Yan Tong

Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors.

Cancer‐related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence‐based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) for CRF and related symptoms.

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.

Predictors of stage of adoption for colorectal cancer screening among African American primary care patients.

Background: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. Objective: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. Methods: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. Results: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. Conclusions: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. Implications for Practice: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.

Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress

Introduction: Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians’ in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients’ EOL care preferences. Methods: One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression. Results: Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support. Conclusions: Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents’ supportiveness. The interaction between optimism and IRM suggests residents’ beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.

Abstract B65: Colorectal cancer screening in nonadherent black Americans

Background: Compared with other racial groups, Black Americans have higher incidence and mortality from colorectal cancer (CRC) and lower screening rates. Theory-based tailored interventions to increase screening are more likely to be successful, especially those tailoring on stage of adoption. The purpose of our study was to examine predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy screening among non-adherent Black Americans. Methods: We analyzed baseline data from 817 Black primary care patients enrolled in a randomized clinical trial. Participants were categorized into precontemplation, contemplation, or preparation groups. Predictor variables examined included: demographics (age, gender, education, employment, income, health insurance, and clinical site), clinical variables (body mass index, family history of CRC, and personal history of cancer), CRC health beliefs and knowledge (perceived risk, perceived benefits, perceived barriers, self-efficacy, cancer fatalism, and knowledge), and social support (marital status, family/friend encouragement, and doctor recommendation). Hierarchical modeling was used to identify significant predictors with p value equal to or less than 0.01. Results: Participants who: were older (OR = 1.04, p = .003); male (OR = 1.70, p = .007); seen at a VA site (OR = 2.80, p Conclusion: Enhancing self-efficacy and encouragements from family and friends may be important components of interventions to promote CRC screening among Black Americans. Healthcare providers can utilize knowledge of the characteristics associated with stage of adoption to educate and motivate their primary care Black American patients to complete CRC screening tests. Citation Format: Hsiao-Lan Wang, Shannon M. Christy, Celette S. Skinner, Victoria L. Champion, Victoria L. Champion, Jeffrey K. Springston, Susan M. Perkins, Susan M. Perkins, Yan Tong, Connie Krier, Netsanet Gebregziabher, Susan M. Rawl, Susan M. Rawl. Colorectal cancer screening in nonadherent black Americans. [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 B65. doi:10.1158/1538-7755.DISP13-B65

Abstract 1817: A computer-tailored intervention increases patient-provider discussion and appointment making for colorectal cancer screening

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL BACKGROUND: Colorectal cancer (CRC) will affect more than 142,000 Americans and almost 52,000 will die from this disease this year. Approximately half of these deaths could be prevented if CRC screening were consistently implemented. Both CRC incidence and mortality rates are highest among African Americans compared to all other racial groups due, in part, to suboptimal screening rates. Interactive health communication, defined as “computer technology designed to access or transmit tailored health information or receive tailored guidance and support on a health-related issue”, can be efficacious in changing individual behavior. PURPOSE: Our objective was to determine if a tailored, interactive computer-based intervention (ICI) on CRC would increase screening discussions between African American patients and their primary care providers. Applying Health Belief Model constructs, we developed an ICI which featured CRC-risk based screening recommendations as well as individually tailored and culturally appropriate messages. The program operated on a user-friendly tablet platform and required an average of 17 minutes to complete. METHODS: We enrolled 556 African Americans who were due for CRC screening in a randomized clinical trial. The sample was predominantly low income (58% <

Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans

15,000 annual income) and 50% male with a mean age of 58 years (sd = 6.3). Demographics did not vary significantly between the two treatment arms. Prior to meeting with primary care providers in the clinic, 273 (49%) patients used the ICI. The remaining 283 (51%) patients received a “usual care” intervention – a non-tailored, CRC screening informational brochure developed by the American Cancer Society. Follow-up telephone interviews were conducted within one week of the clinic visit. RESULTS: Patients in the ICI group were significantly more likely to report talking with their doctor about having a colon screening test (ICI group = 63%, brochure group = 49%, p = 0.001). Colonoscopy was reported as the most frequently discussed test (ICI group = 54%, brochure group = 45%, p = 0.06). Importantly, 30% of the ICI group further reported having an appointment scheduled for a colonoscopy, compared to 21% of the brochure group (p = 0.02). Fecal occult blood test was reportedly discussed by less than one third of patients in both groups (ICI group = 32%, brochure group = 27%, p = 0.15). Few patients reported discussing sigmoidoscopy (ICI group = 9%, brochure group = 7%, p = 0.29). CONCLUSION: Tailored interactive health communications can prompt patient-provider dialogue on CRC screening and colonoscopy appointment making. Future analyses will determine if discussions translate into completion of these preventive tests which, in turn, can decrease cancer incidence and mortality. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1817. doi:10.1158/1538-7445.AM2011-1817