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Article ; Online: Benefits, challenges, and strategies related to using presumptive recommendations for HPV vaccination: A qualitative study with rural and non-rural-serving primary care professionals.

Odebunmi, Olufeyisayo O / Spees, Lisa P / Biddell, Caitlin B / Yemeke, Tatenda / Yanguela, Juan / Higgins, Colleen / Gilkey, Melissa / Ozawa, Sachiko / Wheeler, Stephanie B

Human vaccines & immunotherapeutics

2024 Volume 20, Issue 1, Page(s) 2347018

Abstract: HPV vaccination coverage remains far below the national target of 80% among US adolescents, particularly in rural areas, which have vaccine uptake rates that are 10% points lower than non-rural areas on average. Primary care professionals (PCPs) can ... ...

Abstract	HPV vaccination coverage remains far below the national target of 80% among US adolescents, particularly in rural areas, which have vaccine uptake rates that are 10% points lower than non-rural areas on average. Primary care professionals (PCPs) can increase coverage by using presumptive recommendations to introduce HPV vaccination in a way that assumes parents want to vaccinate. Through semi-structured interviews, we explored PCPs' experiences and perceptions of using presumptive recommendations in rural- and non-rural-serving primary care clinics in North Carolina. Thematic analysis revealed that most PCPs in rural and non-rural contexts used presumptive recommendations and felt the strategy was an effective and concise way to introduce the topic of HPV vaccination to parents. At the same time, some PCPs raised concerns about presumptive recommendations potentially straining relationships with certain parents, including those who had previously declined HPV vaccine or who distrust medical authority due to their past experiences with the healthcare system. PCPs dealt with these challenges by using a more open-ended approach when introducing HPV vaccination to parents. In conclusion, our findings suggest that PCPs in both rural and non-rural settings see value in using presumptive recommendations to introduce HPV vaccination, but to adequately address concerns and ensure increased HPV vaccine uptake, PCPs can use simple and culturally sensitive language to ensure fully informed consent and to maintain parental trust. And to further strengthen HPV vaccine discussions, PCPs can utilize other effective HPV communication techniques, like the Announcement Approach, in discussing HPV vaccinations with hesitant parents.
MeSH term(s)	Humans ; Papillomavirus Vaccines/administration & dosage ; Female ; Rural Population ; Papillomavirus Infections/prevention & control ; Male ; Vaccination/statistics & numerical data ; Vaccination/psychology ; Adolescent ; Primary Health Care ; Parents/psychology ; Qualitative Research ; North Carolina ; Adult ; Attitude of Health Personnel ; Middle Aged ; Vaccination Coverage/statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Patient Acceptance of Health Care/statistics & numerical data ; Health Personnel/psychology ; Interviews as Topic
Chemical Substances	Papillomavirus Vaccines
Language	English
Publishing date	2024-05-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2664176-8
ISSN	2164-554X ; 2164-5515
ISSN (online)	2164-554X
ISSN	2164-5515
DOI	10.1080/21645515.2024.2347018
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Zs.A 6967: Show issues

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Article ; Online: An evaluation of the cost-effectiveness of population genetic screening for familial hypercholesterolemia in US patients.

Hendy, Lauren E / Spees, Lisa P / Tak, Casey / Carpenter, Delesha M / Thomas, Kathleen C / Roberts, Megan C

Atherosclerosis

2024 Volume 393, Page(s) 117541

Abstract: Background and aims: Familial hypercholesterolemia is an underdiagnosed genetic metabolic condition limiting the clearance of low-density lipoprotein cholesterol and increasing lifetime risk of cardiovascular disease. Population genetic screening in ... ...

Abstract	Background and aims: Familial hypercholesterolemia is an underdiagnosed genetic metabolic condition limiting the clearance of low-density lipoprotein cholesterol and increasing lifetime risk of cardiovascular disease. Population genetic screening in unselected individuals could quickly identify cases of familial hypercholesterolemia and enable early prevention, but the economic impact of widespread screening on patients has not been studied. Methods: We assessed the cost-effectiveness of population genetic screening for familial hypercholesterolemia in 20 and 35-year-old adults in the United States from the perspective of patients. We developed a decision tree Markov hybrid model to examine diagnoses, cardiovascular disease, cardiac events, quality of life, and costs under population genetic screening compared to family-based cascade testing. Results: While population genetic screening increased diagnoses and reduced incidence of cardiovascular disease, population genetic screening was not cost-effective compared to cascade testing at current levels of willingness to pay. Lower genetic testing costs, combined screening with other genetic conditions, and support to maintain lipid-lowering therapy use over time could improve the cost-effectiveness of population genetic screening. Conclusions: Future research is needed to examine how cost-sharing strategies may affect the cost-effectiveness of screening to patients and how families and providers experience the clinical and economic outcomes of population screening.
Language	English
Publishing date	2024-04-16
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80061-2
ISSN	1879-1484 ; 0021-9150
ISSN (online)	1879-1484
ISSN	0021-9150
DOI	10.1016/j.atherosclerosis.2024.117541
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Zs.A 226: Show issues

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Article ; Online: Barriers to COVID-19 vaccine uptake among resource-limited adults diagnosed with chronic illness.

Spees, Lisa P / Biddell, Caitlin B / Angove, Rebekah S M / Gallagher, Kathleen D / Anderson, Eric / Christenbury, Ashley / Rocque, Gabrielle / Wheeler, Stephanie B

Frontiers in public health

2023 Volume 11, Page(s) 1046515

Abstract: Background: Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ... ...

Abstract	Background: Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination. Methods: We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination. Results: Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7-15.1) and 18.1 (95% CI: 4.3-32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5-11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake. Conclusion: Among a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care.
MeSH term(s)	Male ; Female ; Humans ; Adult ; COVID-19 Vaccines ; COVID-19/epidemiology ; COVID-19/prevention & control ; Vaccines ; Vaccination ; Chronic Disease
Chemical Substances	COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2023-02-09
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1046515
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Article ; Online: Association of patient-reported financial barriers with healthcare utilization among Medicare beneficiaries with a history of cancer.

Biddell, Caitlin B / Spees, Lisa P / Trogdon, Justin G / Kent, Erin E / Rosenstein, Donald L / Angove, Rebekah S M / Wheeler, Stephanie B

Journal of cancer survivorship : research and practice

2023

Abstract: Purpose: We examined characteristics associated with financial barriers to healthcare and the association of financial barriers with adverse healthcare events among US adult cancer survivors enrolled in Medicare.: Methods: We used nationally ... ...

Abstract	Purpose: We examined characteristics associated with financial barriers to healthcare and the association of financial barriers with adverse healthcare events among US adult cancer survivors enrolled in Medicare. Methods: We used nationally representative Medicare Current Beneficiary Survey data (2011-2013, 2015-2017) to identify adults with a history of non-skin cancer. We defined financial barriers as cost-related trouble accessing and/or delayed care in the prior year. Using propensity-weighted multivariable logistic regression, we examined associations between financial barriers and adverse healthcare events (any ED visits, any inpatient hospitalizations). Results: Overall, 11.0% of adult Medicare beneficiaries with a history of cancer reported financial barriers in the prior year, with higher burden among beneficiaries < 65 years of age vs. ≥ 65 (32.5% vs. 8.2%, p < 0.0001) and with annual income < $25,000 vs. ≥ $25,000 (18.1% vs. 6.9%, p < 0.0001). In bivariate models, financial barriers were associated with a 7.8 percentage point (95% CI: 1.5-14.0) increase in the probability of ED visits. In propensity-weighted models, this association was not statistically significant. The association between financial barriers and hospitalizations was not significant in the overall population; however, financial barriers were associated with a decreased probability of hospitalization among Black/African American beneficiaries. Conclusions: Despite Medicare coverage, beneficiaries with a history of cancer are at risk for experiencing financial barriers to healthcare. In the overall population, financial barriers were not associated with ED visits or hospitalizations. Implications for cancer survivors: Policies limiting Medicare patient out-of-pocket spending and care models addressing health-related social needs are needed to reduce financial barriers experienced.
Language	English
Publishing date	2023-06-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2388888-X
ISSN	1932-2267 ; 1932-2259
ISSN (online)	1932-2267
ISSN	1932-2259
DOI	10.1007/s11764-023-01409-x
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Article ; Online: Characterizing Cancer Burden in the American Indian Population in North Carolina.

Spees, Lisa P / Jackson, Bradford E / Raveendran, Yadurshini / Morris, Hayley N / Emerson, Marc A / Baggett, Christopher D / Bell, Ronny A / Salas, Ana I / Meernik, Clare / Akinyemiju, Tomi F / Wheeler, Stephanie B

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

2024

Abstract: Background: The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White ... ...

Abstract	Background: The American Indian (AI) population in North Carolina has limited access to the Indian Health Service. Consequently, cancer burden and disparities may differ from national estimates. We describe the AI cancer population and examine AI-White disparities in cancer incidence and mortality. Methods: We identified cancer cases diagnosed among adult AI and White populations between 2014-2018 from the North Carolina Central Cancer Registry. We estimated incidence and mortality rate ratios (IRR; MRR) by race. Additionally, between the AI and White populations, we estimated relative frequency differences (RRFs, with 95% confidence limits [CL]) of clinical and sociodemographic characteristics. Lastly, we evaluated the geographic distribution of incident diagnoses among AI populations. Results: Our analytic sample included 2,161 AI and 204,613 White individuals with cancer. Compared to the White population, the AI population was more likely to live in rural areas (48% vs 25%; RRF:1.89;CL:1.81,1.97) and to have Medicaid (18% vs 7%; RRF:2.49;CL:2.27,2.71). Among the AI population, the highest age-standardized incidence rates were female breast, followed by prostate and lung and bronchus. Liver cancer incidence was significantly higher among the AI population than White population (IRR:1.27;CL:1.01,1.59). AI patients had higher mortality rates for prostate (MRR:1.72;CL:1.09,2.70), stomach (MRR:1.82;CL:1.15,2.86), and liver (MRR:1.70;CL:1.25,2.33) cancers compared to White patients. Conclusions: To reduce prostate, stomach, and liver cancer disparities among AI populations in North Carolina, multi-modal interventions targeting risk factors and increasing screening and treatment are needed. Impact: This study identifies cancer disparities that can inform targeted interventions to improve outcomes among AI populations in North Carolina.
Language	English
Publishing date	2024-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	1153420-5
ISSN	1538-7755 ; 1055-9965
ISSN (online)	1538-7755
ISSN	1055-9965
DOI	10.1158/1055-9965.EPI-24-0030
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Zs.A 3693: Show issues

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Article ; Online: Area Vulnerability and Disparities in Therapy for Patients With Metastatic Renal Cell Carcinoma.

Rahman, Syed N / Long, Jessica B / Westvold, Sarah J / Leapman, Michael S / Spees, Lisa P / Hurwitz, Michael E / McManus, Hannah D / Gross, Cary P / Wheeler, Stephanie B / Dinan, Michaela A

JAMA network open

2024 Volume 7, Issue 4, Page(s) e248747

Abstract: Importance: Area-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our ... ...

Abstract	Importance: Area-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our knowledge. Objective: To assess the association between area-level measures of social vulnerability and racial and ethnic disparities in the treatment of US Medicare beneficiaries with mRCC from 2015 through 2019. Design, setting, and participants: This retrospective cohort study included Medicare beneficiaries older than 65 years who were diagnosed with mRCC from January 2015 through December 2019 and were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year before through 1 year after presumed diagnosis or until death. Data were analyzed from November 22, 2022, through January 26, 2024. Exposures: Five different county-level measures of disadvantage and 4 zip code-level measures of vulnerability or deprivation and segregation were used to dichotomize whether an individual resided in the most vulnerable quartile according to each metric. Patient-level factors included age, race and ethnicity, sex, diagnosis year, comorbidities, frailty, Medicare and Medicaid dual enrollment eligibility, and Medicare Part D low-income subsidy (LIS). Main outcomes and measures: The main outcomes were receipt and type of systemic therapy (oral anticancer agent or immunotherapy from 2 months before to 1 year after diagnosis of mRCC) as a function of patient and area-level characteristics. Multivariable regression analyses were used to adjust for patient factors, and odds ratios (ORs) from logistic regression and relative risk ratios (RRRs) from multinomial logistic regression are reported. Results: The sample included 15 407 patients (mean [SD] age, 75.6 [6.8] years), of whom 9360 (60.8%) were men; 6931 (45.0%), older than 75 years; 93 (0.6%), American Indian or Alaska Native; 257 (1.7%), Asian or Pacific Islander; 757 (4.9%), Hispanic; 1017 (6.6%), non-Hispanic Black; 12 966 (84.2%), non-Hispanic White; 121 (0.8%), other; and 196 (1.3%), unknown. Overall, 8317 patients (54.0%) received some type of systemic therapy. After adjusting for individual factors, no county or zip code-level measures of social vulnerability, deprivation, or segregation were associated with disparities in treatment. In contrast, patient-level factors, including female sex (OR, 0.78; 95% CI, 0.73-0.84) and LIS (OR, 0.48; 95% CI, 0.36-0.65), were associated with lack of treatment, with particularly limited access to immunotherapy for patients with LIS (RRR, 0.25; 95% CI, 0.14-0.43). Associations between individual-level factors and treatment in multivariable analysis were not mediated by the addition of area-level metrics. Disparities by race and ethnicity were consistently and only observed within the most vulnerable areas, as indicated by the top quartile of each vulnerability deprivation index. Conclusions and relevance: In this cohort study of older Medicare patients diagnosed with mRCC, individual-level demographics, including race and ethnicity, sex, and income, were associated with receipt of systemic therapy, whereas area-level measures were not. However, individual-level racial and ethnic disparities were largely limited to socially vulnerable areas, suggesting that efforts to improve racial and ethnic disparities may be most effective when targeted to socially vulnerable areas.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Carcinoma, Renal Cell/therapy ; Carcinoma, Renal Cell/ethnology ; United States ; Retrospective Studies ; Medicare/statistics & numerical data ; Kidney Neoplasms/therapy ; Kidney Neoplasms/ethnology ; Healthcare Disparities/statistics & numerical data ; Healthcare Disparities/ethnology ; Aged, 80 and over ; Social Vulnerability ; Vulnerable Populations/statistics & numerical data ; Socioeconomic Factors
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.8747
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Article ; Online: Financial burden among metastatic breast cancer patients: a qualitative inquiry of costs, financial assistance, health insurance, and financial coping behaviors.

Waters, Austin R / Petermann, Victoria M / Planey, Arrianna Marie / Manning, Michelle / Spencer, Jennifer C / Spees, Lisa P / Rosenstein, Donald L / Gellin, Mindy / Padilla, Neda / Reeder-Hayes, Katherine E / Wheeler, Stephanie B

Cancer causes & control : CCC

2024

Abstract: Purpose: Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood.: Methods: Qualitative ... ...

Abstract	Purpose: Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood. Methods: Qualitative interviews were conducted to describe the experiences of financial burden for MBC patients, focusing on the drivers of financial burden, their experience using their health insurance, accessing financial assistance, and any resulting cost-coping behaviors. Interviews were transcribed and qualitatively analyzed using a descriptive phenomenological approach to thematic analysis. Results: A total of n = 11 MBC patients or caregiver representatives participated in the study. MBC patients were on average 50.2 years of age (range: 28-65) and 72.7% non-Hispanic White. MBC patients were diagnosed as metastatic an average of 3.1 years (range: 1-9) before participating in the study. Qualitative analysis resulted in four themes including (1) causes of financial burden, (2) financial assistance mechanisms, (3) health insurance and financial burden, and (4) cost-coping behaviors. Both medical and non-medical costs drove financial burden among participants. All participants reported challenges navigating their health insurance and applying for financial assistance. Regardless of gaining access to assistance, financial burden persisted for nearly all patients and resulted in cost-coping behaviors. Conclusion: Our findings suggest that current systems for health insurance and financial assistance are complex and difficult to meet patient needs. Even when MBC patients accessed assistance, excess financial burden persisted necessitating use of financial coping-behaviors such as altering medication use, maintaining employment, and taking on debt.
Language	English
Publishing date	2024-02-22
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1064022-8
ISSN	1573-7225 ; 0957-5243
ISSN (online)	1573-7225
ISSN	0957-5243
DOI	10.1007/s10552-024-01854-8
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Zs.A 3375: Show issues

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Article ; Online: Inclusion of marginalized populations in HPV vaccine modeling: A systematic review.

Spencer, Jennifer C / Spees, Lisa P / Biddell, Caitlin B / Odebunmi, Olufeyisayo O / Ilyasova, Anna A / Yanguela, Juan / Lich, Kristen Hassmiller / Mills, Sarah D / Higgins, Colleen R / Ozawa, Sachiko / Wheeler, Stephanie B

Preventive medicine

2024 Volume 182, Page(s) 107941

Abstract: Objective: Models simulating the potential impacts of Human Papillomavirus (HPV) vaccine have been used globally to guide vaccination policies and programs. We sought to understand how and why marginalized populations have been incorporated into HPV ... ...

Abstract	Objective: Models simulating the potential impacts of Human Papillomavirus (HPV) vaccine have been used globally to guide vaccination policies and programs. We sought to understand how and why marginalized populations have been incorporated into HPV vaccine simulation models. Methods: We conducted a systematic search of PubMed, CINAHL, Scopus, and Embase to identify studies using simulation models of HPV vaccination incorporating one or more marginalized population through stratification or subgroup analysis. We extracted data on study characteristics and described these overall and by included marginalized groups. Results: We identified 36 studies that met inclusion criteria, which modeled vaccination in 21 countries. Models included men who have sex with men (MSM; k = 16), stratification by HIV status (k = 9), race/ethnicity (k = 6), poverty (k = 5), rurality (k = 4), and female sex workers (k = 1). When evaluating for a marginalized group (k = 10), HPV vaccination was generally found to be cost-effective, including for MSM, individuals living with HIV, and rural populations. In studies evaluating equity in cancer prevention (k = 9), HPV vaccination generally advanced equity, but this was sensitive to differences in HPV vaccine uptake and use of absolute or relative measures of inequities. Only one study assessed the impact of an intervention promoting HPV vaccine uptake. Discussion: Incorporating marginalized populations into decision models can provide valuable insights to guide decision making and improve equity in cancer prevention. More research is needed to understand the equity impact of HPV vaccination on cancer outcomes among marginalized groups. Research should emphasize implementation - including identifying and evaluating specific interventions to increase HPV vaccine uptake.
Language	English
Publishing date	2024-03-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2024.107941
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Zs.A 878: Show issues

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Article ; Online: Barriers to Cervical Cancer Screening by Sexual Orientation Among Low-Income Women in North Carolina.

Spencer, Jennifer C / Charlton, Brittany M / Pretsch, Peyton K / Schnarrs, Phillip W / Spees, Lisa P / Hudgens, Michael G / Barclay, Lynn / Wheeler, Stephanie B / Brewer, Noel T / Smith, Jennifer S

Archives of sexual behavior

2024 Volume 53, Issue 5, Page(s) 1645–1652

Abstract: We sought to examine cervical cancer screening barriers by sexual orientation among low-income women in North Carolina. The MyBodyMyTest-3 Trial recruited low-income women (< 250% of federal poverty level) aged 25-64 years who were 1+ year overdue for ... ...

Abstract	We sought to examine cervical cancer screening barriers by sexual orientation among low-income women in North Carolina. The MyBodyMyTest-3 Trial recruited low-income women (< 250% of federal poverty level) aged 25-64 years who were 1+ year overdue for cervical cancer screening. We compared perceptions of cervical cancer screening among those who self-identified as lesbian, gay, bisexual, or queer (LGBQ; n = 70) to straight/heterosexual women (n = 683). For both LGBQ and straight respondents, the greatest barriers to screening were lack of health insurance (63% and 66%) and cost (49% and 50%). LGBQ respondents were more likely than straight respondents to report forgetting to screen (16% vs. 8%, p = .05), transportation barriers (10% vs. 2%, p = .001), and competing mental or physical health problems (39% vs. 27%, p = .10). Addressing access remains important for improving cervical cancer screening among those under-screened. For LGBQ women, additional attention may be needed for reminders, co-occurring health needs, and transportation barriers.
MeSH term(s)	Humans ; Female ; Uterine Cervical Neoplasms/diagnosis ; North Carolina ; Middle Aged ; Adult ; Early Detection of Cancer/statistics & numerical data ; Poverty ; Health Services Accessibility/statistics & numerical data ; Sexual Behavior ; Sexual and Gender Minorities/statistics & numerical data ; Sexual and Gender Minorities/psychology ; Patient Acceptance of Health Care/statistics & numerical data ; Patient Acceptance of Health Care/psychology ; Mass Screening/statistics & numerical data
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	184221-3
ISSN	1573-2800 ; 0004-0002
ISSN (online)	1573-2800
ISSN	0004-0002
DOI	10.1007/s10508-024-02844-2
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Zs.A 1106: Show issues

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Article ; Online: Understanding the multilevel determinants of clinicians' imaging decision-making: setting the stage for de-implementation of low-value imaging.

Hwang, Soohyun / Birken, Sarah A / Nielsen, Matthew E / Elston-Lafata, Jennifer / Wheeler, Stephanie B / Spees, Lisa P

BMC health services research

2022 Volume 22, Issue 1, Page(s) 1232

Abstract: Background: De-implementation requires understanding and targeting multilevel determinants of low-value care. The objective of this study was to identify multilevel determinants of imaging for prostate cancer (PCa) and asymptomatic microhematuria (AMH), ...

Abstract	Background: De-implementation requires understanding and targeting multilevel determinants of low-value care. The objective of this study was to identify multilevel determinants of imaging for prostate cancer (PCa) and asymptomatic microhematuria (AMH), two common urologic conditions that have contributed substantially to the annual spending on unnecessary imaging in the US. Methods: We used a convergent mixed-methods approach involving survey and interview data. Using a survey, we asked 33 clinicians (55% response-rate) to indicate their imaging approach to 8 clinical vignettes designed to elicit responses that would demonstrate guideline-concordant/discordant imaging practices for patients with PCa or AMH. A subset of survey respondents (N = 7) participated in semi-structured interviews guided by a combination of two frameworks that offered a comprehensive understanding of multilevel determinants. We analyzed the interviews using a directed content analysis approach and identified subthemes to better understand the differences and similarities in the imaging determinants across two clinical conditions. Results: Survey results showed that the majority of clinicians chose guideline-concordant imaging behaviors for PCa; guideline-concordant imaging intentions were more varied for AMH. Interview results informed what influenced imaging decisions and provided additional context to the varying intentions for AMH. Five subthemes touching on multiple levels were identified from the interviews: National Guidelines, Supporting Evidence and Information Exchange, Organization of the Imaging Pathways, Patients' Clinical and Other Risk Factors, and Clinicians' Beliefs and Experiences Regarding Imaging. Imaging decisions for both PCa and AMH were often driven by national guidelines from major professional societies. However, when clinicians felt guidelines were inadequate, they reported that their decision-making was influenced by their knowledge of recent scientific evidence, past clinical experiences, and the anticipated benefits of imaging (or not imaging) to both the patient and the clinician. In particular, clinicians referred to patients' anxiety and uncertainty or patients' clinical factors. For AMH patients, clinicians additionally expressed concerns regarding legal liability risk. Conclusion: Our study identified comprehensive multilevel determinants of imaging to inform development of de-implementation interventions to reduce low-value imaging, which we found useful for identifying determinants of de-implementation. De-implementation interventions should be tailored to address the contextual determinants that are specific to each clinical condition.
MeSH term(s)	Humans ; Male ; Surveys and Questionnaires
Language	English
Publishing date	2022-10-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-08600-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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