Hank Dart

Use of a Web-based Risk Appraisal Tool for Assessing Family History and Lifestyle Factors in Primary Care

ABSTRACTBACKGROUNDPrimary care clinicians can play an important role in identifying individuals at increased risk of cancer, but often do not obtain detailed information on family history or lifestyle factors from their patients.OBJECTIVEWe evaluated the feasibility and effectiveness of using a web-based risk appraisal tool in the primary care setting.DESIGNFive primary care practices within an academic care network were assigned to the intervention or control group.PARTICIPANTSWe included 15,495 patients who had a new patient visit or annual exam during an 8-month period in 2010–2011.INTERVENTIONIntervention patients were asked to complete a web-based risk appraisal tool on a laptop computer immediately before their visit. Information on family history of cancer was sent to their electronic health record (EHR) for clinicians to view; if accepted, it populated coded fields and could trigger clinician reminders about colon and breast cancer screening.MAIN MEASURESThe main outcome measure was new documentation of a positive family history of cancer in coded EHR fields. Secondary outcomes included clinician reminders about screening and discussion of family history, lifestyle factors, and screening.KEY RESULTSAmong eligible intervention patients, 2.0 % had new information on family history of cancer entered in the EHR within 30 days after the visit, compared to 0.6 % of eligible control patients (adjusted odds ratio = 4.3, p = 0.03). There were no significant differences in the percent of patients who received moderate or high risk reminders for colon or breast cancer screening.CONCLUSIONSUse of this tool was associated with increased documentation of family history of cancer in the EHR, although the percentage of patients with new family history information was low in both groups. Further research is needed to determine how risk appraisal tools can be integrated with workflow and how they affect screening and health behaviors.

Eight ways to stay healthy after cancer: an evidence-based message

PurposeSince 1999, in conjunction with the internationally known and award-winning Your Disease Risk (yourdiseaserisk.org) risk assessment tool, the “Eight Ways to Stay Healthy and Prevent Cancer” message campaign has provided an evidence-based, but user-friendly, approach to cancer prevention. The scientific evidence behind the campaign is robust and while not a complete list, provides a great deal of benefit in the reduction of cancer risk. With 12 million cancer survivors in the United States, there is a need for a parallel set of recommendations that oncologists and primary care providers may routinely use for individuals following a cancer diagnosis focused on improving the quantity and quality of life after diagnosis. With increasing survival rates and many cancer survivors dying from noncancer causes, survivorship care necessarily focuses on more than just risk of cancer recurrence and cancer-related mortality.MethodsTo provide a foundation for living a healthy life after a cancer diagnosis, we developed a set of evidence-based health messages for cancer survivors. “Cancer Survivors’ Eight Ways to Stay Healthy After Cancer,” published by the Siteman Cancer Center at Washington University School of Medicine and Barnes Jewish Hospital, documents both the evidence supporting the recommendations as well as tips for implementing them.ResultsThe one-line summary messages are: (1) don’t smoke, (2) avoid secondhand smoke, (3) exercise regularly, (4) avoid weight gain, (5) eat a healthy diet, (6) drink alcohol in moderation, if at all, (7) stay connected with friends, family, and other survivors, (8) get screening tests and go to your regular checkups.ConclusionsThe cancer survivors’ eight ways are the foundation for an evidence-based health promotion program for survivors.

Physical Activity and Chronic Disease Prevention

Regular activity is one of the most important contributors to wellness, quality of life, and disease prevention. Relatively modest amounts of activity can lower the risk of heart disease, stroke, diabetes, osteoporosis, dementia, and numerous cancers. Though there are immediate benefits from physical activity, the majority of prevention and health benefits accrue when it is practiced lifelong—in addition to, and often well after, participation in organized athletics.

Abstract C51: Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project

Purpose: We designed an intervention combining the Zuum health risk assessment tool, healthcare provider, and text messaging (SMS) to deliver critical health messages to diverse populations. Zuum is a mobile version of the evidence-based and scientifically-validated Your Disease Risk suite of health risk assessment tools. Our aim was to assess feasibility and acceptance of integrating the intervention into the primary care setting of Federally-Qualified Health Centers (FQHC). Background: Chronic diseases caused largely by modifiable risk factors are the leading causes of death in the United States. Rates of these diseases and their risk factors are higher among many minorities and the poor. As most adults from all backgrounds have a primary care source, this can be an effective intervention setting. However, provider time remains a major barrier to prevention counseling. Health risk assessment tools can help facilitate counseling, as they have demonstrated improvements in patient risk knowledge and accuracy, integration into primary care and promotion of patient-provider risk discussions. Yet, its influence on health behavior and intentions is not well supported. Supplementing these with interventions shown to directly influence behavior change might improve their efficacy. SMS has shown promising ability to improve health behavior and intentions and may enhance the impact of the risk assessment tool. Procedures: The intervention was conducted in urban FQHCs in St. Louis, Missouri. Eligible patients were adults in the waiting room for a scheduled primary care visit. Participants completed the mobile Zuum assessment and received a summary of their risks for 6 chronic diseases with recommendations to lower those risks. Their physician was given an abridged version to help guide preventative counseling during their appointment. For three months, participants received weekly text messages on lifestyle modification tailored to their risk results and behaviors. Results: We enrolled 107 patients, 85% African-American and ages 20 to 70. Most were high risk for at least one chronic disease (82%), and nearly half for two or more (47%). Most patients screened were interested in participating (69%) and had compatible phones (89%). The majority (95%) had time to complete the Zuum assessment before their appointment. We delivered 5,750 (89%) of generated messages, averaging 4-5 messages weekly. Most participants strongly agreed that answering Zuum questions was easy (95%), the texts were clear (90%) and texting is good method to improve health (84%). Most would recommend health text messages (90%) and the Zuum assessment (73%) to friends and family. The patient level of agreement with the Zuum risk labels was high across all diseases (80-92%). Conclusions: The Zuum intervention integrated well into the FQHC clinic setting and was highly accepted by the FQHC patients. This study advances the knowledge base on the feasibility of harnessing the power of mobile health to deliver effective, efficient, and personalized prevention messages to diverse and underserved patient populations. Findings suggest that the Zuum app, and other interventions like it, are tools that may help meet that need in settings where time and resources are limited. Citation Format: Graham Colditz, Sonya Izadi, Hank Dart, Erika Waters, Aimee James. Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C51.