Abstract
Survivorship Goals, Objectives and Indicators in State Comprehensive Cancer Control Plans: A Systematic Review
Angela Falisi, MPH1, Michelle Mollica, PhD, MPH, RN, OCN1 and Larissa Nekhlyudov, MD, MPH2
(1)National Cancer Institute, Rockville, MD, (2)Harvard Medical School, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
State Comprehensive Cancer Control Plans are an important public health model to address the cancer burden across all phases of the care continuum. Despite substantial progress in cancer survivorship, there remains a need to assess survivorship care quality for use in public health planning, clinical practice, and future research. This study systematically reviewed state cancer control plans to identify survivorship-focused goals, objectives, and indicators, including a content analysis of survivorship domains covered by each plan. Using CDC’s National Comprehensive Cancer Control Program database, along with web searches and direct outreach, the latest versions of all 50 states’ cancer control plans were identified. All state plans included at least 1 survivorship-related goal, though there was substantial inconsistency in content and level of detail. Specifically, 90% (n=45) of plans identified ‘survivorship’ as a key priority area, while others integrated survivorship-related goals into overarching priorities (e.g. Quality of Life; Patient-Centered Care). Commonly identified survivorship-related domains included: (1) survivorship care plans; (2) workforce development; (3) access to clinical and psychosocial services; and (4) health promotion. State cancer plans less often prioritized: (1) care coordination; (2) adherence with post-treatment guidelines; and (3) surveillance for recurrence and second cancers. While cancer survivorship is being incorporated into state comprehensive control plans, there is significant variation across individual states. The impact of the state plans on their respective cancer survivorship outcomes must be evaluated and best practices should be disseminated in order to promote high quality care for the estimated 16-million cancer survivors in the U.S.
Clinical medicine applied in public health Conduct evaluation related to programs, research, and other areas of practice Public health or related organizational policy, standards, or other guidelines Public health or related research
Abstract
Perspectives on patient engagement: Lessons learned from oncologists at a safety net hospital cancer center
Marjory Charlot, MD, MPH, MSc.1, Kelsi Carolan, MSW2, Elmer Freeman, MSW3, Carmen Fonseca, BS2 and Linda Sprague Martinez, PhD2
(1)Boston Medical Center, Boston University School of Medicine, Boston, MA, (2)Boston University School of Social Work, Boston, MA, (3)Center for Community Health Education Research and Service, Inc., Northeastern University, Boston, MA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Participatory research approaches can help ensure research is culturally relevant and aligned with stakeholder priorities, but barriers exist between researchers and community stakeholders, particularly in communities of color. As part of a Patient Centered Outcomes Research Institute (PCORI) Eugene Washington Engagement award, we conducted a survey of oncology providers and researchers at an urban safety net teaching hospital, whose patient base is primarily people of color. The aim of this project was to understand oncologists’ experience with and perspectives on engaging patients in participatory research. We developed a survey that drew on similar surveys utilized as part of other PCORI grants, in an effort to develop an evidence-based survey tailored to this project. A total of 23 oncologists responded to the survey. The majority of respondents indicated that they were moderately or very familiar with the concept of patient centered outcomes research, with nearly half of the respondents indicating no experience engaging in participatory research, and a quarter indicating “a little experience.” Several barriers to engaging patients in the research process were endorsed, including insufficient experience engaging patients in research, research time, and institutional resources for patient engagement as well as lack of compensation for patient participants. These findings have important implications regarding the challenges oncologists face in engaging patients and families in participatory research. Findings indicate that if cancer centers are to implement patient-powered research agendas as recommended by PCORI, a mechanism for preparing and supporting providers and researchers is needed.
Assessment of individual and community needs for health education Diversity and culture Implementation of health education strategies, interventions and programs Other professions or practice related to public health Public health or related public policy Public health or related research
Abstract
Patient Navigation - a Community Engaged Workforce Development Initiative
Nirmal Ahuja1 and Eugene Lengerich2
(1)Penn State College of Medicine, Hershey, PA, India, (2)Penn State University College of Medicine, Hershey, PA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
About 609,640 Americans are expected to die of cancer in 2018, which translates to about 1,670 deaths per day. According to the CDC, Pennsylvania is ranked 2nd among Northeast states with cancer death rate at 174.9 deaths per 100,000 people. Recent studies have demonstrated that patient navigation (PN) can address the cancer-related health disparities, reduce the risk of cancer development and increase likelihood that cancer would be diagnosed at early stage when treatment is more effective. The Penn State Cancer Institute addresses the cancer-related health disparity in the Appalachian county through training and capacity building of local work force as part of their cancer PN training program. Additionally, it has also recognized the need for a central source of educational resources and communication for the community of cancer navigators in Pennsylvania and subsequently formed the Cancer Navigation and Survivorship Network (CaNSuN).This policy has following recommendations for PN as a community engaged workforce in Pennsylvania.
1) We propose state legislation to fully integrate and recognize PN into the existing health care workforce and human health services.
2) Public health advocates & policymakers integrate patient navigators and PN language into local and state healthcare reform legislation.
3) Standard criteria for qualification and training of patient navigators.
4) Employers and funding agencies recognize patient navigators’ contribution to public health infrastructure.
5) Utilization of patient navigators in clinical trial and research recruitment.
6) State and private insurers provide direct reimbursement of PN services.
7) Employers support PN career development and formation of state and local patient navigators’ network.
Public health or related organizational policy, standards, or other guidelines Public health or related public policy
Abstract
Improving the outcomes in communities not predicted to meet HP2020 breast cancer targets: A national study
Rebecca Earlie-Royer, PhD, MPH, CHES1, Jessica Lee, MPH2, Stephanie Birkey Reffey, PhD1, Jeremy Patch, MPH1 and Stephanie McCoy, PhD, MPH, MPS, CHES1
(1)Susan G. Komen, Dallas, TX, (2)Community Partner, Dallas, TX
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
While breast cancer mortality rates have declined since 1990, more than 40,000 women die from breast cancer each year in the U.S. Many of these deaths are due to late-stage diagnosis, when treatment options are limited and prognosis is poor. There is evidence that poor breast cancer outcomes can be attributed to gaps in access to care.
A mixed-methods approach was used to identify U.S. counties that will not meet HP2020 breast cancer targets and to understand those factors that may be contributing to these disparities to identify priority areas for evidence-based program delivery.
Analysis of breast cancer late-stage diagnosis and death rates/trends identified 561 U.S. counties that are not predicted to meet HP2020 breast cancer targets. Health systems analysis identified that 12 of these counties lack access to any breast cancer care, 144 lack access to diagnostic and treatment services, 175 lack access to treatment services and 77% lack accredited breast cancer facilities. These counties were more likely to be rural (76%) and have a higher proportion (53%) of individuals residing in medically underserved areas (i.e., too few primary care providers). Additionally, 101 communities have a substantially larger African-American female population (nearly 40% higher death rate). Qualitative data identified the following common barriers to care: availability of services, lack of education, financial/insurance barriers, transportation, cultural/language barriers, and fear.
These findings were used to identify priority areas in need of evidence-based interventions to overcome the identified barriers to care. They also inform our advocacy efforts to ensure access to breast cancer screening, diagnosis and treatment.
Assessment of individual and community needs for health education Planning of health education strategies, interventions, and programs Provision of health care to the public Public health or related public policy Social and behavioral sciences
Abstract
Improvement of Breast Cancer Screening Access and Quality in an Underserved Population Through System Interventions
Deborah Manst, MD, MPH, Denisse Gil, Elizabeth Marcus, MD and Pamela Ganschow, MD
Cook County Health & Hospitals System, Chicago, IL
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Differences in access to and the quality of screening and treatment are factors that are proposed to contribute to racial disparities in breast cancer outcomes. We examined the impact of systems-based interventions on the access to and quality of mammography services across four sites performing mammograms within an urban safety net health system in Chicago. In 2016, the health system completed the installation of digital machines at all four sites, moved the reading of all mammograms to one site where there were radiologists specialized in mammography imaging, and increased care coordination including enhanced patient outreach efforts. All screening mammograms for six months prior to and after implementation of these changes were assessed via manual chart abstraction to determine if there was a difference in the access to or quality of mammography services across the health system. Quality was evaluated using eleven metrics reflecting radiologist performance as well as facility care processes. After implementation, the capacity for screening mammography increased at all four sites (range of volume increase 31-76%) and each site improved in terms of at least one quality metric (range 1-8). Notably, the proportion of women with timely follow up after abnormal mammogram (30 or 60 days) improved significantly at all four sites, and the cancer detection rate improved at the two sites with the lowest pre-intervention values. These improvements in quality demonstrate the value of implementing system level changes in enhancing breast cancer care, translating to better outcomes for all women.
Implementation of health education strategies, interventions and programs Provision of health care to the public
Abstract
Practical approaches to engage primary care clinics in health systems change: Lessons learned from the Centers for Disease Control and Prevention (CDC)-funded Colorectal Cancer Control Program (CRCCP)
Dara Schlueter, MPH1, Cindy Soloe, MPH2, Laura Arena, MPH2, Amy DeGroff, PhD, MPH1, Florence Tangka, PhD1 and Suhja Subramanian, PhD2
(1)Centers for Disease Control and Prevention, Atlanta, GA, (2)RTI International, Durham, NC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Despite declines in colorectal cancer (CRC) nationally, disparities in incidence and mortality persist among individuals of low socioeconomic status. In 2012, the Institute of Medicine identified CRC screening as an opportunity for integration between public health and primary care to support meaningful improvements in population health, including disparity reduction. In response, the Centers for Disease Control and Prevention (CDC) funded the Colorectal Cancer Control Program (CRCCP) in 2015. The 30 CRCCP grantees partner primarily with federally qualified health centers (FQHCs) whose clinics serve populations with low CRC screening rates. Grantees focus on health system change, collaborating with clinics to implement evidence-based interventions (EBIs) identified in the Guide to Community Preventive Services, and supporting activities. In 2017, CDC conducted qualitative case studies to examine how public health agencies initiate integration and engage primary care clinics within this new model. Case studies included 26 semi-structured, in-depth interviews with grantee- and clinic-level staff within four participating CRCCPs. Interviews explored factors related to clinic recruitment, EBI implementation, and sustainability. Researchers employed a multi-step, iterative process to analyze qualitative transcripts, using inductive and deductive coding to organize data, and identify and compare emerging themes within and across sites. Researchers identified lessons learned for recruiting and engaging FQHCs; facilitating early implementation through relationship-building and formal assessments; integrating program activities into existing health initiatives; and overcoming common challenges to program implementation in clinical settings (e.g., maximizing data quality within electronic health records). Case study findings will be used to support ongoing program improvement.
Clinical medicine applied in public health Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Implementation of Ask-Advise-Connect in a Federally Qualified Health Center: A mixed-methods evaluation using the RE-AIM framework
Diana Stewart Hoover, PhD1, Claire A. Spears, PhD2, Nga Nguyen, MS1, Brbara Pieiro, PhD3, Lorna H. McNeill, PhD, MPH1, David W. Wetter, PhD4 and Jennifer Irvin Vidrine, PhD3
(1)University of Texas MD Anderson Cancer Center, Houston, TX, (2)Georgia State University, Atlanta, GA, (3)University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, (4)The University of Utah and Huntsman Cancer Institute, Salt Lake City, UT
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Quitlines reach only 1% to 2% of smokers. Ask-Advise-Connect (AAC) was designed to link smokers in healthcare settings with quitline-delivered treatment via the electronic medical record. This mixed-methods study, guided by the RE-AIM framework, evaluated the implementation of AAC in a Federally Qualified Health Center (FQHC). AAC was implemented for 18 months at a FQHC serving predominately low-socioeconomic status (SES) Latinos. Primary outcomes were reach (number of smokers who talked with the quitline / total number of identified smokers), efficacy (number of smokers who enrolled in treatment / number who talked with the quitline), and impact (reach x efficacy, or number of identified smokers who enrolled in treatment / the total number of identified smokers). Following implementation, in-depth interviews were conducted with clinical staff (N=9) to evaluate AAC and inform future implementation efforts. Interviews were transcribed and analyzed using NVivo 10. Smoking prevalence was 10.7%. Reach was 12%, efficacy was 95%, and impact was 11.4%. Clinic staff described facilitators of AAC implementation (e.g., AAC streamlined procedures; in-person trainings and "cheat sheets" were useful) and identified advantages of AAC (e.g., procedures fast and easy; smokers seamlessly connected with treatment). Staff recalled excitement about AAC before implementation and believed that AAC fit well in the clinic. Staff were interested in AAC becoming the standard of care and made suggestions for future implementation. AAC was successfully implemented within a FQHC serving primarily low-SES Latino smokers, and clinic staff were pleased with the implementation process. AAC has great potential to reduce tobacco-related disparities.
Administer health education strategies, interventions and programs Assessment of individual and community needs for health education Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
National Asian-Indio Cooperative Enterprises (NICE) Camden County Cancer Project at Cooper Cancer Screening Patient Outcomes
Sharon Byrne, DrNP, MSN, APN, NP-C, AOCNP, CNE1, Tondalya DeShields, MPH, RN, CBE-MC, CN-BN2, Evelyn Robles-Rodriguez, RN, MSN, APN, AOCN2 and Yogini Patel, BA,2
(1)MD Anderson Cancer Center at Cooper, Voorhees, NJ, (2)MD Anderson Cancer Center at Cooper, Camden, NJ
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Reaching Asian-Indio underserved and uninsured women for the purpose of cancer education and screening is a challenge. An innovative partnership was established between the Cancer Screening Program at the MD Anderson Cancer Center at Cooper, Camden, New Jersey and National Indio Cooperative Enterprises, INC. (NICE). A dedicated Advanced Practice Nurse and Community Outreach Worker /Lay Navigator established and implemented a strategy to promote cancer awareness and increase participation in screening services to this unique population. By joining forces with an established community agency, the project has achieved and sustained its goal of providing education, and sustainable annual cancer detection for 255 women.
With IRB approval, a retrospective review of outcomes over 10 years has been conducted. The mean age of patients within the program is 52. 601 encounters have resulted in 8 cancer diagnoses including DCIS, LICS, Stage I breast cancer, Stage III breast cancer, 2 cervical cancers and 2 endometrial cancers and a variety of women’s health and colorectal specific benign conditions. While many facilitators and barriers to screening have been identified in the literature, this select population identified the availability of a dedicated setting with the lay navigator and established female provider, as a factor encouraging their participation in cancer screening. Program development, implementation, evaluation and lessons learned can assist healthcare and public health providers in creating this and other programs targeted toward reducing health disparities related to cancer in the Asian-Indio female population through early detection of cancer through community based screening.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Provision of health care to the public
Abstract
A Hope-based Intervention to Address Disrupted Goal Pursuits and Quality of Life in Young Adult Cancer Survivors
Carla Berg, PhD1, Robin Vanderpool, DrPH2, Betelihem Getachew1, Meghan Johnson, MPH3, Jackelyn Payne, MPH4, Yasmeni Sandridge4, Jennifer Bierhoff4, Jasmine Kelly4, Karen Effinger4, Wendy Demark-Wahnefried5, Sonia Duffy, PhD, RN6 and Ann Mertens4
(1)Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, (2)University of Kentucky College of Public Health, Lexington, KY, (3)University of Kentucky, Lexington, KY, (4)Emory University, Atlanta, GA, (5)University of Alabama, Birmingham, Birmingham, AL, (6)Ohio State University, Columbus, OH
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Unfortunately, >60,000 US young adults are diagnosed with cancer annually, disrupting a critical time entailing several important life transitions and goal pursuits. Since hope, a positive psychology construct regarding goal pursuit, is associated with better quality of life (QOL), we developed Achieving Wellness After Kancer in Early life (AWAKE). This scalable 8-week app-based program consists of educational videos, mood/activity tracking, and telephone-based coaching to promote goal-oriented thinking and QOL in young adults with cancer (YACs). To examine feasibility, acceptability, and obtain parameter estimates, 57 YACs (18-40 years), 2 years post treatment and recruited from two NCI-designated cancer centers, were randomly assigned to AWAKE (n=38) versus an attention control (n=19). Hope (Trait Hope Scale) and the QOL (36-Item Short Form Health Survey, Functional Assessment of Cancer Therapy-General) were assessed at weeks 0, 8, and 24. The mean age was 32.2 years old and 75.0% were female, 77.6% non-Hispanic White, 61.2% employed, and 67.3% married/stable union. Diagnoses included breast cancer (28.6%), hematologic malignancies (12.2%), and melanoma (12.2%). Weekly adherence to AWAKE averaged 86.1% (range: 100.0% at week 1 to 75.7% at week 8). Retention at end-of-treatment was 90.7%. Among AWAKE participants, 90.9% were satisfied with AWAKE and would recommend AWAKE to friends with cancer; >84.8% reported that AWAKE components were helpful. Trends of higher indices of hope and QOL were observed in AWAKE versus control subjects. AWAKE has the potential to address disrupted goal pursuits and QOL among YACSs.
Social and behavioral sciences