have never been investigated in adult survivors of childhood cancer. In this pilot study, utilizing multi-parametric flowcytometry, endothelial colony forming cells (ECFCs), which are the bonafide EPCs, and circulating endothelial cells (CECs), which are not EPCs, were compared between adult survivors of childhood cancer with or without radiation exposure. In addition, their associations with blood-pressure, physical activity and diet were examined. Survivors who received radiotherapy had lower ECFCs and CECs (p<0.05) compared to those without it. Significant positive correlations included physical activity with ECFCs and diet with CECs, while blood-pressure negatively correlated with ECFCs. Further evaluation is needed to examine the effect of radiation and modifiable risk factors on ECFCs and CECs. The preliminary findings from this study suggest evidence of the role of ECFCs as biomarkers of vascular injury following treatment for childhood cancer that may help in early identification of survivors at risk for cardiovascular disease.

Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers

Adoption of clinical decision support CDS systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care CHC setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative HDCC national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use e.g., computerized reminders, provider prompts at point-of-care in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.

Design of a Web-based Symptom Management Intervention for Cancer Patients

The discipline of Human-Computer Interaction design has potential for significant benefit to the field of health informatics. This paper describes the design approach used to develop a web-based interface to help cancer patients manage their chemotherapy side effects. Previous versions of this intervention utilizing telephone technology had been efficacious, but limited. The paper discusses the design decisions made in order to leverage the potential benefits of the Internet in supporting patients while avoiding the potential pitfalls that the patients may encounter with a web-based approach.

Refinement of a Conceptual Model for Adolescent Readiness to Engage in End-of-Life Discussions.

Background: Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions. Objective: The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited. Methods: We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness. Results: Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions. Conclusions: Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation. Implications for Practice: Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.

Design of a paired patient-caregiver support application for people coping with cancer

Smart medical interfaces have the potential to address the unique health needs of each individual user. However, they must be carefully designed and tested to provide a supportive and non-stressful experience for users who are ill or overloaded. This paper documents a design methodology used to develop such an application, describing issues that can be encountered during the development process. The paper also illustrates the use of patient-entered data to drive multiple processes, showing how a smart medical interface can mediate among multiple stakeholders.