Lauren M. Hamel

Computer- and web-based interventions to increase preadolescent and adolescent physical activity: A systematic review

AIM This review examined evidence regarding computer- or web-based interventions to increase preadolescent and adolescent physical activity. BACKGROUND Todays youth are less active and more overweight than their counterparts from 25 years ago. Overweight youth tend to become overweight adults with weight-related maladies, including type 2 diabetes and cardiovascular problems. Interventions to increase physical activity that reach a large audience are needed. Computer- and web-based physical activity interventions are an appealing means to influence physical activity in preadolescents and adolescents. However, their effectiveness must be determined. DATA SOURCES The following electronic databases were searched for studies published from 1998 through 2010: CINAHL, PubMed, PsycINFO, Sociological Abstracts, SportDISCUS and Proquest. REVIEW METHODS A systemic review was conducted. Fourteen randomized control trials or quasi-experimental studies were reviewed to: (1) determine the effect of computer- or web-based interventions on increasing physical activity and/or improving body mass index, weight, percent body fat or waist circumference as a result of increasing physical activity; and (2) examine if additional components associated with these interventions increased success. RESULTS   Although most interventions demonstrated statistically significant increases in physical activity or positive health changes related to physical activity, findings were small or short-lived. The value of conducting the interventions at school, using a theory or model as a framework, and supplementing with individual tailoring and parental involvement, is discussed. CONCLUSION Computer- and web-based interventions can promote physical activity among preadolescents and adolescents, particularly in schools. However, further efforts are needed to sustain positive changes.

Action tendency emotions evoked by memorable breast cancer messages and their association with prevention and detection behaviors

Memorable messages about breast cancer sent by different sources, such as friends and family members, were analyzed for the action tendency emotions that they evoked. Negative emotions of fear, sadness, and anger, and positive emotions of hope and relief were analyzed for their associations with prevention and detection breast cancer behaviors. Messages that evoked fear were significantly more likely to be associated with detection behaviors, whereas messages that evoked relief were significantly less likely to be associated with detection behaviors than messages that did not evoke these emotions. These results are consistent with control theory and also show that friends and family are important sources of memorable messages about breast cancer.

Barriers to clinical trial enrollment in racial and ethnic minority patients with cancer

BACKGROUND Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. METHODS Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. RESULTS Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. CONCLUSION To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.

Critical Shortage of African American Medical Oncologists in the United States

Lauren M. Hamel, Karmanos Cancer Institute/Wayne State University, Detroit, MI Robert Chapman, Josephine Ford Cancer Institute/Henry Ford Health System, Detroit, MI Mary Malloy, Michigan Society of Hematology and Oncology, Detroit, MI Susan Eggly, Louis A. Penner, Anthony F. Shields, Michael S. Simon, Justin F. Klamerus, Charles Schiffer, and Terrence L. Albrecht, Karmanos Cancer Institute/Wayne State University, Detroit, MI

Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

OBJECTIVE Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. METHODS Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. RESULTS The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. CONCLUSION This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. PRACTICE IMPLICATIONS This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists’ language

The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information.

Shared Goal Setting in Team-Based Geriatric Oncology

We present the case of a 92-year-old man, MH, who was given a diagnosis of colorectal cancer. His primary care physician, surgeon, geriatric oncologist, and family members all played important roles in his care. MHs case is an example of a lack of explicit shared goal setting by the health care providers with the patient and family members and how that impeded care planning and health. This case demonstrates the importance of explicitly discussing and establishing shared goals in team-based cancer care delivery early on and throughout the care process, especially for older adults. Each individual members goals should be understood as they fit within the overarching shared team goals. We emphasize that shared goal setting and alignment of individual goals is a dynamic process that must occur several times at critical decision points throughout a patients care continuum. Providers and researchers can use this illustrative case to consider their own work and contemplate how shared goal setting can improve patient-centered care and health outcomes in various team-based care settings. Shared goal setting among team members has been demonstrated to improve outcomes in other contexts. However, we stress, that little investigation into the impact of shared goal setting on team-based cancer care delivery has been conducted. We list immediate research goals within team-based cancer care delivery that can provide a foundation for the understanding of the process and outcomes of shared goal setting.

Measuring the use of examination room time in oncology clinics: A novel approach to assessing clinic efficiency and patient flow

PURPOSE The use of time in outpatient cancer clinics is a marker of quality and efficiency. Inefficiencies such as excessive patient wait times can have deleterious effects on clinic flow, functioning, and patient satisfaction. We propose a novel method of objectively measuring patient time in cancer clinic examination rooms and evaluating its impact on overall system efficiency. METHODS We video-recorded patient visits (N = 55) taken from a larger study to determine patient occupancy and flow in and out of examination rooms in a busy urban clinic in a National Cancer Institute-designated comprehensive cancer center. Coders observed video recordings and assessed patient occupancy time, patient wait time, and physician-patient interaction time. Patient occupancy time was compared with scheduled occupancy time to determine discrepancy in occupancy time. Descriptive and correlational analyses were conducted. RESULTS Mean patient occupancy time was 94.8 minutes (SD = 36.6), mean wait time was 34.9 minutes (SD = 28.8), and mean patient-physician interaction time was 29.0 minutes (SD = 13.5). Mean discrepancy in occupancy time was 40.3 minutes (range, 0.75 to 146.5 minutes). We found no correlation between scheduled occupancy time and patient occupancy time, patient-physician interaction time, and patient wait time, or between discrepancy in occupancy time and patient-physician interaction time. CONCLUSION The method is useful for assessing clinic efficiency and patient flow. There was no relationship between scheduled and actual time patients spend in exam rooms. Such data can be used in the design of interventions that reduce patient wait times, increase efficient use of resources, and improve scheduling patterns.

Abstract A13: Randomized trial of a Question Prompt List to increase patient active participation during racially discordant oncology interactions

Purpose: Communication during racially discordant oncology interactions (i.e., Black patient, non-Black physician) is often of poorer quality than during similar interactions with White patients, and may contribute to racial disparities in cancer treatment. Question Prompt Lists (QPL) have been shown to increase patient active participation in clinical interactions and to influence related outcomes, but have never been tested in racially discordant oncology interactions. This study evaluated the acceptability and effectiveness of a QPL designed to increase patient active participation and related outcomes during clinical interactions in which Black patients discussed medical treatment for breast, colon, or lung cancer with non-Black oncologists. Participants and Methods: Eighteen non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, MI completed baseline measures. Patients were then randomly assigned to one of three arms: 1) usual care; 2) receiving a QPL specifically designed for this study in the form of a booklet (QPL-only); 3) receiving the QPL booklet plus the assistance of a communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Trained observers assessed patient active participation using two measures: a frequency count of active participation communication behaviors (i.e., questions, assertions, and statements of concern) and a global rating scale of seven items indicating active participation (e.g., “The patient asked the doctor a lot of questions”). Observers also rated oncologist patient-centered communication using a 14-item global scale with three subscales (i.e., informativeness, supportiveness, relationship-building). Following interactions, patients rated oncologist patient-centeredness; shared decision-making; trust in their oncologist; and difficulty understanding and remembering what was discussed during the conversation with their oncologist. Intervention arm patients also used a 3-point scale to provide their perceptions of the intervention. Analyses included multi-level regression models, with patients nested within oncologists. Results: Patients in both intervention arms viewed the QPL booklet favorably (M=2.80; SD=.23). Patients in the QPL-plus-Coach arm also viewed the coaching favorably (M=2.83; SD=.29). Interaction length did not significantly differ across arms. Patients in the QPL-only arm participated more actively than patients in the usual care or QPL-plus-coach arm (frequency count: p=.02; global scale p=.06). The intervention had no significant effect on other outcomes. Conclusion: Findings suggest a QPL in the form of a booklet may be an acceptable and effective intervention to increase active participation in oncology interactions among Black patients. Future research should investigate whether the addition of a physician-focused intervention might produce additional benefits, such as better oncologist communication and increased patient trust. Research examining the influence of patient and oncologist characteristics, including race-related attitudes, on patient active participation and related outcomes in racially discordant oncology interactions may inform future interventions to improve the quality of communication and care for Black patients with cancer. Citation Format: Susan Eggly, Lauren Hamel, Terrance L. Albrecht, Tanina Foster, Robert Chapman, Louis A. Penner. Randomized trial of a Question Prompt List to increase patient active participation during racially discordant oncology interactions. [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 A13.

Partnering around cancer clinical trials (PACCT): study protocol for a randomized trial of a patient and physician communication intervention to increase minority accrual to prostate cancer clinical trials

BackgroundCancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients’ decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial.Methods/designData collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients’ understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes.DiscussionPACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers.Trial registrationClinical Trials.gov registration number: NCT02906241 (September 8, 2016).