Victoria L. Champion

Effect of interventions on stage of mammography adoption

Mammography has been found significantly to impact mortality in women; however, compliance is still problematic. A theoretical model which combined Health Belief Model (HBM) constructs with stage of mammography adoption was used to investigate the effect of an individualized belief and/or informational intervention on mammography compliance. A control group and three intervention groups (belief, information, and belief and information) were used. A probability sample of 405 women ages 40–88 years without a prior history of breast cancer was randomly assigned to groups. Subjects in the intervention group received individually tailored messages to alter beliefs or provider information related to mammography screening. Women in the combined belief/information group were over two times more likely to have been compliant with mammography 1 year postintervention than those in the control. In addition, groups who received the belief intervention had significantly more women that went from a lower to a higher stage of mammography adoption.

Breast self-examination in women 35 and older: A prospective study

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to frequency and total performance (frequency and proficiency) of breast self-examination (BSE). The probability sample consisted of 362 women, ages 35 and over, who were initially contacted via random digit dialing. Data were collected during in-home interviews by trained graduate assistants and by telephone interview 1 year later. Results supported the ability of past performance, perceived barriers, and knowledge to predict current total performance (combined frequency and proficiency). In addition, frequency for breast self-examination was predicted by past frequency, barriers, health motivation, control, being taught by a doctor, confidence, having BSE procedure checked, benefits, and susceptibility. Results lend support to use of attitudinal and experiential variables in predicting womens actual behaviors in relation to breast self-examination.

Differences in health and cultural beliefs by stage of mammography screening adoption in African American women

Behavioral studies show that womens stage of readiness to adopt mammography screening affects their screening rates and that beliefs about breast cancer and screening affect stages of screening. The purposes of this study were to determine, first, the relationship between particular health and cultural beliefs and stage of mammography screening adoption in urban African American women, and second, whether demographic and experiential characteristics differed by stage. Data were analyzed from 344 low‐income African American women nonadherent to mammography screening who participated in a 21‐month trial to increase screening. At baseline, these women were randomized into 1 of 3 groups: tailored interactive computer instruction, targeted video, or usual care. Participants were categorized by stage of mammography screening adoption at 6 months as precontemplators (not planning to have a mammogram), contemplators (planning to have a mammogram), or actors (had received a mammogram). Although demographic and experiential variables did not differentiate stages of screening adoption at 6 months postintervention, some health and cultural beliefs were significantly different among groups. Actors were more preventive‐health–oriented than precontemplators and had fewer barriers to screening than did contemplators. Precontemplators had more barriers, less self‐efficacy, and greater discomfort with the mammography screening environment than did contemplators or actors. These results will be useful, not to change cultural beliefs, but to guide the design of health education messages appropriate to an individuals culture and health belief system. Cancer 2007.

Managing Symptoms Among Patients With Breast Cancer During Chemotherapy: Results of a Two-Arm Behavioral Trial

PURPOSE In this study, we compare symptom response and times to response among patients with breast cancer who were assigned to either a cognitive behavioral Nurse-Administered Symptom Management intervention or an Automated Telephone Symptom Management (ATSM) intervention. PATIENTS AND METHODS Patients with breast cancer were identified from a larger trial. Baseline equivalence existed between arms, and there was no differential attrition by arm. Anchor-based definition of response using mild, moderate, and severe categories of symptom severity were used. Responses and times to response for 15 symptoms were investigated in relation to trial arm, comorbid conditions, treatment protocols, and metastatic versus localized disease. RESULTS The ATSM arm was more effective among patents with metastatic disease. Compared with patients receiving combination chemotherapy protocols, those treated with single agents had greater response and shorter time to response. CONCLUSION An educational information intervention delivered via an automated voice response system that assesses symptoms and refers patients to a Symptom Management Guide is more effective than a complex cognitive behavioral approach in terms of producing greater symptom responses in shorter time intervals among patients with metastatic disease.

Barriers to recruiting urban African American women into research studies in community settings.

This qualitative study identified barriers to African American womens participation in a community-based behavioral intervention trial to increase mammography screening. Four themes emerged from focus group discussions with community agency providers and research team members. These themes were (1) going to the gatekeepers; (2) knowing the culture; (3) location is everything; and (4) protocols, policies, and possibilities. A checklist of actions that nurse researchers could consider to increase African American womens participation in community trials is provided.

Promoting colorectal cancer screening discussion: A randomized controlled trial

BACKGROUND Provider recommendation is a predictor of colorectal cancer (CRC) screening. PURPOSE To compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening. DESIGN Two-group RCT with data collected at baseline and 1 week post-intervention. SETTING/PARTICIPANTS African-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. INTERVENTION Participants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit. MAIN OUTCOME MEASURES Between-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. RESULTS Compared 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). CONCLUSIONS The 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. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00672828.

Analyzing Symptom Management Trials: The Value of Both Intention-to-Treat and Per-Protocol Approaches

PURPOSE/OBJECTIVES Two analytical approaches are described for a randomized trial testing interventions for symptom management. DESIGN To compare an intention-to-treat with a perprotocol approach. SETTING Patients were accrued from six cancer centers. SAMPLE 94 men and 140 women with solid tumors were accrued. METHODS An intention-to-treat approach (as randomized) and per-protocol analyses (at least one symptom reaching threshold and one follow-up intervention) were compared. The analysis determines how each approach affects results. A two-arm, six-contact, eight-week trial was implemented. In one arm, nurses followed a cognitive behavioral protocol. In the second arm, a non-nurse coach referred patients to a symptom management guide. MAIN RESEARCH VARIABLES Trial arm; summed severity scores; interference-based severity categories at intake, 10 weeks, and 16 weeks; site; and stage of cancer. FINDINGS Each arm produced a reduction in severity at 10 and 16 weeks with no differences between arms. In the per-protocol analyses, symptoms reported at the first contact required more time to resolve. Older patients exposed to the nurse arm resolved in fewer contacts. CONCLUSIONS The intention-to-treat analyses indicated that both arms were successful but offered few insights into how symptoms or patients influenced severity. Per-protocol analyses (intervention and dose), when, and which strategies affected symptoms. IMPLICATIONS FOR NURSING Each analytical strategy serves a purpose. Intention-to-treat defines the success of a trial. Per-protocol analyses allow nurses to pose clinical questions about response and dose of the intervention. Nurses should participate in analyses of interventions to understand the conditions where interventions are successful.

Development of a Measure of Skin Care Belief Scales for Persons With Spinal Cord Injury

OBJECTIVES To develop and validate a measure of skin care beliefs and to describe the skin care behaviors of persons with spinal cord injury (SCI). DESIGN A mixed-methods design was used to develop the Skin Care Beliefs Scales (SCBS). The health belief model framed the hypotheses. Phase 1 included item development, content validity testing, and pilot testing. Phase 2 included testing the scale structure (principal components analysis), internal consistency reliability, test-retest reliability, and relationships between the belief scales and care behaviors. SETTING Two acute rehabilitation hospitals and Internet websites. PARTICIPANTS Patients with SCI (N=462; qualitative/pilot n=56; psychometric study n=406) participated. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The pilot and phase 2 studies, respectively, used 146-item and 114-item versions of the SCBS. A skin care activity log was used to record skin care behaviors. RESULTS Content validity indicated that the items were relevant and clear. The analysis resulted in 11 independent scales reflecting 3 general beliefs (susceptibility, severity, self-efficacy) and barrier and benefit behavior-specific scales for skin checks, wheelchair pressure reliefs, and turning and sitting times. With the exception of skin check barriers (α=.65), Cronbach alphas of the scale ranged from .74 to .94. Test-retest intraclass correlations were fair to excellent (range, .42-.75). Construct validity was supported. Hierarchical linear regression indicated that turning benefits, barriers, susceptibility, and self-efficacy were significant predictors of turning time. Benefits or barriers were correlated significantly with skin check and pressure relief adherence (ρ range, -.17 to -.33). Self-efficacy was correlated with wheelchair pressure relief (ρ=.18). Skin care behavior adherence varied widely (eg, 0%-100%). CONCLUSIONS The scales showed acceptable reliability and validity. Further testing with larger samples is desirable.

Spirituality, emotional distress, and post-traumatic growth in breast cancer survivors and their partners: an actor-partner interdependence modeling approach.

The association between spirituality and emotional health has been well documented in healthy individuals. A small literature has shown that spirituality plays a role in well‐being for some breast cancer (BC) survivors; however, this link is virtually unexplored in partners/spouses of survivors. The current study aimed to assess the relationship between spirituality, emotional distress, and post‐traumatic growth for BC survivors and their partners using a dyadic analyses approach.

Associations of metabolic syndrome and C-reactive protein with mortality from total cancer, obesity-linked cancers and breast cancer among women in NHANES III

Although metabolic syndrome (MetS) is a prognostic factor for cancer occurrence, the association of MetS and cancer mortality remains unclear. The purpose of this study was to evaluate whether MetS, components of MetS and C‐reactive protein (CRP) are associated with cancer mortality in women. A total of 400 cancer deaths, with 140 deaths from obesity‐linked‐cancers (OLCas), [breast (BCa), colorectal, pancreatic and endometrial], linked through the National Death Index, were identified from 10,104 eligible subjects aged ≥18 years. Cox proportional hazards regression was used to estimate multivariable‐adjusted hazard ratios (HR) for cancer mortality. MetS was associated with increased deaths for total cancer [HR = 1.33, 95% confidence interval (CI) 1.04–1.70] and BCa [HR = 2.1, 95% CI, 1.09–4.11]. The risk of total cancer [HR = 1.7, 95% CI, 1.12–2.68], OLCas [HR = 2.1, 95% CI, 1.00–4.37] and BCa [HR = 3.8, 95% CI, 1.34–10.91] mortality was highest for women with all MetS components abnormal, compared to those without MetS. Linear associations of blood‐pressure [HR = 2.5, 1.02–6.12, Quartile (Q) 4 vs Q1, p trend = 0.004] and blood‐glucose [HR = 2.2, 1.04–4.60, Q4 vs. Q1, p trend = 0.04] with total‐OLCas mortality were observed. A threefold increased risk of BCa mortality was observed for women with enlarged waist circumference, ≥100.9 cm, [HR = 3.5, 1.14–10.51, p trend = 0.008] and in those with increased blood glucose, ≥101 mg/dL, [HR = 3.2, 1.11–9.20, p trend = 0.03] compared to those in Q1. None of the components of MetS were associated with total‐cancer mortality. CRP was not associated with cancer mortality. In conclusion, MetS is associated with total‐cancer and breast‐cancer mortality, with waist circumference, blood pressure and blood glucose as independent predictors of OLCas and BCa mortality.