Low Literacy Patients Research Articles

Quality intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non safety net centers.

284 Background: Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH). Methods: Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers. Results: All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians. Conclusions: The 4R Care Sequence is a promising quality tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment. Does Care Sequence help / rationale % of all clinicians N=18 % of safety net clinicians n=10 % of non safety net clinicians n=8 P value Helps Explain Timing of Biomarkers & Decision, Need to Wait for Results 100 100 100 1 - Describes how biomarker testing fits into overall care plan 94 100 88 .4 - Visually depicts timing of testing & treatment decision 83 80 88 1 - Recommends patients to be active preparing for treatment while waiting 78 80 75 1 - As a standard, normalizes timing of results, decisions 56 30 88 .02* Helps Discuss With Lower Health Literacy Patients 89 90 88 1 - Combines visual timeline & succinct checklist 61 60 63 1 - Uses plain language as possible 39 60 13 .02* - Helps address SDOH while waiting 72 70 75 1 Helps Train Fellows 92 100 67 .2 - Reminds to order biomarkers, other workup 77 80 67 1 - Helps develop narrative, organize discussion of biomarkers 77 80 67 1 - Prompts to discuss SDOH, refer to related care 62 80 0 .04* *Statistically significant, p<.05.

Protocol paper for an implementation science approach to promoting colorectal cancer screening in Federally Qualified Health Center clinics: A stepped-wedge, multilevel intervention trial.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States. Despite the Healthy People 2030 goal of 70.5%, colorectal cancer (CRC) screening rates in Federally Qualified Health Centers (FQHCs) are suboptimal at about 40%. The Colorectal Cancer Awareness, Research, Education and Screening-Rural Expansion, Access, and Capacity for Health (CARES-REACH) study seeks to address this disparity and accelerate the adoption and utilization of effective, evidence-based CRC screening practices. This paper describes the CARES-REACH study design and implementation methods. Informed by a community-based participatory research (CBPR) framework and enriched by implementation science approaches, CARES-REACH features a stepped wedge design with extension for maintenance to support an implementation strategy focused on multiple levels: organizational, provider, and patient levels that entail processes to boost initial and repeat screening among average risk and age-eligible adults. This multilevel study entails the implementation of a core set of evidence-based interventions (EBIs) that include low literacy patient education (English, Spanish, and Haitian Creole language); provider education, system-wide electronic medical record (EMR) tools including provider prompts and patient reminders, FIT (fecal immunochemical test) kit distribution, plus an organization-wide cancer control champion who motivates providers, coaches and navigates patients, and monitors system-wide CRC screening activities. NCT04464668.

Developing a multimedia patient-reported outcomes measure for low literacy patients with a human-centered design approach.

Almost all patient-reported outcomes measures (PROMs) are text-based, which impedes accurate completion by low and limited literacy patients. Few PROMs are designed or validated to be self-administered, either in clinical or research settings, by patients of all literacy levels. We aimed to adapt the Patient Reported Outcomes Measurement Information System Upper Extremity Short Form (PROMIS-UE) to a multimedia version (mPROMIS-UE) that can be self-administered by hand and upper extremity patients of all literacy levels. Our study in which we applied the Multimedia Adaptation Protocol included seven phases completed in a serial, iterative fashion: planning with our community advisory board; direct observation; discovery interviews with patients, caregivers, and clinic staff; ideation; prototyping; member-checking interviews; and feedback. Direct observations were documented in memos that underwent rapid thematic analysis. Interviews were audio-recorded and documented using analytic memos; a rapid, framework-guided thematic analysis with both inductive and deductive themes was performed. Themes were distilled into design challenges to guide ideation and prototyping that involved our multidisciplinary research team. To assess completeness, credibility, and acceptability we completed additional interviews with member-checking of initial findings and consulted our community advisory board. We conducted 12 hours of observations. We interviewed 17 adult English-speaking participants (12 patients, 3 caregivers, 2 staff) of mixed literacy. Our interviews revealed two distinct user personas and three distinct literacy personas; we developed the mPROMIS-UE with these personas in mind. Themes from interviews were distilled into four broad design challenges surrounding literacy, customizability, convenience, and shame. We identified features (audio, animations, icons, avatars, progress indicator, illustrated response scale) that addressed the design challenges. The last 6 interviews included member-checking; participants felt that the themes, design challenges, and corresponding features resonated with them. These features were synthesized into an mPROMIS-UE prototype that underwent rounds of iterative refinement, the last of which was guided by recommendations from our community advisory board. We successfully adapted the PROMIS-UE to an mPROMIS-UE that addresses the challenges identified by a mixed literacy hand and upper extremity patient cohort. This demonstrates the feasibility of adapting PROMs to multimedia versions. Future research will include back adaptation, usability testing via qualitative evaluation, and psychometric validation of the mPROMIS-UE. A validated mPROMIS-UE will expand clinicians' and investigators' ability to capture patient-reported outcomes in mixed literacy populations.

Educational intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non-safety net centers.

9023 Background: Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH). Methods: Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers. Results: All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians. Conclusions: The 4R Care Sequence is a promising educational tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment. [Table: see text]

Improvement of patients’ antibiotic adherence: a descriptive analysis of pharmacists’ interventions

Community and hospital pharmacists are responsible for the correct dispensation of antibiotics and patient counselling. This descriptive study aimed to identify the potentially effective pharmacists’ interventions which improved patients’ antibiotic adherence, based on the findings of a set of studies identified in a previous developed systematic review. Only controlled trials evaluating the impact of pharmaceutical interventions on patient adherence to antibiotics, i.e., intervention group vs. usual care/control group were conveniently selected. These studies were grouped and analyzed based on the distinction between trials with significant vs. non-significant improvements on patients’ adherence to antibiotics. Twenty-one trials were identified, but only 2/3 presented statistically significant results. Diverse pharmaceutical interventions significantly improved patients’ antibiotic adherence, such as structured interventions, the use of visual aids, detailed counseling, written information, call-back phone calls, or the dispensation of personalized doses of antibiotics. Reinforced pharmacist education is likely to be especially relevant in the case of complex therapies (e.g., H. pylori treatment) and/or low literacy patients. In conclusion, structured and/or reinforced pharmaceutical interventions can significantly improve patients’ antibiotic adherence in community or hospital pharmacies, according to some of the analyzed studies.

Analysis of Psychosocial Factors Affecting Dietary Behavior among People with Type 2 Diabetes Mellitus in Indonesia

Dietary behavior is essential to diabetes self-management in people with type 2 diabetes mellitus. Understanding factors influencing diabetes self-management will help in designing appropriate intervention. The study aims to determine the effect of psychosocial on dietary behavior. This study was an analytical observational with a cross-sectional design. The sample size was 138 respondents recruited with multistage random sampling. Psychosocial factors were identified using; 1) Spoken Knowledge in Low Literacy patients with Diabetes Scale, 2) The Coping Scale, 3) Diabetes Distress Scale, 4) Hensarling Diabetes Family Support Scale, 5) Perceived nurse support questionnaire, while dietery behaviour was measured by Self-Management Dietary Behaviors Questionnaire. Data analysis used multiple linear regression. Among five psychosocial factors only two factors influenced dietary behaviour, such as; distress and perceived family support (p=0.004; p=0.001 < α=0.05). Meanwhile, knowledge, coping, and perceived nurse support did not affect diabetes diet (p=0.133; p=0.527; p=0.535 > α=0.05) with R2 = 0.275 (F=11.148; p=0.001 <α=0.05). Distress and perceived family support are two psychosocial factors that can affect dietary behavior. Preventing the occurrence of distress and increasing family support are important to improve dietary behavior adherence in people with type 2 diabetes mellitus.

Development and Validation of COVID-19 Vaccine Messaging Materials for Latinx Communities

With pervasive health misinformation and mistrust, many of those at greatest risk from COVID-19 have demonstrated lower vaccine acceptance. In Chicago, IL, surveillance data has revealed lower rates of vaccine uptake among Black and Latinx individuals compared with others. We partnered with two local federally qualified health centers (FQHCs) to develop and implement language-concordant, low literacy patient education materials to promote COVID-19 vaccine knowledge, acceptance, and uptake. Our multi-phase study included: 1) iterative content generation and refinement by health literacy experts, health center providers and staff, and community-dwelling adults; and 2) materials testing via a two-arm randomized experiment among adults from Latinx communities in the Chicagoland area. Results indicate that our English and Spanish-language COVID-19 Fact Sheets increase knowledge about COVID-19 vaccination. These materials are publicly available and can be used by health centers or community organizations to promote COVID-19 vaccination among diverse populations.

Content and Clinical Validation of the Nursing Outcome “Health Literacy Behaviour”: A Validation Protocol

To validate the contents of the nursing outcome 'Health Literacy Behaviour (2015)' in order to use them in nursing care plans, and to evaluate their psychometric properties, application level, and effectiveness in nursing care to detect low health literacy patients. a methodological two-phased study: (1) an exploratory study and content validation by expert consensus, who will evaluate revised content of nursing outcomes; (2) methodological design by clinical validation. The validation of this nursing outcome in NOC will enable the generation of a helpful tool that would facilitate nurses to set individualised and efficient care interventions and identify low health literacy populations.

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Is reducing the early postoperative complications of percutaneous suprapubic catheterization affected by the method of healthcare education in low-literacy patients? A prospective randomized comparative study

Abstract Background Suprapubic catheters (SPCs) are associated with a wide spectrum of undesirable symptoms and complications, ranging from skin overgranulation to septicemia. They can be effectively managed through various medical and healthcare interventions. We compared the impact of illustrated brochure healthcare education (IBHE) and verbal-only healthcare education (VOHE) on early postoperative complications of SPC in patients with low literacy levels. Materials and methods Eighty patients with low literacy levels who underwent SPC insertion were randomly allocated to receive either IBHE or VOHE between January 2019 and June 2020. Variables, including postoperative complications (within 30 days), were compared. This study was approved by our institutional review board (IRB number: 1780011/2019). Results The IBHE and VOHE groups included 40 patients each. The mean age ± standard deviation was 52.75 ± 16.46 and 53.25 ± 17.19 years, respectively. Acute urinary retention was the main presenting symptom (36 [90%] vs. 34 [85%]), and benign prostatic hyperplasia was the main underlying pathology (16 [40%] vs. 15 [37.5%]). The incidence of SPC obstruction (p = 0.000), urine leakage (p = 0.006), falling out (p = 0.003), suprapubic pain (p = 0.012), exit skin manifestations (p = 0.000), bleeding (p = 0.041), change (p = 0.003), and hematuria (p = 0.000) was significantly lower in IBHE than in VOHE. However, catheter-associated bladder discomfort (p = 0.247), bacteriuria (p = 0.154), and gross pyuria (p = 0.625) were not significantly different between the groups. The frequency of Clavien-Dindo grades was significantly higher in the VOHE group than in the IBHE group. Grade I (87.5% vs. 67.5%, p = 0.032) and grade IIIa (2.5% vs. 22.5%, p = 0.007) were significantly more frequent in the highest grade in IBHE and VOHE groups, respectively. Conclusions IBHE appears to be a suitable and effective method for educating low-literacy patients undergoing SPC insertion. It significantly reduced the incidence and grade of early postoperative SPC complications compared with VOHE, except for catheter-associated bladder discomfort, bacteriuria, and gross pyuria.

Successes and challenges of latent TB screening and treatment in a high-prevalence US region.

BACKGROUND: South Texas has higher TB disease incidence than much of the United States. We evaluated a multi-site South Texas interferon-gamma release assay (IGRA)-based testing and latent TB infection (LTBI) treatment program targeting high-risk populations.METHODS: Number of IGRA tests, test results, LTBI confirmation, and treatment outcomes were collected over 2.5 years. Sixteen semi-structured patient interviews and 10 site-based focus groups were conducted with providers, nurses, and administrators. Grounded theory identified themes associated with successful outcomes.RESULTS: Of 9,050 IGRA tests, 687 (8%) were positive; 340 (49%) confirmed as LTBI; 191 initiated LTBI treatment; and 130 (68% of initiators) completed treatment. Patient barriers to treatment completion included lack of knowledge, misconceptions, and treatment toxicities. Clinic staff concurred that toxicity was a barrier to treatment and requiring new processes with limited resources were implementation barriers.CONCLUSIONS: Over 9,000 patients were screened with a high prevalence of IGRA positivity, but confirming LTBI, initiating, and completing treatment were challenging. Qualitative evaluation supports low literacy patient education on LTBI and toxicities and expanded support for process implementation and provider training. These findings highlight challenges at all levels of the LTBI care cascade and provide patient, staff, and provider perspectives on implementation of these programs.

Effectiveness of Video-discharge Instructions about Colostomy Self-care on Awareness and Self-efficacy of Low-Literacy Patients

Effectiveness of Video-discharge Instructions about Colostomy Self-care on Awareness and Self-efficacy of Low-Literacy Patients

Efeitos de intervenção educativa no letramento em saúde e no conhecimento sobre diabetes: estudo quase-experimental

ABSTRACT Objective To analyze the effects of educational intervention on health literacy and knowledge about diabetes in adults assisted in primary health care. Method This is a quasi-experimental study with educational intervention during the nursing consultation with 33 adults diagnosed with type 2 diabetes mellitus registered in a Family Health Strategy Unit in southern Brazil and involving group activity and telephone follow-up. Sociodemographic and clinical instruments were applied before and after the intervention; these instruments included the Spoken Knowledge in Low Literacy Patients with Diabetes and the Eight-Item Health Literacy Assessment Tool. Data were analyzed using the Wilcoxon, Spearman, and McNemar correlation coefficient tests. Results Most participants were women (69.7%), with a mean age of 57.0 years, less than nine years of schooling (69.7%), and ≤10 years of diagnosis (51.5%). After the intervention, there was an increase in knowledge about diabetes (p = 0.001), correlated with health literacy (r = 0.494; p = 0.001) and the time of diagnosis (r = 0.455; p = 0.001). Conclusion and implications for practice The instruments to measure health literacy and knowledge about diabetes enabled the construction of educational strategies aimed at existing gaps, increasing the knowledge, thereby favoring the development of skills for self-management.

A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease

BackgroundType 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components:Meetings of peer support groupsPersonalised telephone-based health coaching for patients with low literacy and/or low patient activationPersonalised patient feedbackA browser-based web portalMethodsStudy participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention.DiscussionIf the intervention proves effective, it may be included into the DMPs for T2DM and CHD.Trial registrationThe study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network (https://www.drks.de/drks_web/setLocale_EN.do) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given (https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.

Developing a protocol for adapting multimedia patient-reported outcomes measures for low literacy patients.

Self-administration of patient-reported outcomes measures (PROMs) by patients with low literacy is a methodologic and implementation challenge. There is an increasing emphasis on patient-centered care and wider adoption of PROMs to understand outcomes and measure healthcare quality. However, there is a risk that the use of PROMs could perpetuate health disparities unless they are implemented in an inclusive fashion. We present a protocol to adapt validated, text-based PROMs to a multimedia format (mPROMs) to optimize self-administration in populations with limited literacy. We describe the processes used to develop the protocol and the planned protocol implementation. Our study protocol development was guided by the International Quality of Life Assessment (IQOLA) protocol for translating and culturally adapting PROMs to different languages. We used the main components of IQOLA's protocol to generate a conceptual framework to guide development of a Multimedia Adaptation Protocol (MAP). The MAP, which incorporates human-centered design (HCD) and takes a community-engaged research approach, includes four stages: forward adaptation, backward adaptation, qualitative evaluation, and validation. The MAP employs qualitative and quantitative methods including observation, cognitive and discovery interviews, ideation workshops, prototyping, user testing, co-creation interviews, and psychometric testing. An iterative design is central to the MAP and consistent with both the IQOLA protocol and HCD processes. We will pilot test and execute the MAP to adapt the Patient Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Short Form for use in a mixed literacy hand and upper extremity patient population in Baltimore, Maryland. The MAP provides an approach for adapting PROMs to a multimedia format. We encourage others to evaluate and test this approach with other questionnaires and patient populations. The development and use of mPROMs has the potential to expand our ability to accurately capture PROs in limited literacy populations and promote equity in PRO measurement.

Knowledge and Attitude of Low-Literacy Patients Undergoing Suprapubic Catheter Insertion

Background: Providing the patient with sufficient knowledge about his illness improves the outcomes when delivered properly. Aims: To assess the knowledge and attitude of low-literacy patients undergoing suprapubic catheter insertion. Methods: Study design: Descriptive research design was utilized. Setting: Urology and Nephrology Hospital, Assiut University. Subjects: Eighty patients undergoing suprapubic catheter were selected consecutively within a 12-month period (with maximally primary school educations). Tools: Patient interview questionnaire included 4 parts; parts 1 and 2 to assess demographic and medical data, parts 3 and 4 to assess patients' level of knowledge and attitude. Results: All patients were males with 47.5% of them aged from 50-65 years old. They had poor knowledge about the indications (0%), definition (0%), function (6.3%), procedures of insertion (2.5%) and change (22.5%), receipt of education at the primary care settings (47.5%), ability of self-healthcare (40%), previous experiences (10%) postoperative symptoms (0%) and complications among the studied patients (17.5%) including urine leakage (8.7%) and obstruction (17.5%) of the suprapubic catheter. While most of the patients (95%) reported insufficient healthcare education at the primary settings, all the studied patients wished to have a suitable method for education. There was no statistically significant relation between total knowledge levels and the demographic data. Conclusions: Most of the patients had poor knowledge about the suprapubic catheter and favorable attitudes towards suitable education. Recommendations: Designing a simple method to provide healthcare education for low-literacy patients undergoing suprapubic catheter.

Abstract PO-051: Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video

Abstract In public health settings, where availability of genetic counseling (GC) and testing for hereditary breast and ovarian cancer is limited, telehealth could expand access to academic centers where these services are concentrated. However, little is known about the effectiveness of remote modes for ethnically diverse and low health literacy patients. Methods. From 2017-20 UCSF researchers partnered with 3 public hospitals to conduct a partially randomized preference noninferiority trial with English-, Spanish-, and Cantonese-speaking patients with strong personal and/or family history of cancer. Participants received GC in person, by phone, or via video. Pre- and post-GC telephone surveys measured study outcomes: knowledge, cancer- specific distress, decisional conflict, risk perception, and satisfaction. A subset of 23 participants was recruited for case studies (CS) to elucidate quantitative findings. CS integrated patient and counselor in-depth interviews, GC session transcripts, and survey and tracking data for a multi-dimensional understanding of each individual’s GC experience. Results. Among 23,633 family history forms collected, 1,574 patients were eligible; 1404 were reached and 708 consented. Of 394 randomized, 322 attended GC and 312 completed the final survey. After GC, mean knowledge scores increased, and cancer-specific distress and decisional conflict decreased overall. Counseling attendance varied significantly by assigned mode (75% via video at a clinic, 77% in person, and 92% by phone), but the modes yielded noninferior outcomes. Respondents overwhelmingly rated all modes as “very convenient” and satisfaction with counseling as “very high.” Compared with baseline, knowledge increased significantly regardless of mode. However, this increase was significantly less for African Americans and for those with less education (with each adjusted for the other) across all modes. Completion of genetic testing (GT) was the inverse of counseling attendance: 94% in person, 93% video, and 65% by phone. Case studies (CS) revealed the complexities of counseling public hospital patients. Phone patients valued the access despite connection issues, but phone appointments tended to be briefer, and qualitative interviews suggested that communication was less effective by phone. While many phone patients said they would not be able to access GC any other way, several felt they would get more out it in person. Importantly, GT was offered on the spot to in-person patients while some counseled by phone had second thoughts and other barriers. CS of video counseling found benefits similar to in-person GC such as use of visual cues and formation of meaningful connections. Conclusion. Our findings indicate that GC can be delivered to high-risk public hospital patients remotely by phone, video, or in-person in order to fill a gap in access to critical genetic services. Further research is needed to achieve optimal outcomes for all patients and to increase the rate of testing for those counseled by phone. Citation Format: Rena J Pasick, Susan L. Stewart, Robin Lee, Claudia Guerra, Celia Kaplan, Galen Joseph, Selina Flores, Janice Tsoh, Niharika Dixit, Miya Frick, Heather Cedermaz, Lily Wong, Amal Khoury, Brittany Campbell. Genetic counseling for high-risk public hospital patients: A randomized and preference-based trial compares delivery in person, by phone, and video [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-051.

Analysis of the Sociodemographic and Psychological Factors of the Family Caregivers’ Self-Management Capabilities for Type 2 Diabetes Mellitus

Introduction: The successful management of Type 2 diabetes mellitus is determined by the role of the family in self-management as a family caregiver. Many factors influence the capability of the family caregivers to carry out diabetes self-management. The purpose of this study was to analyze the factors that influence the family caregiver capability of performing diabetes self-management in people with Type 2 diabetes mellitus.Methods: The study design was an analytical observation using a cross-sectional approach. The sample was 220 family caregivers of people with Type 2 diabetes mellitus in Jember Regency, East Java Province, Indonesia. The multistage random sampling technique was used as the sampling technique. The research instrument was a questionnaire. The questionnaires used in this study were the Diabetes Management Self Efficacy Scale, the Spoken Knowledge in Low Literacy Patients with Diabetes Questionnaire, the Motives for Caregiving Scale, the Spirituality Index of Well-Being, the Sense of Coherence Scale, the Coping Scale, the Hensarling Diabetes Family Support Scale, and the Family Caregiver's Perception of the Role of the Nurse Questionnaire. The data analysis was performed using the Pearson correlation test, the Spearman rank test, and the multiple linear regression test.Results: The results of the Pearson correlation test and Spearman rank test showed that the sociodemographic factors associated with diabetes self management were age (p=0.000), gender (p=0.016), education (p=0.000), income (p=0.000), and kinship (p=0.000). The psychosocial factors associated with diabetes self management were diabetes knowledge (p=0.000), motivation (p=0.000), coping skills (p=0.000), spirituality (p=0.000), family coherence (p=0.000), family support (p=0.000) and the role of the nurses (p=0.000). The multiple linear regression test showed that the factors associated with diabetes self management were diabetes knowledge (β=0.047), motivation (β=0.094), coping (β=0.188), spirituality (β= -0.082), family coherence (β= −0.043), family support (β= 0.296) and the role of the nurses (β= 0.512).Conclusion: Efforts to increase the family caregiver’s capabilities in terms of diabetes self-management should pay attention to the socio-demographic and psychosocial factors to prevent complications and to improve the health status, and quality of life of people with Type 2 diabetes mellitus.

Development of Pictograms to Communicate Technological Solution Instructions (Labeling) Among Low-Literacy Users

Conveying information for appropriate use of devices is uniquely challenging in low-resource settings. Drug makers have previously developed culturally meaningful informational pictograms to, for example, convey timing of doses, among low-literacy patients. We tested a similarly structured process among Ugandan smallholder farmers. Over 67% of the pictograms scored a passing grade after the second round of testing, meeting our overall success criterion. The process is efficacious in developing instructional/teaching (labeling) pictograms. These findings can help solution/device developers for low-resource settings to provide correctly interpretable pictograms and thus eliminate misuse-driven low uptake.

Randomized trial of web-based genetic education versus usual care in advanced cancer patients undergoing tumor genetic testing: Results from the ECOG-ACRIN NCI Community Oncology Research Program (NCORP; EAQ152) COMET trial.

2008 Background: Enthusiasm for precision oncology may obscure the complex psychosocial and ethical considerations for tumor genetic testing. Low patient genetic knowledge has been documented and heightens the risk for adverse experiences. We developed a web-based intervention to increase genetic knowledge and decrease distress among advanced cancer patients undergoing tumor genetic testing. Methods: 594 patients (80% from NCORP Community Sites) were recruited and randomized to web-intervention (n = 293) or usual care (n = 301), prior to receipt of tumor genetic test results. Primary outcomes were genetic knowledge, anxiety, depression, and cancer-specific distress measured at T0 (prior to intervention), T1 (post-intervention), T2 (after receipt of tumor results) and T3 (3 months post receipt of tumor results). Secondary outcomes included satisfaction, regret and disappointment. The effect of web-intervention was evaluated using t-test, multiple linear regression and logistic regression, with an intent-to-treat approach. Results: Patients randomized to web-intervention had better knowledge improvement than those randomized to usual care (T1-T0, p < 0.0001; T2-T0, p = 0.003). No difference was observed in change scores for anxiety, depression or cancer-specific distress. To find the moderators of intervention effect (including sex, age, education, and literacy) two 2-way interactions were noted with statistical significance: higher depression among those in the intervention arm versus the control arm for patients with lower literacy (p = 0.03); and lower cancer-specific distress among women in the intervention arm than with usual care but no such effect noted in men (p = 0.01). 71% of patients reported receiving tumor test results and this did not differ by arm. Only 20% of patients reported regret and disappointment at T2, which was more likely for those without a mutation of interest (MOI) detected vs those with a MOI detected (OR = 2.08, 95% CI, 1.13 to 3.83, p = 0.02). Conclusions: Web-based education prior to receipt of tumor genetic test results increases patient understanding of tumor genetic testing. While the intervention did not significantly reduce distress, results suggest that women who received the intervention had lower cancer-specific distress than those with usual care. Future refinements to the web-intervention are needed to address low literacy groups, men and patients with no actionable results. Clinical trial information: NCT02823652.