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Biomedical subjects

Victoria L Champion

Publications and source records attributed to Victoria L Champion.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of three interventions to increase mammography screening in low income African American women.

BACKGROUND: Low-income African American women are more likely to die of breast cancer than their Caucasian counterparts, and at least part of the difference in mortality results from differential screening adherence. The purpose of this study was to identify more efficacious methods of promoting routine mammography screening in underserved populations. METHODS: A prospective randomized intervention study of 344 low income African American women compared the impact of three interventions on mammography adherence and stage of readiness: (1) pamphlet only; (2) culturally appropriate video; and (3) interactive computer-assisted instruction program. RESULTS: The interactive computer intervention program produced the greatest level of adherence to mammography (40.0%) compared to the video group (24.6%) and the pamphlet group (32.1%). When subjects in the pamphlet and video groups were combined to form a non-interactive group, this group had a significantly lower adherence than the group who received the interactive computer intervention (27.0% versus 40.0%). There was also significantly more forward movement in mammography stage of readiness among participants in the computer group (52.0%) compared to those in the pamphlet group (46.4%) or the video group (31.3%). When combining the non-interactive technology (pamphlet and video) there was also more forward movement in mammography stage of readiness for those in the interactive intervention group (52.0% moved 1 or 2 stages) compared to those in the non-interactive group (36.2%). CONCLUSIONS: These data indicate that tailored approaches are more effective than targeted messages either in print or video format. Another finding of this study is that interactive interventions are more effective than non-interactive interventions in increasing adherence and moving African American women forward in their mammogram stage of readiness.

Adult↗
PubMed2006

Tailored interventions for screening mammography among a sample of initially non-adherent women: when is a booster dose important?

OBJECTIVE: To assess added value of a booster dose of a tailored mammography intervention. METHODS: Participants, non-adherent at baseline, were randomly assigned to usual care or one of three tailored interventions. Intervention group members (n=657) were further randomly assigned to receive/not receive a booster intervention dose. Electronic record mammography data were collected following initial intervention and at 6 and 15 months post-booster. RESULTS: Booster had no effect among women not screened after first intervention dose (n=337). Among women screened after initial dose (n=320), booster predicted re-screening at 6 but not 15 months. A boosterxrace interaction showed a booster effect at 6 months for African Americans (OR=4.66, p=.0005) but not Caucasians (OR=0.74, p=.44). CONCLUSIONS: Findings suggest if a first-dose intervention does not facilitate screening, neither will a booster dose. However, among women for whom a first dose is effective, boosters can facilitate timely repeat adherence, especially among African Americans. At 6 months booster recipients were less likely to be off-schedule but, by 15 months, the groups were similar. PRACTICE IMPLICATIONS: Boosters may effect when, but not whether, women continue screening.

Black or African American↗
PubMed2006

Sociocultural context of mammography screening use.

PURPOSE/OBJECTIVES: To examine variations in cultural and health beliefs about mammography screening among a socioeconomically diverse sample of African American and Caucasian women and to identify which set of beliefs predicted mammography screening adherence. DESIGN: Descriptive, retrospective, cross-sectional study. SETTING: Community-based organizations and public housing. SAMPLE: 111 African American women and 64 Caucasian women, aged 40 years or older, with no history of breast cancer. METHODS: Telephone and in-person structured interviews were conducted. Items used previously validated scales based on the Cultural Assessment Model for Health and the Health Belief Model. MAIN RESEARCH VARIABLES: Race or ethnicity, education, income, personal space, health temporal orientation, personal control, fatalism, susceptibility, benefits, barriers, self-efficacy, and mammography screening adherence. FINDINGS: African American women were more fatalistic about breast cancer and perceived fewer benefits to screening. Mammography screening-adherent women were more future oriented, believed that they had less control over finding health problems early, had fewer barriers to screening, and experienced more physical spatial discomfort during the screening procedure than nonadherent women. CONCLUSIONS: Several of the cultural beliefs were not significantly different by race or ethnicity. However, cultural and health beliefs were significant predictors of mammography screening. IMPLICATIONS FOR NURSING: Theoretically based cultural beliefs are important to consider for behavioral interventions to increase mammography screening in African American and Caucasian women.

Adult↗
PubMed2005

A cognitive behavioral intervention for symptom management in patients with advanced cancer.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of a cognitive behavioral intervention in decreasing symptom severity in patients with advanced cancer undergoing chemotherapy. DESIGN: Prospective, randomized clinical trial based on cognitive behavioral theory. SETTING: Six urban cancer centers in the midwestern United States. SAMPLE: 124 patients 21 years of age or older were recruited and randomized to receive conventional care or conventional care and an intervention. Participants were newly diagnosed with stage III, stage IV, or recurrent cancer (solid tumor or non-Hodgkin lymphoma), undergoing chemotherapy, cognitively intact, and able to read and speak English. METHODS: Data were gathered via telephone interviews at baseline and 10 and 20 weeks after randomization. Nurses with experience in oncology delivered a five-contact, eight-week intervention aimed at teaching patients problem-solving techniques to affect symptom severity. MAIN RESEARCH VARIABLES: Gender, site of cancer, age, symptom severity and depressive symptoms at baseline, group (i.e., experimental versus control), and total symptom severity. FINDINGS: Patients in the experimental group and those with lower symptom severity at baseline had significantly lower symptom severity at 10 and 20 weeks; the experimental difference at 20 weeks occurred primarily in those 60 years of age and younger. Depressive symptoms at baseline predicted symptom severity at 20 weeks; however, age, gender, and site of cancer did not affect symptom severity at either time point. CONCLUSIONS: A cognitive behavioral intervention to teach problem-solving skills can be effective for patient symptom self-management during and following an intervention. IMPLICATIONS FOR NURSING: Problem-solving strategies should be included in educational programs for patients with advanced cancer, particularly those 60 years of age and younger.

Adult↗
PubMed2005

Patients' interest in discussing cancer risk and risk management with primary care physicians.

Little is known about patients' preferences for discussing cancer risks and risk management with primary care physicians. We sought to determine whether patients want to discuss such topics and what factors are associated with this interest. Participants (375 patients ages 40-85, of diverse race and education level) completed a telephone survey prior to scheduled physician visits. Survey included items on perceived health, perceived cancer risk, education level, and whether participants would like to discuss with a physician their breast, ovarian or colon cancer risk, tamoxifen, cancer genetic counseling, and colon cancer screening. Greater proportions were interested in discussing risks for each cancer, compared with those who were not (P < 0.0001). More participants were interested in discussing mammograms (80%) and cancer genetic counseling (60%) than tamoxifen (49%) or colon cancer screening modalities (43-53%). For many topics, poorer perceived health was associated with greater interest in future discussion; higher education level was associated with less interest.

Adult↗
PubMed2005

Secondary prevention of cancer.

OBJECTIVES: To review criteria for mass cancer screening among asymptomatic populations and barriers to secondary prevention of breast, cervical, and colorectal cancers. To describe challenges to implementing theoretically based interventions to increase appropriate cancer screening, follow-up, and surveillance. DATA SOURCES: Published journal articles, text books, and epidemiologic reports. CONCLUSION: Interventions to increase breast, cervical, and colorectal cancer screening participation must be approached from a systems perspective that includes patient, health care provider, and health care system variables. IMPLICATIONS FOR NURSING PRACTICE: Understanding the array of factors that impede progress in the secondary prevention of cancer is necessary to improve care. Nurses have an important role in decreasing morbidity and mortality from breast, cervical, and colorectal cancers.

Clinical Nursing Research↗
PubMed2005

Impact of the Cancer Risk Intake System on patient-clinician discussions of tamoxifen, genetic counseling, and colonoscopy.

The Cancer Risk Intake System (CRIS), a computerized program that "matches" objective cancer risks to appropriate risk management recommendations, was designed to facilitate patient-clinician discussion. We evaluated CRIS in primary care settings via a single-group, self-report, pretest-posttest design. Participants completed baseline telephone surveys, used CRIS during clinic visits, and completed follow-up surveys 1 to 2 months postvisit. Compared with proportions reporting having had discussions at baseline, significantly greater proportions of participants reported having discussed tamoxifen, genetic counseling, and colonoscopy, as appropriate, after using CRIS. Most (79%) reported CRIS had "caused" their discussion. CRIS is an easily used, disseminable program that showed promising results in primary care settings.

Adult↗
PubMed2004

A cost-effectiveness comparison of three tailored interventions to increase mammography screening.

BACKGROUND: Mammography is the primary method used for breast cancer screening. However, adherence to recommended screening practices is still below acceptable levels. This study examined the cost-effectiveness of three combinations of tailored telephone and mailed intervention strategies for increasing adherence to mammography. METHODS: There were 1044 participants who were randomly assigned to one of four groups. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences, and a ratio of cost/improvement in mammogram adherence evaluated the cost-effectiveness. RESULTS: All three of the interventions (tailored telephone, tailored mail, and tailored telephone and mail) had significantly better adherence rates compared with the control group (usual care). However, when also considering costs, one emerged as the superior strategy. The cost-effectiveness ratios for the three interventions show that the tailored mail (letter) was the most cost-effective strategy, achieving 43.3% mammography adherence at a marginal cost of dollar 0.39 per 1% increase in women screened. The tailored mail plus telephone achieved greater adherence (49.4%), but at a higher cost (dollar 0.56 per 1% increase in women screened). CONCLUSIONS: A tailored mail reminder is an effective and economical intervention to increase mammography adherence. Future research should confirm this finding and address its applicability to practice in other settings.

Adult↗
PubMed2004

A breast cancer fear scale: psychometric development.

Fear of breast cancer has been inversely associated with participation in screening. However, investigators have generally used only one item or global scales to measure fear. This report describes development of a fear scale specific to breast cancer. Data from a large study involving mammography adherence were used to test the breast cancer fear scale for validity and reliability. Construct validity was verified through factor analysis and regression analysis predicting mammography. All items loaded on a single factor and theoretical relationships were verified by linear and logistic regression. The Cronbach alpha for the scale was.91.

Aged↗
PubMed2003

Differences in perceptions of risk, benefits, and barriers by stage of mammography adoption.

PURPOSE: The purpose of this report was to identify the relationship of mammography adoption with perceived susceptibility to breast cancer and perceived benefits and barriers to mammography. METHODS: Stage of mammography adoption was based on the Transtheoretical Model. Previously validated scales for susceptibility, benefits, and barriers were administered. The sample included 694 women who were recruited from a large Health Maintenance Organization and general medicine clinic. The mean age was 61.2 years; 30% were African American and 67% were Caucasian. RESULTS: Women who were currently compliant (action) had lower perceived barriers than other groups. Precontemplators and Relapse Precontemplators had lower perceived benefits scores than those who were currently compliant or those who were thinking of having a mammogram. Women who had never received a mammogram were more likely to feel they were too old for the procedure. Stage matched interventions are discussed. CONCLUSIONS: Beliefs differ among women in various stages of mammography adoption. These differences may inform interventions to increase mammography use.

Aged↗
PubMed2003

Beliefs associated with fecal occult blood test and colonoscopy use at a worksite colon cancer screening program.

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Although regular screening can decrease morbidity and mortality from CRC, screening rates nationwide are very low. This descriptive study assessed beliefs associated with fecal occult blood test and colonoscopy use among participants of a worksite colon cancer screening program. Randomly selected employees, aged 40 and older, were mailed a survey on CRC screening-related beliefs. Instruments were tested for reliability and validity. Results indicated that fecal occult blood test use was significantly associated with being female, Caucasian, having low perceived barriers, and provider recommendation. Colonoscopy use was significantly associated with higher knowledge, lower barriers, higher benefits, higher self-efficacy, and provider recommendation. Findings may be used to develop interventions designed to improve CRC screening rates.

Adult↗
PubMed2003

The cost effectiveness of 5 interventions to increase mammography adherence in a managed care population.

OBJECTIVE: To determine the cost effectiveness of 5 combinations of strategies for increasing adherence to mammography recommendations in a population of women between the ages of 50 and 85 years enrolled in a large midwestern health maintenance organization. STUDY DESIGN: A randomized control trial comparing interventions believed to increase mammography adherence. PATIENTS AND METHODS: Intervention strategies included 5 combinations of physician recommendation, telephone, and in-person counseling. A total of 652 participants were randomly assigned to 1 of 6 intervention groups and 628 (95.9%) were available at 6-month follow-up. A logistic regression model with adherence as the dependent variable and group as the independent variable was used to test for significant differences between groups. A ratio of cost to improvement in mammogram adherence evaluated the cost effectiveness at 6 months. RESULTS: All 5 interventions resulted in significantly higher rates of adherence compared to no intervention. However, when considering costs, only 1 emerged as the superior strategy for the overall study population. In-person counseling was the most cost-effective strategy overall, followed closely by in-person counseling and physician's letter intervention. For women contemplating mammography, the telephone contact and physician's letter combination was the most cost-effective intervention. For women not contemplating mammography, the physician's letter was superior. The physician's letter worked best with women who had previous mammograms. For women with no mammogram history, the in-person counseling and physician's letter combination was clearly superior. CONCLUSIONS: The cost effectiveness of mammography screening interventions varies based on women's prior history of mammograms and their future intent. Further, managed care organization member characteristics can be used to determine the most cost-effective mammography screening intervention based on individual readiness.

Aged↗
PubMed2002

Population-based cancer screening.

PURPOSE/OBJECTIVES: To provide an overview of current issues surrounding the prevention of and screening for lung, breast, cervical, colorectal, ovarian, prostate, and skin cancer. DATA SOURCES: Original research, review articles, and published guidelines. DATA SYNTHESIS: Although morbidity and mortality rates have decreased for these cancers, prevention and early detection still require increased funding and research. CONCLUSIONS: More behavioral scientists must be trained in prevention and early detection of cancer, and increased research funding is necessary to encourage advances in primary and secondary prevention. IMPLICATIONS FOR NURSING: Oncology nurses should incorporate appropriate prevention and early-detection strategies into practice.

Adult↗
PubMed2002

Intervention to improve psychological functioning for newly diagnosed patients with cancer.

PURPOSE/OBJECTIVES: To test the effects of a computer-based nursing intervention designed to provide patients and family caregivers with concrete, objective information on symptom management; provide education about disease and treatment; coordinate medical resources; and provide emotional support and counseling. DESIGN: Two-site, randomized clinical trial. SETTINGS: A large, urban, midwestern, tertiary-cancer center and a community-based cancer center in a medium-sized midwestern city. SAMPLE: 109 patients newly diagnosed with breast, colon, or lung cancer who were receiving chemotherapy; 54 received standard care, and 55 participated in the intervention group. METHODS: Outcome data were collected via structured telephone interviews at three time points: baseline, midway through the intervention, and one month postintervention. The intervention consisting of nine visits, five in person and four by telephone, was conducted over 18 weeks by advanced practice oncology nurses. MAIN RESEARCH VARIABLES: Psychosocial functioning, anxiety, and depression. FINDINGS: Patients who received the intervention had significantly less depression between baseline and the midway point, as well as less anxiety and greater improvement in the role-emotional and mental health subscales of the Medical Outcomes Study 36 Short Form. CONCLUSIONS: Cancer-care nursing interventions can decrease psychosocial morbidity and improve quality of life for newly diagnosed patients with cancer undergoing treatment. Additional research is needed to understand who benefited most from the intervention. IMPLICATIONS FOR NURSING: This nurse-directed intervention resulted in improved mental health for patients; however, physical subscales were not changed. Further work is needed to determine why depression and mental health were affected yet physical health and symptoms did not differ between groups. Results support the important role of nurses in addressing mental health issues in patients and families experiencing cancer.

Adult↗
PubMed2002

Comparisons of tailored mammography interventions at two months postintervention.

The recent decrease in breast cancer mortality has been linked in part to increased breast cancer screening. Although the percentage of women screened once is rising, rate of continued adherence is poor. The purpose of this article is to assess the effects of tailored mammography interventions implemented prospectively in a factorial design contrasting groups receiving either (a) usual care (no intervention), (b) tailored telephone counseling for mammography, (c) tailored mailed materials promoting mammography, or (d) a combination of tailored mail and telephone counseling. This prospective, randomized study with a 2 x 2 factorial design included women 51 years and older (N = 1,367) who were not adherent with mammography at baseline. The intervention is based on integration of the Transtheoretical and Health Belief Models. Participants were enrolled in one of two health maintenance organizations or seen in a university-related primary care clinic. Baseline data were collected on mammography history and beliefs and knowledge related to mammography. Data were collected via telephone interviews using previously developed scales. The follow-up interviewers were conducted with 976 women. The sample was 41% White, 56% African American, and 3% other. Mean age at baseline was 66.5. Logistic regression indicates that postintervention mammography status in all three intervention groups was significantly better than usual care, with odds ratios ranging from 1.66 (telephone only) to 2.16 (telephone plus mail).

Aged↗
PubMedDate not supplied

Psychosocial factors related to repeat mammography screening over 5 years in African American women.

The purpose of this study was to investigate health beliefs associated with repeat mammography screening in African American women 51 years or older over a 5-year period. Long-term repeat mammography screening is inconsistent in African American women; therefore, this study measured demographic, knowledge, and health belief predictors of repeat screening. The theoretical framework for this study was the health belief model. Baseline data from a larger randomized controlled trial were analyzed using descriptive statistics and logistic regression. The sample consisted of 602 African American women with no breast cancer history and at least 1 reported screening mammogram in the past 5 years. They were recruited from 3 primary care health settings. Having been screened 4 to 5 times in the past 5 years was associated with more knowledge about screening guidelines and fewer perceived barriers to screening. Results point to the importance of collaborating with African American communities to promote life-long mammography screening by increasing access to culturally appropriate information on screening guidelines and ameliorating barriers to screening within the context of the African American experience.

Black or African American↗
PubMedDate not supplied

Development of cultural belief scales for mammography screening.

PURPOSE/OBJECTIVES: To develop instruments to measure culturally related variables that may influence mammography screening behaviors in African American women. DESIGN: Instrumentation methodology. SETTING: Community organizations and public housing in the Indianapolis, IN, area. SAMPLE: 111 African American women with a mean age of 60.2 years and 64 Caucasian women with a mean age of 60 years. METHODS: After item development, scales were administered. Data were analyzed by factor analysis, item analysis via internal consistency reliability using Cronbach's alpha, and independent t tests and logistic regression analysis to test theoretical relationships. MAIN RESEARCH VARIABLES: Personal space preferences, health temporal orientation, and perceived personal control. FINDINGS: Space items were factored into interpersonal and physical scales. Temporal orientation items were loaded on one factor, creating a one-dimensional scale. Control items were factored into internal and external control scales. Cronbach's alpha coefficients for the scales ranged from 0.76-0.88. Interpersonal space preference, health temporal orientation, and perceived internal control scales each were predictive of mammography screening adherence. CONCLUSIONS: The three tested scales were reliable and valid. Scales, on average, did not differ between African American and Caucasian populations. IMPLICATIONS FOR NURSING: These scales may be useful in future investigations aimed at increasing mammography screening in African American and Caucasian women.

Adult↗