Biomedical subjects

Alfred C Marcus

Publications and source records attributed to Alfred C Marcus.

12 recordsLinked to original sources

PubMed2006

Effect of a mailed brochure on appointment-keeping for screening colonoscopy: a randomized trial.

BACKGROUND: Even when primary care physicians have face-to-face discussions with patients before referring them for screening colonoscopy, patient nonadherence can be substantial. Often, primary care physicians lack sufficient time to educate patients and address their potential misconceptions and fears about this procedure. OBJECTIVE: To test whether an informational brochure sent to patients' home addresses after referral for screening colonoscopy would increase patient completion of the procedure. DESIGN: Randomized, controlled trial. SETTING: 2 general internal medicine practices affiliated with the University of Colorado Health Sciences Center. PATIENTS: 781 consecutive patients 50 years of age or older referred by their primary care physicians for screening colonoscopy. INTERVENTION: Patients were randomly assigned to receive usual care (control group) versus usual care plus an informational brochure (intervention group). The brochure was mailed within 10 days of referral for screening colonoscopy; it mentioned the name of the patient's primary care physician and encouraged patients to schedule a procedure. It also described colorectal cancer and polyps and the similar lifetime risks for colorectal cancer for men and women, colonoscopy and risk for perforation, the nature of bowel preparation for the procedure, and alternative screening tests. MEASUREMENTS: Rates of adherence to screening colonoscopy in the 2 study groups. RESULTS: The overall adherence rate was 11.7 percentage points (95% CI, 5.1 to 18.4 percentage points) greater in the intervention group than in the control group (70.7% vs. 59.0%). Older patients were more adherent than younger patients. Patients with low-income insurance plans, such as Medicaid, were less adherent despite being sent a brochure. LIMITATIONS: The small number of clinical practices and minority patients may limit generalizability. In addition, it was not possible to determine the degree to which adherence was influenced by a reminder to schedule a procedure versus detailed information about colonoscopy. CONCLUSIONS: An inexpensive mailed brochure is an effective way to increase patient adherence to primary care physician referral for screening colonoscopy.

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PubMed2005

A case study in dissemination: lessons learned from a pilot study involving the National Cancer Institute's Cancer Information Service.

The Cancer Information Service Research Consortium (CISRC) was funded by the National Cancer Institute to disseminate as a pilot study a longitudinally tailored print intervention to promote the 5 A Day for Better Health program among callers to the National Cancer Institute's Cancer Information Service (CIS). Using a one-group (intervention-only) study design, 1,022 eligible CIS callers were enrolled to receive the intervention consisting of four mailings of tailored print materials over a 3-month period. Program evaluation focused on process and implementation evaluation, including adherence to the baseline interviews by CIS information specialists based on live-call monitoring (n = 55 eligible callers), and the timeliness of the intervention mailouts (4,088 scheduled mailouts). Adherence to the baseline interviews by CIS information specialists was extremely high, exceeding 90% for all indicators of quality control. Of the 4,088 intervention mailings, 75% occurred on or before the target date, while 95% occurred within 21 days of the target date. All delays in the scheduled mailouts occurred in the first mailing, due to changes made in the production process (batch printing of all tailored print materials at baseline). This change required additional system upgrades and more intensive and time-consuming quality control than originally anticipated, which was exacerbated by the faster-than-expected accrual of eligible participants. Based on this pilot study, the CIS is now positioned for widespread dissemination of the 5 A Day tailored print intervention. Several key lessons learned are also identified to facilitate the transition from research to dissemination.

Evaluation Studies as Topic↗

PubMed2005

The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute's Cancer Information Service.

In this large randomized trial among callers to the Cancer Information Service (CIS), tailored print materials were tested for efficacy in promoting colorectal cancer (CRC) screening (fecal occult blood test [FOBT], flexible sigmoidoscopy, or colonoscopy). All participants completed baseline interviews at the end of their usual service calls to the CIS, as well as short-term (6-month) and longer-term (14-month) telephone follow-up interviews. The study sample (n = 4,014) was restricted to English-speaking CIS callers 50 + years of age, who would be eligible for CRC screening at 14 months follow-up and did not call the CIS about CRC or CRC screening. Four experimental conditions were compared: a single untailored (SU) mailout of print material (the control condition); a single tailored (ST) mailout of print material; four (multiple) tailored (MT) mailouts of print materials spanning 12 months, all of which were tailored to information obtained at baseline; and four (multiple) retailored (MRT) mailouts also spanning 12 months, with retailoring of the print materials (mailouts 2, 3, and 4) based on updated information obtained from the 6-month follow-up interviews. Consistent with the main hypothesis of this trial, a significant linear trend across the SU, ST, MT, and MRT groups was found at 14 months (42%, 44%, 51%, and 48%, respectively, p = 0.05). Only for MT was there a significant difference compared with SU (p = 0.03) for the sample as a whole, while no differences were found for MT vs. MRT at 14 months. Significant moderator effects in the predicted direction were found among females, younger participants, and among those with a history of CRC screening, all of which involved the SU vs. MT MRT comparisons. Only among younger participants (ages 50-59) was there a difference between SU vs. ST at 14 months. Given these results, we conclude from this trial the following: (1) the MRT intervention failed to show added benefit beyond the MT intervention, (2) the significant intervention effects involving the MT and MRT conditions can be explained by tailoring and/or the longitudinal nature of both interventions, and (3) the most compelling evidence in support of tailoring was found for the ST condition among younger participants, where a significant need for interventions exists at the national level. Directions for future research are discussed in light of the results summarized above.

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PubMed2005

The CIS model for collaborative research in health communications: a brief retrospective from the current generation of research.

The Cancer Information Service (CIS) of the National Cancer Institute (NCI) is the premiere organization for providing cancer information to the nation. The CIS provides a stellar example of how a service organization dedicated to health communications also can serve as a laboratory for research. This journey by the CIS into health communication research is described briefly, along with the current generation of research summarized in this issue of the Journal of Health Communication (JHC). The CIS model for collaborative research is presented as an exemplar that other service organizations might embrace as a strategic tool for quality improvement in health communications.

Biomedical Research↗

PubMed2005

Multiple tailored messages are effective in increasing fruit and vegetable consumption among callers to the Cancer Information Service.

Results are reported from a large (n = 3,402) four-group randomized trial to increase fruit and vegetable consumption among callers to the National Cancer Institute's (NCI's) Cancer Information Service (CIS) using tailored print materials. Following a baseline telephone interview, which included a brief educational message (BEM), participants were assigned randomly within CIS offices to one of four groups: single untailored (SU) group-one untailored set of materials; single tailored (ST) group-one tailored booklet; multiple tailored (MT) group-four tailored materials; and multiple retailored (MRT) group-four tailored materials with retailoring based on new information obtained at 5 months follow-up. Follow-up telephone interviews were conducted at 5 (n = 2,233) and 12 months (n = 1,927) after baseline. The main outcome measure was self-reported fruit and vegetable consumption using a seven-item food frequency questionnaire. At 12 months follow-up, there was a significant linear trend across groups of 0.21 servings (p = 0.0002). Specific nested hypotheses then were tested and revealed significant mean serving differences between SU (5.07) vs. MT (5.64) (p = 0.002) and SU vs. MRT (5.71; p < 0.001). Although the mean for ST (5.40) was greater than that for SU (5.07), the difference was not statistically significant (p = 0.07), and no difference was found between MT vs. MRT (p = 0.69). A higher proportion of recipients of tailored materials reported reading all of the materials and believing that they were written especially for them. No differences by experimental condition were found for the perceived usefulness or motivational impact of the print materials. In this trial, MT print materials were more effective at increasing fruit and vegetable (FV) consumption than were SU materials. The intervention mechanisms responsible for this effect merit further research. Retailoring did not produce a significant difference when compared with longitudinal baseline tailoring.

Adult↗

PubMed2005

Predictors of nonadherence to screening colonoscopy.

BACKGROUND: Colonoscopy has become a preferred colorectal cancer (CRC) screening modality. Little is known about why patients who are referred for colonoscopy do not complete the recommended procedures. Prior adherence studies have evaluated colonoscopy only in combination with flexible sigmoidoscopy, failed to differentiate between screening and diagnostic procedures, and have examined cancellations/no-shows, but not nonscheduling, as mechanisms of nonadherence. METHODS: Sociodemographic predictors of screening completion were assessed in a retrospective cohort of 647 patients referred for colonoscopy at a major university hospital. Then, using a qualitative study design, a convenience sample of patients who never completed screening after referral (n=52) was interviewed by telephone, and comparisons in reported reasons for nonadherence were made by gender. RESULTS: Half of all patients referred for colonoscopy failed to complete the procedure, overwhelmingly because of nonscheduling. In multivariable analysis, female sex, younger age, and insurance type predicted poorer adherence. Patient-reported barriers to screening completion included cognitive-emotional factors (e.g., lack of perceived risk for CRC, fear of pain, and concerns about modesty and the bowel preparation), logistic obstacles (e.g., cost, other health problems, and competing demands), and health system barriers (e.g., scheduling challenges, long waiting times). Women reported more concerns about modesty and other aspects of the procedure than men. Only 40% of patients were aware of alternative screening options. CONCLUSIONS: Adherence to screening colonoscopy referrals is sub-optimal and may be improved by better communication with patients, counseling to help resolve logistic barriers, and improvements in colonoscopy referral and scheduling mechanisms.

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PubMed2004

Disseminating effective cancer screening interventions.

A large gap exists between the results of research concerning efficacious cancer screening programs and the programs delivered in practice. In this article, the authors discuss issues in, barriers to, and lessons learned regarding the dissemination of interventions. They summarize previous reviews, exemplary studies, and theories regarding the diffusion and dissemination of cancer screening interventions. Six lessons learned address the involvement of key stakeholders, factors influencing diffusion, the need for different types of efficacy and effectiveness studies with greater attention to external validity, replication, the use of theoretical and evaluation models, and the importance of policy infrastructure. In this article, the authors make recommendations for future research and practice, including improving the understanding of the intervention process and changing the types of grants funded and review criteria used. Also needed are an enhanced infrastructure, including policies to support dissemination, and the involvement of researchers, health care administrators, clinicians, and funding organizations in dissemination if the gap between research and practice in cancer screening is to be reduced.

Delivery of Health Care↗

PubMed2003

Brief physician-initiated quit-smoking strategies for clinical oncology settings: a trial coordinated by the Eastern Cooperative Oncology Group.

PURPOSE: Although tobacco use by cancer patients increases the risk of relapse, diminishes treatment efficacy, and worsens quality of life, about one third of patients who smoked before their diagnosis continue to smoke. Because patients have regular contact with oncologists, the efficacy of a physician-based smoking cessation treatment was evaluated. METHODS: Cancer patients (n = 432) were randomly assigned to either usual care or a National Institutes of Health (NIH) physician-based smoking intervention. The primary outcome was 7-day point prevalence abstinence at 6 and 12 months after study entry. RESULTS: At the 6-month follow-up, there was no significant difference in quit rates between the usual care (11.9%) and intervention (14.4%) groups, and there was no significant difference between the usual care (13.6%) and intervention (13.3%) groups at the 12-month follow-up. Patients were more likely to have quit smoking at 6 months if they had head and neck or lung cancer, began smoking after the age of 16, reported at baseline using a cessation self-help guide or treatment in the last 6 months, and showed greater baseline desire to quit. Patients were more likely to have quit smoking at 12 months if they smoked 15 or fewer cigarettes per day, had head and neck or lung cancer, tried a group cessation program, and showed greater baseline desire to quit. Finally, there was greater adherence among physicians to the NIH model for physician smoking treatment for patients in the intervention versus the usual care group. CONCLUSION: While training physicians to provide smoking cessation treatment to cancer patients can enhance physician adherence to clinical practice guidelines, physician smoking cessation interventions fail to yield significant gains in long-term quit rates among cancer patients.

Adult↗

PubMed2003

Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition.

The gap between research and practice is well documented. We address one of the underlying reasons for this gap: the assumption that effectiveness research naturally and logically follows from successful efficacy research. These 2 research traditions have evolved different methods and values; consequently, there are inherent differences between the characteristics of a successful efficacy intervention versus those of an effectiveness one. Moderating factors that limit robustness across settings, populations, and intervention staff need to be addressed in efficacy studies, as well as in effectiveness trials. Greater attention needs to be paid to documenting intervention reach, adoption, implementation, and maintenance. Recommendations are offered to help close the gap between efficacy and effectiveness research and to guide evaluation and possible adoption of new programs.

Diffusion of Innovation↗

PubMed2002

Telephone counseling in psychosocial oncology: a report from the Cancer Information and Counseling Line.

Providing psychosocial counseling services to cancer patients and their significant others by telephone is emerging as an alternative to traditional (in-person) counseling programs in psychooncology. In this paper, data are reported describing the clients of such a program that has been in continuous operation since 1981: the Cancer Information and Counseling Line (CICL) of the AMC Cancer Research Center. An examination of call record forms completed between 1 June 1998 and 30 May 1999 (N = 1627) revealed that the vast majority of callers were female (77%), non-Hispanic White (77%), with at least some college education (62%). Only 27% were cancer patients/survivors, compared to 43% who were spouses, other relatives and friends of cancer patients/survivors, and 16% who were symptomatic callers. Breast cancer was by far the most frequently mentioned cancer site (30%). Although initial topics of inquiry were dominated by requests for medical information (77%), with only a small percentage of callers initially requesting psychosocial support and counseling (12%), by the time, the call was completed, 67% had received some form of psychosocial support and/or counseling. Recommendations for future research are discussed within the context of this review.

Adult↗

PubMed2002

Increasing cervical cancer screening among underserved women in a large urban county health system: can it be done? What does it take?

BACKGROUND: Further reduction in avoidable cervical cancer morbidity and mortality may require system-wide, integrated approaches implemented in the public health facilities serving the nation's indigent and minority women. OBJECTIVES: Report on the evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation. MATERIALS AND METHODS: A longitudinal nonequivalent control group design was utilized. Data were collected during a baseline (no intervention) year and 2.5 years of intervention. A large hospital, one feeder Comprehensive Health Centers (CHC), and three of the health center's feeder Public Health Centers (PHC) received the intervention. Another hospital, CHC and its three feeder PHCs (matched on size, patient characteristics, and range of services provided) served as comparison sites. Independent random samples of patients 18 years and older were drawn annually at each site (n = 18,642). The outcome measure was a receipt of a Papanicolaou smear during a 9-month period. RESULTS: At the Hospital and CHC levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the PHCs. CONCLUSION: An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women. Retention of program elements in the postresearch phase, and the difficulties and importance of conducting this type of research, is described.

Adult↗

PubMed2002

A brief assessment of concerns associated with genetic testing for cancer: the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire.

The Multidimensional Impact of Cancer Risk Assessment (MICRA) is a new tool to measure the specific impact of result disclosure after genetic testing. The authors compared its performance with that of questionnaires measuring general and cancer-specific distress. Participants (158 women) responded 1 month after they received genetic test results. The women were divided into 4 standard clinical test result groups: BRCA1/2 positive, BRCA1/2 negative, panel negative, and true negative. Factor analysis supported the formation of 3 subscales: Distress (6 items, alpha = .86), Uncertainty (9 items, alpha = .77), and Positive Experiences (4 items, alpha = .75). All 3 MICRA subscales differentiated participants who were BRCA1/2 positive from the other 3 groups. MICRA thus helps identify subgroups of vulnerable genetic testing participants.

Adult↗