Rifky Tkatch

Disclosure of Sexual Assault: Characteristics and Implications for Posttraumatic Stress Symptoms Among African American and Caucasian Survivors

Although the general trauma literature links disclosure of abuse to positive psychological and physical health outcomes, findings for sexual assault survivors are mixed. Supportive responses can reaffirm self-worth; however, negative responses can increase feelings of shame and isolation. This study examined the effects of disclosure in a community sample of Caucasian and African American sexual assault survivors who completed computer-assisted self-interviews. Among the 58.6% of survivors who had disclosed to someone (n = 136), 96% had disclosed to at least 1 informal and 24% at least 1 formal support provider. The experiences of African American and Caucasian survivors were similar in many ways. Participants received more positive than negative responses from others, although only negative responses were related to posttraumatic stress disorder symptoms, and particularly so for African American participants. Regretting disclosure and disclosure to formal providers were also related to posttraumatic stress disorder symptoms. Suggestions are made for programs to decrease negative responses to disclosure.

Development of a Question Prompt List as a Communication Intervention to Reduce Racial Disparities in Cancer Treatment

Racial disparities have been found in the use of chemotherapy as cancer treatment. These disparities may be, in part, due to well-documented differences in the quality of communication during clinical interactions with oncologists and Black versus White patients. In this study using a community-based participatory research approach, academic researchers, community members, and oncologists formed a partnership to develop a communication intervention to address racial disparities in cancer care. Partners developed a question prompt list (QPL), a simple tool that can be used to improve communication, and thus treatment, during clinical interactions in which oncologists and Black patients discuss chemotherapy. Partners endorsed the use of a QPL, provided specific suggestions for content and format, conducted and analyzed qualitative interviews with Black patients receiving chemotherapy, and approved the final version. The feasibility and effectiveness of the QPL that resulted from this research process are currently under evaluation in a separate study

Social network and health outcomes among African American cardiac rehabilitation patients.

OBJECTIVE We tested the hypotheses that the number of close social network members and the health-related support provided by social network members are predictive of coping efficacy and health behaviors. METHODS Cross-sectional data were collected from 115 African Americans enrolled in cardiac rehabilitation. Measures included the social convoy model, SF-36, the Social Interaction Questionnaire, the Patient Self-Efficacy Questionnaire, and an investigator-developed assessment of health behaviors. RESULTS Bivariate relationships were found between the number of inner network members and coping efficacy (r = .19, P < .05) and health behaviors (r = .18, P < .06), and between health-related support and coping efficacy (r = .22, P < .05) and health behaviors (r = .28, P < .001). Regression analyses support the hypothesis that close network members predicted better coping efficacy (β = .18, P < .05) and health behaviors (β = .19, P < .05). Health-related support also predicted coping efficacy (β = .23, P < .05) and health behaviors (β = .30, P < .01). CONCLUSION African Americans with larger inner networks have more health support, better health behaviors, and higher coping efficacy. The number of close social network members and related health-support promote health through health behaviors and coping efficacy.

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.

Barriers to Cancer Screening Among Orthodox Jewish Women

The increased risk of genetic cancer mutations for Ashkenazi Jews is well known. However, little is known about the cancer-related health behaviors of a subset of Ashkenazi Jews, Orthodox Jews, who are a very religious and insular group. This study partnered with Rabbinical leadership and community members in an Orthodox Jewish community to investigate barriers to cancer screening in this community. Orthodox Jewish women were recruited to participate in focus groups designed to elicit their perspectives on barriers to cancer screening. A total of five focus groups were conducted, consisting of 3–5 members per group, stratified by age and family history of cancer. Focus groups were audio recorded and transcribed. Transcripts were coded using conventional content analysis. The resulting themes identified as barriers to cancer screening were: preservation of hidden miracles, fate, cost, competing priorities, lack of culturally relevant programming, lack of information, and fear. These results provide a unique perspective on barriers to cancer screening in a high risk but understudied population. Findings from this study may serve to inform culturally appropriate cancer education programs to overcome barriers to screening in this and other similar communities.

Correlates of depression at baseline among African Americans enrolled in cardiac rehabilitation.

PURPOSE To compare baseline psychosocial characteristics of African Americans entering phase 2 cardiac rehabilitation who have depression symptoms at or above threshold (Center for Epidemiological Studies Depression Scale [CES-D] score ≥16) with those who do not (CES-D score <16). METHODS A nonrandom sample of 112 men and women (n = 78 without depression, n = 34 with depression) was recruited through local phase 2 cardiac rehabilitation programs. Data were obtained by a structured interview and brief physical examination using several reliable and valid instruments. Chi-square tests, Kruskal-Wallis 2-sample tests, Spearman rank correlation coefficients, and logistic regression models were used for analyses. RESULTS We found that 30% of the participants were above the depression symptom threshold. Demographic characteristics were not significantly different between individuals at or above threshold and those below threshold. However, depressed individuals above threshold were more likely to be dissatisfied with their neighborhoods (P = .01) and had lower optimism scores (P < .0001), higher stress scores (P < .0001), lower adaptive coping scores (P = .05), and higher problematic coping scores (P < .01) than their counterparts who were below threshold. In the logistic regression model, the odds of being above the depression symptom threshold increased with stress (P < .001) and decreased with optimism (P = .03); none of the other psychosocial characteristics had an independent effect on depression symptoms. CONCLUSIONS At baseline, African Americans starting phase 2 cardiac rehabilitation with depression symptoms at or above threshold had more stress and fewer stress resilience factors. Assessing depression and stress resilience factors is important and may lead to more active participation in cardiac rehabilitation once enrolled, as well as optimal cardiovascular health outcomes.

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.

Breast Cancer Incidence Rates Among Orthodox Jewish Women

BRCA 1/BRCA2 founder mutations have been documented among Ashkenazi Jews. Little is known about cancer rates and cancer-related health behaviors among an insular subset of this population, Orthodox Jews. The goal of this study was estimate the risk of breast and ovarian among the Orthodox Jewish population. We used geo-coding with surveillance, epidemiology, and end results (SEER) data to identify this subgroup and estimate breast and ovarian cancer rates. Relative to neighborhoods with lower estimated Jewish populations, higher breast cancer rates were found in neighborhoods with higher estimated Orthodox Jewish population, there were no comparable differences in ovarian cancer rates. Implications include more research on health behaviors that may contribute to breast cancer in this insular community.

Abstract A49: Correlates of race-related thoughts and feelings among black cancer patients

Background and Purpose: The purpose of this study was to examine the relationship between the race-related thoughts and feelings of black individuals with cancer and their perspectives on treatment-related issues. Research suggests that black patients9 race-related thoughts/feelings may contribute to racial disparities in cancer treatment, but there is a dearth of information on how these thoughts/feelings may affect patients9 perspectives on treatment and related issues. Further, the few studies that have examined these relationships have typically used one measure (e.g., perceived discrimination), implicitly assuming that other measures would show equivalent effects. This study addressed two questions: (a) whether black patients9 scores on three measures of race-related thoughts/feelings would be correlated; and (b) whether the three measures would show comparable patterns of association with patients9 socio-demographic characteristics, self-reported health, and perspectives on cancer treatment. Methods: Participants were self-identified black patients scheduled for initial consultations to discuss adjuvant or neo-adjuvant chemotherapy for breast, colon, or lung cancer at one of two cancer centers in Detroit, Michigan. After consenting to participate in the study, patients completed three measures of related, but conceptually distinct aspects of race-related thoughts and feelings: racial identity (i.e., the extent to which patients9 race is an integral part of their self-identity); group-based suspicion of medical care (i.e., the extent to which patients believe Blacks as a group should be suspicious of the healthcare they receive); and perceived past discrimination (i.e., the extent to which a patient has experienced discrimination in different settings). Patients also completed measures of socio-demographic characteristics, subjective health and well-being, and perspectives on treatment. Results: A total of 101 patients participated. They were predominantly older (mean age=59.94) women (90%) with breast cancer (81%). Regarding the first research question, findings showed the three measures were not significantly related to one another. Regarding the second question, the three measures showed different patterns of association with the other measures of interest. For example, whereas suspicion was significantly (p Conclusion: Findings suggest that these three measures may represent quite different constructs and are potentially related to different clinical consequences. Research and clinical interventions that address relationships between patients9 racial attitudes to improve medical outcomes should consider what aspect might be most relevant to the specific focus of the research. Citation Format: Susan Eggly, Louis A. Penner, Richard Gonzalez, Hayley Thompson, Rifky Tkatch, Robert Chapman, Terrance L. Albrecht. Correlates of race-related thoughts and feelings among black cancer patients. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A49.

Assessing cancer clinic visit time as a marker of quality care.

95 Background: The uses of patient time and clinic space in outpatient cancer clinics can be indicators of efficiency and quality of cancer care. Inefficient use of these can have deleterious effects on clinic flow, patient satisfaction, physician/staff morale, and treatment adherence. We tested a unique method of assessing patient time and clinic space in cancer clinics as a measure of cancer care quality. METHODS We video recorded patient occupancy in exam rooms in two outpatient cancer clinics (n = 53) using an IRB-approved, custom-designed unobtrusive recording system (Albrecht et al. 2005) and analyzed use of time. Coders assessed: Patient Occupancy Time (total time in the exam room; POT); Patient Wait Time (time spent in the exam room prior to seeing the oncologist; PWT); and Physician-Patient Interaction Time (PPIT). POT was compared with Scheduled Occupancy Time (from clinic records; SOT) to obtain measures of Discrepancy in Occupancy Time (difference in scheduled exam room time and actual time the patient spent in the exam room; DiOT). RESULTS Mean POT across both clinics was 82.0 minutes (SD = 36.2), mean PWT was 24.8 minutes (SD = 26.0), and mean PPIT was 31.4 (SD = 14.9) minutes. SOT was only available for Clinic A in which case mean DiOT was 42.6 minutes with a range of 3.5 to 146.5 minutes. Only three cases used the room for less time than originally scheduled. SOT was unrelated to POT, PWT, and PPIT. DiOT was unrelated to PPIT. CONCLUSIONS This method of objectively measuring cancer clinic time can help inform interventions to improve clinic efficiency. We found wait times were lengthy, suggesting an inefficient use of time and space. Importantly, there was no consistent relationship between scheduled and actual time spent in the exam room, reflecting an inefficient use of resources and potential inaccuracy in using scheduled time as a valid measure of quality. [Table: see text].