Wesley O. Petersen

Centering prayer for women receiving chemotherapy for recurrent ovarian cancer: a pilot study.

PURPOSE/OBJECTIVES To explore the feasibility of implementing centering prayer in chemotherapy treatment and assess its influence on mood, spiritual well-being, and quality of life in women with recurrent ovarian cancer. DESIGN Descriptive pilot study. SETTING Outpatient chemotherapy treatment suite in a large cancer center in the midwestern United States. SAMPLE A convenience sample of 10 women receiving outpatient chemotherapy for recurrent ovarian cancer. METHODS A centering prayer teacher led participants through three one-hour sessions over nine weeks. Data were collected prior to the first session, at the conclusion of the final session, and at three and six months after the final session. MAIN RESEARCH VARIABLES Feasibility and influence of centering prayer on mood, spiritual well-being, and quality of life. FINDINGS Most participants identified centering prayer as beneficial. Emotional well-being, anxiety, depression, and faith scores showed improvement. CONCLUSIONS Centering prayer can potentially benefit women with recurrent ovarian cancer. Additional research is needed to assess its feasibility and effectiveness. IMPLICATIONS FOR NURSING Nurses may promote or suggest centering prayer as a feasible intervention for the psychological and spiritual adjustment of patients with recurrent ovarian cancer.

Evaluation of a program to train nurses to screen for breast and cervical cancer among native American women

BACKGROUND Routine screening for breast and cervical cancers lowers mortality from these diseases, but the benefit has not permeated to Native American women, for whom the five-year survival rate is the lowest of any population group in the United States. To help address this problem, an educational/training program was designed to enhance the skills of nurses and other health service providers and develop clinic support systems to better recruit, screen, and follow clients for breast and cervical cancer screening services. METHODS A total of 131 nurses participated in the training program at 33 different sites between 1995 and 2000. Prior to and following training, each participant was given a questionnaire to determine knowledge of breast and cervical cancer screening techniques and recommendations, cancer survival and risk factors, and situational scenarios. RESULTS The average score for the pretest was 54% correct. The posttest average was 89% correct. The percent correct increased 35% from pre- to posttest (p < 0.001). CONCLUSION The knowledge to implement a successful screening program can be acquired through the current curriculum.

Outcomes of Training Nurses To Conduct Breast and Cervical Cancer Screening of Native American Women

Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) womens need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEBs impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels.

Erratum to: Development and Pilot Evaluation of a Cancer-Focused Summer Research Education Program for Navajo Undergraduate Students

This paper describes the development and pilot testing of a 10-week cancer research education program for Navajo undergraduate students. The program was piloted at Diné College with 22 undergraduates (7 men, 15 women) in 2007 and 2008. Students completed a pre–post program survey assessing attitudes, opinions, and knowledge about research and about cancer. The program was found to be culturally acceptable and resulted in statistically significant changes in some of the attitudes and opinions about research and cancer. Combining all 13 knowledge items, there was a significant (p = 0.002) change in the mean total correct percent from baseline [70.3 (SD = 15.9)] to post-program [82.1 (SD = 13.1)]. The curriculum was adapted for a new cancer prevention and control course now offered at Diné College, enhancing sustainability. Ultimately, these efforts may serve to build capacity in communities by developing a cadre of future Native American scientists to develop and implement cancer research.

Assessing follow-up care after prostate-specific antigen elevation in American Indian / Alaska native men: A partnership approach

Background: Although many studies conducted among American Indian and Alaska Native (AI/AN) populations may help to advance medical science and lead to improvements in health and health care, historically few have endeavored to share their findings, benefits, and/or expected outcomes with the communities in which they are conducted. This perceived lack of responsiveness has contributed to a perception in some AI/AN communities that researchers are disrespectful and may not make community needs a priority.Objectives: In the context of a study assessing the care received by AI/AN men with incident elevated prostate-specific antigen (PSA) levels, this paper describes our experience building collaborative relationships, planning, conducting analyses, and disseminating findings with four AI/AN communities.Methods: We established formal partnerships with three Northern Plains AI communities and one AN tribal health organization, convened a 12-member Community Advisory Board (CAB), and obtained study approvals from all necessary tribal and institutional review bodies before implementing our study. A menu of options for study implementation was given to key collaborators at each site. CAB members and collaborating tribes contributed to each phase of the study. After data analysis, results were shared with tribal and institutional leaders.Lessons Learned: Face-to-face communication, flexibility, and adaptability, as well as clearly defined, respectful roles contributed to the success of the study on the part of both the researchers and community partners.Conclusions: This study demonstrates the importance and feasibility of forging collaborative relationships with AI/AN community leaders in regions of Alaska and the Northern Plains in cancer control initiatives for AI/AN men.

Abstract C86: Launch of an intervention to improve mammographic screening adherence in women of one Bemidji Area tribe: The “No squeeze can defeat me: Mammograms for life!” project

Purpose: To increase women9s adherence with one tribe9s mammographic screening guidelines. This tribe recommends annual mammograms beginning at age 40. Currently, adherence stands at 36%. Our previous work identified a demographic feature and variables within four theoretical models of health behavior that significantly differentiated nonadherent women from adherent women. In “No Squeeze Can Defeat Me: Mammograms for Life!” (No Squeeze) we are developing a messaging menu (e.g., posters, pamphlets, videos, digital stories, articles, and letters) that is guided by the differentiating variables and features. The program also is developing a supplement to an existing intake form for women to complete before they see their providers for annual Well Woman exams. The supplement intake form will help providers tailor face-to-face messages to encourage screening of known nonscreeners, known nonadherent screeners, and women approaching screening age. Procedures: This program works through a Community Advisory Project Board (CAPB) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. The CAPB members take the lead on all aspects of messaging and intake form design. In their role, they have designed a logo, determined wording and design of posters; identified locations for messaging; recruited community women for video interviews and use of their images on materials; determined incentive amounts; and delegated tasks to a project implementation team (PIT) made of tribal and IHS staff. PIT members9 responsibilities include posting new messages every six to eight weeks, obtaining feedback on messaging and intake forms, implementing the intake form, and organizing video interviews and photographic sessions. At this time, effort is being devoted to poster development, placement, and a refreshment schedule and to final design of intake forms. Evaluation of progress on this project involves collection and analysis of community women9s surveys related to messaging and intake forms, CAPB feedback on messaging, documentation of poster placements and refresh dates, and tracking changes in screening participation. First-year analysis covers a seven-month period ending on June 30, 2017. Data Summary: Early analysis shows that: 1) community women find poster messaging generally interesting, appealing, important, and mostly persuasive. They prefer images of community women and favor fewer words in most messages. 2) The intake form supplement is easy to answer (little time to complete), appropriate as an addition to the existing Well Woman intake questions, and noninvasive. The questions were considered reasonable and women held mixed opinions regarding whether the form should be self-administered or filled in during an interview by a nurse. The CAPB assessments of messaging showed 19 of 78 posters were recommended for some revision and 10 posters were not liked at all. In general, wording was not offensive and more than half of the posters conveyed the central message in the fewest words possible. Half of the posters were rated visually attractive. As of the first poster placement period, 5 posters have been placed in two of three targeted communities and in 38 individual locations, including clinic/hospitals, post office and grocery store bulletin boards, an exercise facility, and in one casino. Between January 2017 and April 2017, radiology reported a 19% increase in screening. Conclusions: While these data are from the early period of implementation, results show that developing messages and intake forms focused on influential variables derived from demographic and theoretical models of health behavior are generally well received by the community and with continued refinement could result in sustained increases in screening. At this point we cannot discern whether documented increases are from the existing population of nonadherent screeners. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Robert A. Vierkant. Launch of an intervention to improve mammographic screening adherence in women of one Bemidji Area tribe: The “No squeeze can defeat me: Mammograms for life!” project [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C86.

Abstract B83: Elements of theoretical models of health behavior: Planning for breast cancer screening interventions in an American Indian tribe

Purpose: To identify within demographic features and theoretical models of health behavior, the variables demonstrating differences in the behaviors, beliefs, attitudes, associations, and capacities of sporadic (non-adherent) and persistent (adherent) mammographic screeners for the purpose of guiding future interventions to improve mammographic screening adherence. Procedures: A survey was designed and mailed to all screening-age women of one Bemidji Area tribe. The survey incorporated demographic questions, and questions designed to inform about salient features of respondents9 health literacy, social networks, social support, social norms, planned behavior, and health beliefs. Prior to mailing, each survey was assigned a unique identifier and sealed in an envelope. Surveys were mailed to 1,554 women in manner that ensured anonymity of the women9s responses and no potential for investigators to discern women9s identity via their mailing addresses or other information. Self-report data from returned surveys was used to determine women9s mammographic screening status as adherent with local screening guidelines (annual mammogram beginning at age 40 for women at average risk) or non-adherent. Responses for all demographic and theoretical models of health behavior were appropriately categorized and analyzed utilizing global tests of hypotheses. Inherent multicollinearity issues required a two-step process of factor analysis followed by a multivariate analysis of variance. Where themes (e.g., demographics, health literacy, etc.) and factors within themes were significant, a univariate analysis was conducted to ascertain specific questions and responses that significantly differentiated the non-adherent from adherent screeners. Summary of data: We found no significant differences in non-adherent and adherent screeners9 responses to questions related to social networks or social norms. We did find that responses from these two groups did differ on demographic features as well as on aspects of health literacy, social support, planned behavior and health beliefs. o Demographic differences involved biopsy histories and employment status. o Differentiating health literacy variables involved recognition of certain terms (e.g., annual) and understanding concepts such as ultrasound and biopsy. o Social support variables that distinguished non-adherent from adherent screeners involved sources of information support, characteristics of providers of emotional support, and sources of emotional support (e.g., solitary or communal). o Planned behavior variables illuminating differences between the screening groups involved (in additions to self-reported screening behaviors): attitudes toward the behavior of obtaining mammograms, intentions to engage in screening, and control beliefs . o Health Beliefs variables distinguishing the two sets of screeners comprised responses to questions about perceived barriers, self-efficacy , and cues to action. Conclusions: Study findings point to opportunities for tribal health and Indian Health Service (IHS) providers and staff to intervene in two broad areas. 1. Some findings associated with social support, planned behavior, and health beliefs can be used to design patient intake forms to alert tribal health and IHS providers to current and potentially non-adherent. 2. Using this information, providers can design interventions to move non-adherent and potentially non-adherent women toward persistent mammographic screening participation. An intervention study will be funded by the Minnesota Department of Health through its Eliminating Health Disparities Initiative. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Robert A. Vierkant, Corinna Sabaque. Elements of theoretical models of health behavior: Planning for breast cancer screening interventions in an American Indian tribe. [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 B83.

Abstract B98: Do demographic characteristics and theoretical mediators of health behavior differentiate American Indian adherent mammographic screeners from non-adherent screeners?

Purpose: American Indian (AI) women have lower rates of cancer, but later stages of diagnosis and higher mortality than the US general population. We hypothesized that mediators found within different theoretical models of health behavior differentiate women who adhere to mammographic screening guidelines from those who do not. Such mediators may be useful in the design of interventions to increase adherence. Experimental Procedures: As a community-based participatory research project, tribal health, Indian Health Service representatives, and community representatives worked with the Mayo Clinic team to design a survey derived from 53 interviews with documented adherent and non-adherent women from one Bemidji Area tribe. The survey explored demographic characteristics and six theoretical mediators: Health Literacy, Social Networks, Planned Behavior, Social Norms, Social Support, and Health Beliefs. The survey was mailed to 1200 women with the goal of obtaining 600 responses. Women completing the survey were provided a modest gift card through an impartial third party who not know their names or responses. Responses were analyzed using Fisher9s Exact Test or the Chi-square test where appropriate. Summary of Data: To date, we have achieved a 30% response rate (91 self-described non-adherent and 91 self-described adherent breast cancer screening (mammography) respondents). Mediators from the six theoretical models and demographic features do differentiate AI adherent and non-adherent screeners and may be useful for developing interventions to expand screening adherence. Among significant differences were the following with which adherence associates: (1) Demographic (≤0.01): being married, full-time employed, living at greater distances from health care facility, surgical menopause, and having had a breast biopsy. (2) Health Literacy (≤ 0.001): accurate conceptual understanding of annual mammogram, ultrasound, and family history as a risk factor. (To accommodate the survey format, we replaced the usual measures of health literacy (Short Test of Functional Health Literacy and Rapid Estimate of Adult Literacy in Medicine) for understanding of basic breast screening and breast cancer concepts.) (3) Social Networks (≤ 0.03): having mothers who have encouraged good health. (4) Planned Behavior (≤ 0.001): behavioral beliefs, and intentions. a.) Behavioral Beliefs : looking forward to getting my mammogram; getting my scheduled mammogram rather than accepting an invitation to be with friends; viewing my mammogram as very important. b) Intentions: expecting to screen in each of the next five years, and getting my next mammogram when it is scheduled. (5) Social Norms (≤ 0.001): role of family as a positive influence on my life. (6) Social Support (≤ 0.001): availability of family to comfort one in times of worry. (7) Health Beliefs (≤ 0.001): discounting physical limitations and exam discomfort as justifications for avoiding screening and believing there are no justifications for avoiding mammogram; knowing: how to prepare for a mammogram, what happens during the mammogram process, knowing a mammograms importance, knowing what to do if one feels something unusual in the breast, and knowing someone who has been diagnosed with breast cancer. Conclusions: No single theoretical model appears to differentiate adherent from non-adherent screeners, but mediators associated with each of the various models do differentiate these screeners. These differentiating mediators should be considered for how they might guide development of interventions to improve screening behavior. The self-report nature of the survey demands that results be considered as tentative and limited, in any case, to the respondents of this tribe. Citation Format: Wesley O. Petersen, Ann M. Nicometo, Corinna Sabaque. Do demographic characteristics and theoretical mediators of health behavior differentiate American Indian adherent mammographic screeners from non-adherent screeners? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B98.

Abstract B73: Do generational cohort differences in social networks influence persistent and sporadic screeners' perceptions of breast cancer screening?

Purpose: Low breast cancer screening participation and adherence to guidelines is problematic. Our prior work found that on average 18% of women from four tribes adhered to Indian Health Service (IHS) mammographic screening guidelines over five years (study funded by Native American Research Centers for Health (NARCH IV). We sought to identify how adherent (persistent) and non-adherent (sporadic) screeners may differ by demographic and theoretical mediators that have successfully guided interventions in other health disparities populations. As part of planning interventions to increase AI/AN women9s persistent screening, we characterized differences in persistent and sporadic screeners9 responses to Social Norms and Health Beliefs in the context of social networks. Methods: From 2013-2014, we interviewed 55 recruited women (41 sporadic screeners and 14 persistent screeners) who had been randomly assigned unique identifiers. Data from interviews included demographic characteristics, assessments of health literacy, and social relationships from theoretical perspectives of: Theory of Planned Behavior, Social Support, Social Norms, Health Beliefs, and Social Networks. In this study, we examined areas that distinguished persistent from sporadic screeners—social norms and health beliefs--and we conceptualized the make-up of screeners9 social networks to consider members by their generational status relative to the screener. We coded and categorized data; Fisher9s Exact Test and Kruskal-Wallis Test were applied as appropriate. Results: We identified three mediators with four significant differences. 1. Social Norms: (A) Persistent screeners were significantly more likely to believe reservation women favored getting an annual mammogram while sporadic screeners were more likely to believe women were against getting annual mammograms (P = 0.03). Responses are consistent with Social Norms theory, but screeners9 beliefs about friends9 screening participation appear less consistent with the theory. (B) Persistent screeners by a large proportion believed friends obtained fewer mammograms than themselves while sporadic screeners had no prevailing view (P = 0.02). 2. Health Beliefs (susceptibility to breast cancer): (C) While sporadic screeners expressed considerable uncertainty about their susceptibility, persistent screeners expressed no uncertainty (P = 0.02). 3. Social Networks: (D) Examination of the generational membership of screeners9 Social Networks showed that sporadic screeners9 networks had significantly more members from generations younger than themselves compared to persistent screeners9 networks ( P = 0.01). Conclusions: Screeners with younger social networks may in part be influenced to be sporadic screeners because they do not benefit from exposure to more mature and experienced individuals in their social networks. The excess of younger generation members in sporadic screeners9 networks may expose them generally to people who do not screen (or have limited screening experience) due to age. This exposure would confirm for them that reservation women generally do not favor screening and would explain their mixed view of friends9 screening behavior. The younger membership of sporadic screeners9 networks also may explain why this group would express substantial uncertainty about their own susceptibility to breast cancer relative to other women. If the network is not of an age where breast cancer and screening are pertinent topics, screeners may not have a knowledgebase (accurate or not) from which to build their views. We anticipate further testing to ascertain the role of social networks in the views and behaviors of sporadic and persistent screeners before considering any interventions. Citation Format: Corinna Sabaque, Ann M. Nicometo, Robert Vierkant, Wesley O. Petersen. Do generational cohort differences in social networks influence persistent and sporadic screeners9 perceptions of breast cancer screening? [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 B73.

Abstract B91: Advancing toward interventions: Summary of two projects and a proposed intervention to improve mammography participation in Bemidji area native women

Purpose: The ultimate purpose of these studies and the proposed study is to use community-based interventions to increase overall use of mammographic services and to increase adherence with tribes9 screening guidelines. Our immediate purposes by study: For Study 1, the purpose was to understand the risk and screening adherence profiles of women from four Bemidji Area tribes; for Study 2, the purpose was to ascertain whether non-adherent screeners and adherent screeners could be differentiated on any of six theoretical mediators of health behavior; in the proposed Study 3, the purpose is to use theoretical mediators that distinguish adherent and non-adherent screeners to design and test interventions to increase screening participation and adherence with tribes9 screening guidelines. Experimental Procedures: All studies were designed to reflect principles of community-based participatory research. Study 1 was a chart review study that involved four tribes. Each tribe desired different levels of involvement that ranged from close control of all elements of the chart review to assigning the investigators to do the retrieval, review, and replacement of the medical records, and all elements of the analysis. All tribes managed the unique identifiers book which was a list of all women who were 40 years and older who had no prior history of breast cancer. Investigators retained only the unique identifiers and each individual9s associated screening history and risk factors. Tribes received aggregated results from the study, but did not receive information on individual women9s screening adherence or risk factors. Study 2, is guided by a community advisory committee that meets quarterly and involves one tribe. The study employs one tribal member and one tribal subcontractor, and has supported one student participant. The study team interviewed 55 women and used the results to develop a survey that is being administered to approximately 1400 women who are age 40 and older. Both the interviews and the survey are designed to examine the influence of six theoretical mediators (social norms, social networks, social support, health literacy, health beliefs, and theory of planned behavior) and demographic features on the behaviors of adherent and non-adherent mammographic screeners. Study 3 will involve four tribes and is designed to use the findings from Study 2 to develop and test interventions based on influential screening mediators. Each tribe has identified members who will serve on tribal research and advising units that will determine the specific interventions and receive training and mentoring to design and administer the interventions. The proposed interventions will be based on a case-control intervention design. Unpublished Data to Date: STUDY 1 showed that there were few significant differences (p = 0.05) based between adherent and non-adherent screeners based on risk factors. STUDY 2 interview results have shown some significant differences (p= 0.05) between adherent and non-adherent screeners related to self-efficacy (health beliefs model), perceived community support for annual mammograms (social norms), presence of 3rd degree relatives in social networks. There were no significant differences associated with health literacy, social support, and the theory of planned behavior. Conclusions: Findings in Study 2 show that potential differences between adherent and non-adherent screeners justify continuation to the survey phase. Should results of the survey demonstrate significant differences in the influential mediators of adherent compared to non-adherent screeners, follow-up with the intervention study (Study 3) will be an important next step. Citation Format: Wesley Petersen, Ann Nicometo, Robert Vierkant. Advancing toward interventions: Summary of two projects and a proposed intervention to improve mammography participation in Bemidji area native women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B91. doi:10.1158/1538-7755.DISP13-B91