Faculty Bibliography

OBJECTIVE: This study sought to determine if physician's personal discomfort with the topic of FP and a patient's prognosis would have an impact on the likelihood of discussing FP with cancer patients. METHODS: Data from larger studies of qualitative semi-structured interviews with pediatric and adult oncologists were analyzed using grounded theory and crystallizing immersion method to examine the themes of "personal comfort" and "patient prognosis" in relation to discussion. RESULTS: Results showed that, across both physician types, the majority of respondents' personal comfort with the topic of FP was related to the likelihood of discussion. Personal discomfort manifested as: (a) lack of knowledge; (b) language/cultural barriers; (c) perception that subject of FP adds more stress to situation; (d) general uncertainty about success of FP methods. Data also indicate physicians do not feel discussions are appropriate for patients with poor prognosis. CONCLUSION: Despite the ASCO guidelines suggesting physicians should discuss FP with all patients, the majority of physicians are not following these guidelines. PRACTICE IMPLICATIONS: Improved training on recognition of such biases and communication strategies may improve the quality and frequency of such discussions. Involving the entire healthcare team in discussions may alleviate the need for physicians to have sole responsibility.

BACKGROUND: Recent survey evidence indicates a decline in mammography use among older women. PURPOSE: The objective of this study was to detect sensitivity of self-reported mammography use and pose evidence-based suggestions to increase survey accuracy. METHODS: Using the 1991-2006 Medicare Current Beneficiary Survey, 15,357 women, aged > or =65 years, were selected based on use of mammography services. The women were interviewed in the community setting at random periods after screening and asked, Have you had a mammogram or breast X-ray since [today's date or previous supplement round interview date] a year ago? Statistical analyses were conducted between March 11 and April 28 of 2008. This study tested whether sensitivity (i.e., probability of an affirmative response) was dependent on length of the recall period and on respondent demographic and socioeconomic characteristics. RESULTS: Overall, 90.4% of the older women self-reported use; however, sensitivity decreased as the recall period lengthened (90% at 6 months, 80% at 12 months). This time effect was significantly higher among older, economically disadvantaged women. Sensitivity also decreased an additional 13.8% if the event occurred in the previous calendar year, and 3.5% if conducted in a non-English language or by proxy. CONCLUSIONS: Greatest sensitivity occurred during the 6-month period after service without straddling calendar years. These findings may aid the tailoring of future surveys for older adults, improving the recall of preventive services.

OBJECTIVE: To fill a gap in research by examining cancer patient-provider communication regarding tobacco use and patients' perspectives regarding their experiences with smoking cessation and relapse. METHODS: In-depth interviews were conducted with 20 lung and head and neck cancer patients and 11 health care providers. RESULTS: Qualitative analyses revealed that cancer patients express high levels of motivation to quit smoking; however, patients do not ask providers for assistance with quitting and maintaining abstinence and relapsed patients are reluctant to disclose smoking behavior due to stigma and guilt. Health care providers vary in the advice and type of assistance they supply, and their awareness and sensitivity to relapsed patients' feelings. Whereas providers emphasized long-term risks of continued smoking in their interactions with patients and recommendations for intervention content, patients expressed a preference for a balance between risks and benefits. CONCLUSION: Findings underscore the need for increased awareness, emphasis, and communication about the immediate risks of continued smoking and the benefits of continued abstinence specifically for cancer patients. PRACTICE IMPLICATIONS: Our findings demonstrate the potential to affect cancer outcomes by improved training in conducting smoking cessation and relapse-prevention interventions. Additional training could be given to health care providers to increase adherence to clinical practice guidelines (5 A's), to learn ways to enhance patients' motivation to maintain abstinence, and to deliver smoking messages in a non-threatening manner.

The lifetime risks for both breast and ovarian cancer for BRCA mutation carriers far exceeds the general population risk of 13% for breast cancer and 1.4% for ovarian cancer. BRCA carriers have unique and medically complicated decisions to make regarding their cancer treatment or risk reduction. As BRCA testing becomes increasingly common among unaffected individuals in families with a previously documented BRCA mutation, there are a growing number of individuals with unique psychosocial needs and concerns. This review paper describes the BRCA 1/2 population, discusses preimplantation genetic diagnosis (PGD), and describes the decisions and ethical issues related to PGD among the BRCA 1/ 2 population.

OBJECTIVE: Limited research has been conducted on the extent to which fertility preservation is discussed by pediatric oncologists with patients and less is known about the discussion content. This study sought to examine factors that may influence the discussion with pediatric cancer patients and families. METHODS: Qualitative data were collected using open-ended, in-depth interviews with 24 pediatric oncologists in Florida at 13 children's cancer centers, representing 87% of the centers in the state. RESULTS: Providers practiced between 0.5 and 35 years, treated most types of pediatric cancers, and most were board certified in pediatric hematology/oncology. The main factors associated with a discussion of fertility preservation options were: (1) physician factors that contribute to communication issues with FP discussion (e.g., awareness and sense of comfort in discussing issues, perceptions of the priority); (2) parent factors (e.g., receptiveness and cultural background); (3) patient factors (e.g., receptiveness and age); and (4) institutional factors (e.g., referral sites and practice guidelines). CONCLUSIONS: Pediatric oncologists may benefit from education about fertility preservation options for pediatric cancer patients, particularly females. PRACTICE IMPLICATIONS: Training on how to address parents' and patients' emotions, culture, and other factors may also promote the discussion. Although guidelines have been established, barriers related to availability and affordability of resources must also be addressed.

With cancer survival rates increasing, new directions have focused on issues of survivorship, with an intense focus on quality of life. One area gaining increased attention is fertility preservation and future parenthood among cancer survivors. Although medical options for fertility preservation exist, most are not well understood by physicians, patients and family members, and are not readily accessible to patients and their health care providers. This paper discusses the current difficulties in communicating information about fertility preservation in the United States. Physician level of knowledge about fertility preservation, attitudes and comfort level with the topics, patient preferences, and financial and practice barriers may serve as obstacles in the communication process. Social, interaction and behavioral research studies are well poised to address the communication barriers and provide possible solutions to problems in understanding fertility preservation, for patients, family members and health care providers alike.

The development of smoking cessation and relapse prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in recruiting this population into clinical trials. The problem is particularly acute for relapse prevention studies, which must recruit women who have already quit smoking because of their pregnancy. Although these individuals are an important target for tobacco control efforts, they represent an extremely small subgroup of the general population. This paper describes multiple recruitment strategies used for a clinical trial of a self-help relapse prevention program for pregnant women. The effectiveness of the strategies and the direct expense per participant recruited are provided. A proactive recruitment strategy (telephoning women whose phone numbers were purchased from a marketing firm) was ultimately much more successful than a variety of reactive strategies (advertisements, press releases, direct mail, Web placement, health care provider outreach). We found few differences between proactively and reactively recruited participants on baseline variables. The primary difference was that the former had smoked fewer cigarettes per day and reported lower nicotine dependence prior to quitting. Strengths and limitations of the recruitment strategies are discussed.