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Background Understanding perceptions of telehealth  implementation from patients and providers can improve the utility and sustainability of these programs, particularly in under-resourced rural settings. The purpose of this study was to evaluate both patient and provider perceptions of telehealth visits in a large rural healthcare system during the COVID-19 pandemic. To promote sustainability of telehealth approaches, we also assessed whether the percentage of missed appointments differed between in-person and telehealth visits. Methods Using anonymous surveys, we evaluated patient preferences and satisfaction with telehealth visits from November 2020 -March 2021 and assessed perceptions of telehealth efficiency and value among rural providers from September–October 2020. We examined whether telehealth perceptions differed according to patients’ age, educational attainment, insurance status, and distance to clinical site and providers’ age and length of time practicing medicine using ANOVA test. We also examined whether the percentage of missed appointments differed between in-person and telehealth visits at a family practice clinic within the rural healthcare system from April to September 2020 using a Chi-square test. Results Over 73% of rural patients had favorable perceptions of telehealth visits, and satisfaction was generally higher among younger patients. Patients reported difficulty with scheduling follow-up appointments, lack of personal contact and technology challenges as common barriers. Over 80% of the 219 providers responding to the survey reported that telehealth added value to their practice, while 36.6% agreed that telehealth visits are more efficient than in-person visits. Perception of telehealth value and efficiency did not differ by provider age ( p  = 0.67 and p  = 0.67, respectively) or time in practice ( p  = 0.53 and p  = 0.44, respectively). Technology challenges for the patient (91.3%) and provider (45.1%) were commonly reported. The percentage of missed appointments was slightly higher for telehealth visits compared to in-person visits, but the difference was not statistically significant (8.7% vs. 8.0%; p  = 0.39). Conclusions Telehealth perceptions were generally favorable among rural patients and providers, although satisfaction was lower among older patients and providers. Our findings suggest that telehealth approaches may add value and efficiency to rural clinical practice. However, technology issues for both patients and providers and gaps in care coordination need to be addressed to promote sustainability of telehealth approaches in rural practice.

Breast cancer is the most commonly diagnosed cancer worldwide and is one of the leading causes of cancer death. The incidence, pathological features, and clinical outcomes in breast cancer differ by geographical distribution and across racial and ethnic populations. Importantly, racial and ethnic diversity in breast cancer clinical trials is lacking, with both Blacks and Hispanics underrepresented. In this forum article, breast cancer researchers from across the globe discuss the factors contributing to racial and ethnic breast cancer disparities and highlight specific implications of precision oncology approaches for equitable provision of breast cancer care to improve outcomes and address disparities.

Provider recommendation for the HPV vaccine is considered a critical determinant of vaccine uptake compared to other interventions such as parent education. However, providers cite continued barriers to discuss the vaccines with parents including sexual concerns and other misconceptions. The purpose of this mixed methods study was to evaluate physician knowledge and comfort discussing the vaccine with parents and perceived barriers to vaccine uptake among pediatric residents and attending physicians at a university-affiliated county health clinic. Physicians completed surveys guided by HPV Roundtable information to assess HPV vaccine knowledge, comfortability, and parental barriers to administration. A total of 28 pediatric physicians (20 residents and 8 attendings) completed the survey. HPV vaccine knowledge was high among providers in this study, with 75% of providers reporting high confidence. The majority of physicians in this study reported being comfortable or very comfortable talking to parents about the HPV vaccine (82.1%), recommending the HPV vaccine (89.3%), and recommending the HPV vaccine specifically to hesitant parents (82.1%). Attendings were more comfortable than residents talking to (p = .009) and recommending the vaccine to parents (p = .002). However, physicians reported parents’ sexual concerns, vaccine safety, and misconceptions as the predominant barriers. These findings suggest that persistent stigma about the HPV vaccine as prevention for sexually transmitted infection, rather than the HPV vaccine as cancer prevention persist. Findings from this study suggest the need for HPV vaccine education for parents and provider training on targeted communication strategies.

An additional strength of this study was the inclusion of comprehensive information on potential confounders including body mass index, alcohol consumption, family history of breast cancer, and use of nonsteroidal anti-inflammatory medication; factors which were not considered in prior population registry-based studies in Denmark [5, 6] where no associations between receipt of glucocorticoid prescription and breast cancer risk were observed. [...]given that ER-positive tumors tend to be less aggressive than ER-negative tumors, the inverse associations observed for early stage disease may reflect the preponderance of ER-positive tumors in this group. [...]this is the first study to evaluate whether the relationship between glucocorticoids and breast cancer differs according to hormone receptor status, histology, and tumor stage. [...]results need to be confirmed in large epidemiologic studies with detailed information on tumor characteristics to address the small number of in situ, ER-negative, and late stage breast cancers included in the current study.

Background Socioeconomically disadvantaged and racially minoritized populations bear an elevated risk of adverse childhood experiences (ACEs), but few studies evaluate whether racial disparities in ACEs persist within socioeconomic strata. We examine the effect of both childhood socioeconomic characteristics and race on ACE burden. Methods Data are from a population-based sample ( N  = 1381) of US-born non-Hispanic Black (NHB) and White (NHW) women aged 20–49 years in Metropolitan Detroit and Los Angeles County, 2011–2014. Recalled data on ACEs aged < 13 years, childhood household socioeconomic position (chSEP) aged < 13 years, childhood neighborhood poverty rate (cNPR) aged 6 years (based on US Census tract), and covariates were collected during in-person interviews. ACEs are parameterized as an index (i.e., number of adversities, range 0–12) and as individual adversities. We estimate associations between cNPR (≥ 20%/10- < 20%/< 10%), chSEP index (low/medium/high), race (NHB/NHW), joint cNPR/race, and joint chSEP/race and ACEs using weighted logistic regression, to calculate odds ratios (OR), and using weighted zero-inflated Poisson regression, to calculate estimated ACE index. Results Participants who lived in poorer neighborhoods (i.e., cNPR ≥ 20%) or households (i.e., low chSEP index) during childhood reported significantly more ACEs than participants in wealthier neighborhoods (i.e., cNPR < 10%) or households (i.e., high chSEP index). NHB vs NHW participants overall had a higher mean ACE index (3.18 vs 2.25, respectively, p < 0.05), but NHB and NHW participants who lived in poorer neighborhoods or households had a similarly elevated ACE burden (e.g., estimated ACE index for low chSEP was 3.63 [95%CI 1.19–4.97] and 4.16 [95%CI 3.68–4.65], respectively). NHB participants experienced significant discrimination at all levels of cNPR and chSEP, which contributed to their overall increased ACE risk. Conclusions US-born NHB and NHW girls residing in poorer neighborhoods or households had a similarly substantially elevated burden of ACEs, indicating childhood poverty is a crucial determinant of ACE risk, independent of race.

Background Champions are integral across research in cancer, yet studies exploring their roles are limited and have produced mixed results. The current review examines and synthesizes descriptions of how champions emerged and the types of activities they most often performed. By examining evidence from across the translational research continuum, this scoping review aims to characterize the role of champions and strategies that facilitate their involvement in the implementation of cancer care interventions in both clinical and community-based settings. Methods This scoping review was designed and implemented in compliance with PRISMA-ScR. The review focused on peer-reviewed articles in English-language journals. We searched five databases: PubMed (including MEDLINE), Scopus (including EMBASE), CINAHL, PsycINFO, and the Cochrane Library. Articles published from 1971 to 2022 were included. Two members of the team reviewed in duplicate each article and then a single member of the team extracted the data in Covidence, with a second member comparing the extraction to the original article. Qualitative and quantitative data were extracted and then synthesized. These data were used to summarize core champion activities and implementation strategies and to characterize barriers and facilitators to using champions in research. Results A total of 74 articles were included in the review. The qualitative synthesis highlighted facilitators and barriers to the effective use of champions. Facilitators included consideration of an individual’s characteristics when identifying champions, time spent planning for the specific responsibilities of champions, working within a supportive environment, and identifying champions embedded in the target setting. Major barriers included constrained time, low self-efficacy among champions, inadequate training, high turnover rates of champions, and a lack of buy-in from organizational leadership toward the intervention. Champions also were mostly assigned their roles, had varied core activities, and used complementary strategies to empower their target populations. Champions’ most frequent core activities include facilitation, outreach/promotion, and recruitment of participants into studies. Conclusions Champions were used in research of many cancer types and often serve similar roles regardless of where they are located within the translational research process. Despite their critical role, evidence is lacking on the impact of champions specifically on outcomes of many of the research studies that include them. Future research is needed to understand the nuances of champion-driven approaches across diverse cancer care settings.

Identification of barriers to cancer screening among female migrant farmworkers is needed to inform intervention development and healthcare policy. Thus, our purpose was to systematically review and summarize findings from prior studies of barriers faced by Latinx migrant farmworkers in accessing cervical and breast cancer screenings in the US. Medline and Embase were used to identify literature through October 2021 using the search terms “migrant farmworkers AND. . .cancer; healthcare access; breast; cervical; federally qualified health centers,” and “migrant cancer screening” and “migrant farmworker cancer screening.” Snowball sampling by reviewing citations in each selected article was also used. Exclusion criteria included those articles that focused on specific types of cancer other than breast or cervical, those not within the US, not referencing Latinx migrants, not referencing cancer screening, or those focused on pediatric populations. Data was synthesized by 3 authors and selected articles were assessed for common themes. Nineteen articles met inclusion criteria. Common themes about barriers to cancer screening included: lack of cancer knowledge, cost/inability to pay, lack of health insurance coverage, cultural perceptions, fear, language difficulties, and transportation and time constraints. Findings suggest that barriers to cancer screening among migrant farmworkers may be addressed by providing education about cancer screening and treatment, addressing fear, language, and cultural barriers, and providing transportation and health insurance coverage. Consideration of these barriers is necessary to effectively address cancer disparities in this vulnerable population of female farmworkers.

PurposePrior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality.MethodsUsing an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008–2013) across rural counties and between rural and urban counties using four rural–urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service’s rural–urban continuum codes, and Urban Influence Codes.ResultsAlthough a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%).ConclusionsRural cancer disparities persist across multiple rural–urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural–urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Purpose This study examines providers’ and clinic staff’s perspectives on patient-reported outcomes (PROs) implementation at an academic medical center. Methods An anonymous and voluntary survey was administered to Henry Ford Cancer providers and clinic staff 18 months after PROs program implementation in September 2020, to obtain their feedback on perceived barriers, impact on workflows, and PROs administration frequency in routine cancer care. Results A total of 180 providers and 40 clinic staff were invited to complete the survey; 31% and 63% completed the survey, respectively. Approximately 68% of providers reported that electronically integrated PROs scores were either beneficial or somewhat beneficial to their patients, while only 28% of the clinic staff reported that PROs were beneficial or somewhat beneficial to patients. According to the clinic staff, the most common barriers to PROs completion included lack of patients’ awareness of the utility of the program with respect to their care, patients’ health status at check-in, and PROs being offered too frequently. Conclusion There is favorable acceptance of the PROs program by providers, but clinic staff found it less favorable. Interventions to address barriers and improve program engagement are needed to ensure broad adoption of PROs in oncology practice.

Background. This study was undertaken to evaluate trends in breast cancer incidence in Egypt from 1999 to 2008 and to make projections for breast cancer occurrence for the years 2009–2015. Patients and Methods. We utilized joinpoint regression and average annual percent change (AAPC) measures with 95% confidence intervals (CI) to describe the trends in breast cancer incidence rates from the Gharbiah Cancer Registry by age and stage at diagnosis and to estimate expected breast cancer caseloads for 2009–2015. Results. From 1999 to 2008, the AAPC in breast cancer incidence rates in Gharbiah significantly increased among women 50 years and older and among localized tumors (AAPC %, 95% CI, 3.1% to 8.0%). Our results predict a significant increase in breast cancer caseloads from 2009 to 2015 among women aged 30–39 (AAPC %, 95% CI, 0.9% to 1.1%) and among women aged 40–49 years (AAPC %, 95% CI, 1.0% to 2.6%). Conclusion. These results have important implications for allocating limited resources, managing treatment needs, and exploring the consequences of prior interventions and/or changing risk factors in Egypt and other developing countries at the same stages of demographic and health transitions.