Susan M. Rawl

Promoting colorectal cancer screening discussion: A randomized controlled trial

BACKGROUNDnProvider recommendation is a predictor of colorectal cancer (CRC) screening.nnnPURPOSEnTo compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening.nnnDESIGNnTwo-group RCT with data collected at baseline and 1 week post-intervention.nnnSETTING/PARTICIPANTSnAfrican-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics.nnnINTERVENTIONnParticipants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit.nnnMAIN OUTCOME MEASURESnBetween-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012.nnnRESULTSnCompared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05).nnnCONCLUSIONSnThe computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient-provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP.nnnTRIAL REGISTRATIONnThis study is registered at www.clinicaltrials.gov NCT00672828.

Integrating men's health and masculinity theories to explain colorectal cancer screening behavior.

Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men’s CRC screening behavior that integrates masculinity norms, gender role conflict, men’s health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men’s CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors.

Cancer-Related Pain and Disability: A Longitudinal Study

CONTEXTnAlthough the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied.nnnOBJECTIVESnData from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months.nnnMETHODSnA total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression.nnnRESULTSnBaseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b=-0.17, t=-5.33, P<0.001) and ≥14 disability days in the past month (odds ratio=0.85; 95% confidence interval, 0.79-0.93; P<0.001).nnnCONCLUSIONnDisability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.

End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness

OBJECTIVEnThe study objective was to examine factors that influence African American (AA) family members end-of-life care decision outcomes for a relative who recently died from serious illness.nnnMETHODSnA cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales.nnnRESULTSnFamily members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict.nnnCONCLUSIONSnThis research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.

Writing a Competitive Individual National Research Service Award (F31) Application

The National Institutes of Health (NIH) are committed to increasing the number of PhD-prepared persons to meet the demand for well-trained behavioral, biological, and biobehavioral scientists. The Ruth L. Kirschstein National Research Service Award (NRSA) individual Predoctoral Fellowship (F31) program provides financial support for full-time PhD students who are committed to research careers in scientific health-related fields relevant to the NIH. This article provides guidance for PhD nursing students who are preparing an individual NRSA application with emphasis on those being submitted to the National Institute of Nursing Research. The advantages of receiving this award are described along with the steps to complete the application. After careful self- and environmental assessments, the task of writing begins in close collaboration with research mentors. Essential components of NRSA applications are described along with strategies for making applications competitive and, ultimately, successful.