Screening Intentions Research Articles

Prostate cancer screening in Black men: Screening intention, knowledge, attitudes, and reasons for participation

ABSTRACT The objective of the present study is to capture the prostate cancer screening intention, knowledge levels, attitudes, and reasons for participation in screening among African American men. African American men aged from 35 to 65 in Georgia, North Carolina, and Ohio were recruited for study (N = 168). Questionnaires were administered using validated instruments. Findings suggest critical needs for community-based social workers to communicate the importance of prostate cancer screening and risk factors among African American men. Increasing the use of culturally relevant community health education might benefit underserved minority men at risk of having prostate cancer.

Developing a predictive model for prostate cancer screening intent among African American males

The purpose of this cross-sectional, predictive correlational study was to examine the relationship between African American male inmates’ behavioral intentions with regard to the intention to screen for prostate cancer. To this end, the study devised and tested a model of relevant predictors, including Direct Attitude, Indirect Subjective Norms, Indirect Outcome Evaluation, and Health Literacy. Data were analyzed using descriptive and inferential statistics. The findings suggest that African American male inmates in the federal prison system may have slightly different priorities relative to non-incarcerated populations. The implications for nurses and other healthcare providers working in the prison system include: empowering inmates by building a trusting relationship; investigating ways to improve health literacy in this population, and developing an understanding of the factors that inspire African American inmates to engage in the decision-making process. The limitations of this study include a reliance on participant self-reports and a relatively small sample size, which limit the generalizability of the results. Nonetheless, future interventions may arise from providers’ greater ability to understand and predict health-related behaviors and foster proactive health attitudes in the inmate population.

Abstract 3385: Liquid biopsy to detect MET exon 14 skipping (METex14) and MET amplification in patients with advanced NSCLC: Biomarker analysis from VISION study

Abstract Purpose: In the ongoing, single-arm, Phase 2 VISION study (NCT02864992), tepotinib (a highly selective MET inhibitor) has shown durable clinical activity in NSCLC patients (pts) with METex14 skipping. Here, we report the biomarker profile of pts screened with liquid biopsy (LBx) for inclusion in the study. Methods: Pts with advanced NSCLC and previously confirmed EGFR/ALK wild-type status were prospectively screened for MET alterations using plasma samples collected during pre-screening/screening. Plasma ctDNA sequencing was performed at a central laboratory using a 73-gene next-generation sequencing panel (Guardant360®). Results: Of 6,034 pts screened, 813 pts had results pending at data cut and of 5,221 pts tested, sequencing failed in 41 pts. The success rate of LBx testing was consistent across centers. Of 5,180 patients analyzed, 694 pts (13.4%) had no mutation detected. Despite the intent of screening EGFR/ALK wild-type pts, 327 pts (6.3%) had EGFR mutations and 49 (0.9%) had ALK/ROS fusions. 188 pts (3.6%) had METex14 skipping (Table) and 256 pts (4.9%) had MET amplification (amp) without METex14 skipping. The median age of METex14 pts was 72 years; 47% were male; 46% were never smokers and 65% had adenocarcinoma histology. In METex14 pts, the most frequently occurring driver co-alterations were amp in MET (13.3%), EGFR (7.4%), CDK4 (6.4%), BRAF (5.3%) and CDK6 (4.8%), and mutations in GNAS (5.3%). In METamp pts, the most frequently occurring driver co-alterations were CDK6 (60.5%), BRAF (43.4%), EGFR (28.9%), MYC (21.9%) and CCNE1 (19.9%) amps. Overall, TP53 mutations were detected in 55.9% of METex14 pts and 79.7% of METamp pts. Table:Characterization of METex14 skipping (n=188)n (%)Insertions/deletions (indels)93 (49.5)Indel at acceptor site54 (28.7)Indel at donor site36 (19.1)Whole exon 14 deletion3 (1.6)Single nucleotide variation (SNV)95 (50.5)SNV at donor site93 (49.5)SNV at acceptor site2 (1.1)SNVs and indelsSNV/indel at donor site129 (68.6)SNV/indel at acceptor site56 (29.8)SNV/indel whole exon 14 deletion3 (1.6) Conclusions: In this population, METex14 skipping can be successfully detected through non-invasive LBx analysis using a next-generation sequencing panel. The rate of METex14 skipping and the genomic profile and demographics of pts were similar to previously reported data. Citation Format: Xiuning Le, Dariusz Kowalski, Byoung Chul Cho, Pierfranco Conte, Enriqueta Felip, Marina Chiara Garassino, Santiago Viteri, Gee-Chen Chang, John Richart, Luiz Paz-Ares, Dilafruz Juraeva, Josef Straub, Christopher Stroh, Paul Paik. Liquid biopsy to detect MET exon 14 skipping (METex14) and MET amplification in patients with advanced NSCLC: Biomarker analysis from VISION study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3385.

Does theory of planned behaviour play a role in predicting uptake of colorectal cancer screening? A cross-sectional study in Hong Kong

ObjectiveColorectal cancer (CRC) ranked second in terms of cancer mortality worldwide. It is associated with a substantial global disease burden. We aimed to examine whether the theory of planned behaviour...

Barriers and facilitators towards colonoscopy: a qualitative systematic review.

Colonoscopy is integral in the early detection of colorectal cancer (CRC), be it for screening, diagnostic or therapeutic intentions. Despite the presence of multiple screening modalities, colonoscopy remains integral in providing a definitive CRC diagnosis. However, uptake rates remain low worldwide with minimal understanding towards stakeholders' perspectives. This systematic review is the first to outline the barriers and facilitators faced by providers and patients in receiving colonoscopy specifically. Using PRISMA guidelines, our systematic review consolidates findings from Medline, Embase, CINAHL, PsycINFO and Web of Science Core collection. All perceptions of healthcare providers and screening participants aged 45 and above towards colonoscopy were included. Forty-five articles were included in our review. Five major analytical themes were identified - procedural perceptions, personal experiences, thoughts and concerns, societal influences, doctor-patient relationship and healthcare system. The discrepancies in knowledge between patients and providers have evidently reduced in the present decade, potentially attributable to the rising influence of social media. The sharing of providers' personal experiences, involvement of patients' family in colonoscopy recommendations and propagation of patients' positive recounts were also more apparent in the past compared to the present decade, highlighting the need to reevaluate the balance between medical confidentiality and personal touch. Additionally, Asian patients were reportedly more apathetic towards CRC diagnosis due to their strong belief in destiny, a crucial association consistent with present studies. This study highlights pertinent gaps in our healthcare system, providing crucial groundwork for interventions to be enacted in engendering higher colonoscopy uptake rates.

Health beliefs as predictors of intentions toward prostate cancer screening among Nigerian immigrant men

Prostate cancer (PCa) globally impacts men of African descent disproportionately more than any other ethnicity. Studies focusing on PCa among the U.S.-based Nigerian immigrant men (NIM) are limited. The purpose of this study was to investigate the predictive effects of health beliefs on NIM’s prostate cancer screening intention using select constructs of two health behavior models. This study consisted of (N = 130) U.S. NIM, aged 40 years and older, who were recruited from local nonprofit associations in New Jersey. Pen-and-paper questionnaire data were gathered using the Behavioral Intention Scale and the modified version of the Champion’s Health Belief Model Scale for Prostate Cancer, along with demographic questions. Data were analyzed in SPSS 25.0. Multiple regression analysis was conducted to evaluate how well perceived susceptibility, benefits, and barriers predicted the intention to undergo screening for prostate cancer. The model was significantly related to intention (R2 = 0.22, F (4,125) = 9.02, p < 0.001). Beta weights indicated that only perceived susceptibility and perceived benefit shared in the 22% of intention variability. Perceived susceptibility (β = 0.61, p < 0.001) and perceived benefits (β = 0.41, p < 0.001) were thus the variables that significantly contributed to the model. Continuous education and awareness of prostate cancer and the importance of screening, as well as a better understanding of health belief perceptions, remain strategies healthcare providers can utilize to reach at-risk minority populations.

Barriers to flexible sigmoidoscopy colorectal cancer screening in low uptake socio-demographic groups: A systematic review.

To synthesise qualitative evidence related to barriers and facilitators of flexible sigmoidoscopy screening (FSS) intention and uptake, particularly within low socio-demographic uptake groups. FSS uptake is lower amongst women, lower socio-economic status (SES), and Asian ethnic groups within the United Kingdom (UK) and United States of America. A total of 12 168 articles were identified from searches of four databases: EMBASE, MEDLINE, PsycINFO and Web of Science. Eligibility criteria included: individuals eligible to attend FSS and empirical peer-reviewed studies that analysed qualitative data. The Critical Appraisal Skills Program tool evaluated the methodological quality of included studies, and thematic synthesis was used to analyse the data. Ten qualitative studies met the inclusion criteria. Key barriers to FSS intention and uptake centred upon procedural anxieties. Women, including UK Asian women, reported shame and embarrassment, anticipated pain, perforation risk, and test preparation difficulties to elevate anxiety levels. Religious and cultural-influenced health beliefs amongst UK Asian groups were reported to inhibit FSS intention and uptake. Competing priorities, such as caring commitments, particularly impeded women's ability to attend certain FSS appointments. The review identified a knowledge gap concerning factors especially associated with FSS participation amongst lower SES groups. Studies mostly focussed on barriers and facilitators of intention to participate in FSS, particularly within UK Asian groups. To determine the barriers associated with FSS uptake, and further understand how screening intention translates to behaviour, it is important that future qualitative research is equally directed towards factors associated with screening behaviour.

A Strategy to Prepare Primary Care Clinicians for Discussing Stopping Cancer Screening With Adults Older Than 75 Years.

Background and ObjectivesAdults older than 75 years are overscreened for cancer, especially those with less than 10-year life expectancy. This study aimed to learn the effects of providing primary care providers (PCPs) with scripts for discussing stopping mammography and colorectal cancer (CRC) screening and with information on patient’s 10-year life expectancy on their patients’ intentions to be screened for these cancers.Research Design and MethodsPatient participants, identified via PCP appointment logs, completed a questionnaire pre- and postvisit. Primary care providers were given scripts for discussing stopping screening and information on patient’s 10-year life expectancy before these visits. Primary care providers completed a questionnaire at the end of the study. Patients and PCPs were asked about discussing stopping cancer screening and patient life expectancy. Patient screening intentions (1–15 Likert scale; lower scores suggest lower intentions) were compared pre- and postvisit using the Wilcoxon signed-rank test.ResultsNinety patients older than 75 years (47% of eligible patients reached by phone) from 45 PCPs participated. Patient mean age was 80.0 years (SD = 2.9), 43 (48%) were female, and mean life expectancy was 9.7 years (SD = 2.4). Thirty-seven PCPs (12 community-based) completed a questionnaire. Primary care providers found the scripts helpful (32 [89%]) and thought they would use them frequently (29 [81%]). Primary care providers also found patient life expectancy information helpful (35 [97%]). However, only 8 PCPs (22%) reported feeling comfortable discussing patient life expectancy. Patients’ intentions to undergo CRC screening (9.0 [SD = 5.3] to 6.5 [SD = 6.0], p < .0001) and mammography screening (12.9 [SD = 3.0] to 11.7 [SD = 4.9], p = .08) decreased from pre- to postvisit (significantly for CRC). Sixty-three percent of patients (54/86) were interested in discussing life expectancy with their PCP previsit and 56% (47/84) postvisit.Discussion and ImplicationsPCPs found scripts for discussing stopping cancer screening and information on patient life expectancy helpful. Possibly, as a result, their patients older than 75 years had lower intentions of being screened for CRC.Clinical Trials Registration NumberNCT03480282

노인의 암검진 행위에 영향을 미치는 요인 : 앤더슨 모델과 건강신념 모델을 중심으로

Purpose: This study tried to provide a baseline information for increasing the rate of cancer screening in the elderly by examining the factors influencing cancer screening behavior in the elderly using Andersen’s model and health belief model. Methods: Participants included 259 elderly from D city, South Korea. The data were collected from July to August, 2019 using structured questionnaires including subjects’ characteristics, knowledge toward cancer screening and health belief variables. Results: The cancer screening rate of the subjects was 66.0%. There were significant differences in monthly income, perception of the National Cancer Screening Program (NCSP), death from cancer in a family member, cancer screening intention, knowledge toward cancer screening, perceived benefit and perceived barrier between two groups. The factors influencing cancer screening behaviors in the elderly were death from cancer in a family member, perception of the NCSP, perceived barrier. Conclusion: This results suggest to increase the rate of cancer screening in the elderly, it is necessary to develop NCSP promotion program and proper education program for the elderly. Additionally, we recommended the research identifying the specific perceived barriers of cancer screening behavior of the elderly. This study provides a reference for developing the policy measures and strategies to increase the cancer screening behavior of the elderly.

Is it disgusting or am I just easily disgusted? The relation between situational disgust, dispositional disgust, and colonoscopy intentions.

While early detection is an effective way to reduce mortality from colorectal cancer, screening rates are low. An underlying factor in screening completion failure may be experiences of disgust when learning about screening and/or dispositional disgust. Participants recruited via Amazon MTurk (N=296) read information about colonoscopy and completed an online survey assessing both dispositional forms of disgust (i.e. trait disgust and disgust sensitivity) and situational forms, including state disgust and disgust associated with colonoscopy. Participants reported intentions to discuss colonoscopy with a provider and to prepare for and complete screening. Greater state disgust and the degree to which one associated disgust with colonoscopy predicted lower screening, preparation and provider discussion intentions. By contrast, neither trait disgust nor disgust sensitivity was associated with intentions. Both disgust sensitivity and trait disgust moderated the state disgust to intentions relation. This is one of few investigations of disgust examining the relation between specific types and colonoscopy intentions. Screening uptake may be improved by identifying specific components of disgust that have an effect on colonoscopy intentions. Future work focusing on the interplay between different disgust mechanisms as they relate to colonoscopy behaviour is important for intervention development.

Abstract C100: Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75

Abstract The purpose of this investigation was to explore perceptions of Black and White women 50-75 years of age about current breast cancer screening guidelines from three national organizations (National Comprehensive Cancer Network, American Cancer Society, and the U.S. Preventive Services Task Force) and in how these guidelines impact their screening intentions. Non-Hispanic Black (n = 29) and White (n = 28) average risk women were recruited from Houston community sites serving those with low-SES to participate in focus groups. Using questionnaires, women reported on: sociodemographic information, knowledge of screening guidelines, personal history of mammograms, and screening intentions. During the focus groups, participants were presented with the three organizations’ screening guidelines and engaged in discussion on the benefits and harms of breast cancer screening mammography. We used a qualitative descriptive approach with inductive and deductive coding to analyze transcripts of video-recorded focus groups. Descriptive statistics were used to summarize questionnaire data. Participant average age was 65.93 years (SD=7.10). Among Black women, 12 had more than a high school degree and $30k was the median annual household income. Among White women, 25 held higher than high school degree and $60k-$70k was the median income. All women reported receiving a mammogram. Most women also reported they “definitely will be tested” in the next year (Black N=22, White N=21). Qualitative analysis revealed both groups of women expressed they enjoyed learning about the three guidelines but questioned the rationale for guideline development; Black women appeared to do so more strongly, whereas some White women expressed satisfaction with multiple guidelines. Although Black and White women expressed concern for younger generations’ access to screening information, White women expressed additional concern for low resource groups. Both groups expressed mistrust with the healthcare system, yet Black women expressed a desire to receive screening information from providers with whom they have deep and lasting relationships with, whereas White women expressed an interest in seeking information from multiple doctors in a less personal manner. Differences also emerged regarding screening intentions; while Black women expressed renewed motivation to continue screening, White women expressed greater openness to screen with less frequency and with discontinuation. These findings help to inform the ways healthcare providers might effectively customize and communicate screening information to racially/ethnically diverse groups of women. Although both groups of women expressed concerns regarding the guidelines, differences emerged in preferences for communicating and receiving screening information, as well as in the impact on their screening intentions. Citation Format: Maggie Britton, Ashley J. Housten, Diana S. Hoover, Lorna H. McNeill, Robert J. Volk. Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C100.

Abstract D018: Dietary and cultural practices of minorities in New York City as an indicator of colorectal cancer screening behavior and screening intent

Abstract There are significant racial and gender disparities in health behaviors and health outcomes in the United States, and these differences are vast and not well understood. As colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, and African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the U.S., it is essential to ascertain the interplay between individual health behaviors that may be unique racial patterns, and health outcomes. This research study is a pilot study that is a part of a larger study with existing preliminary data on the intersection between diet and colorectal cancer. This pilot study examines dietary habits and practices of individuals identifying as Black as a predictor for colorectal cancer screening. This study will assess the relationship between dietary habits and screening behavior and intent. This study will evaluate the correlation between individuals with a higher intake of healthy options and their intent to screen for colorectal cancer within a year. The novelty of this study is rooted in its utilization of a study sample that includes participants who are not currently age eligible for screening according to the new recommended guidelines, but will be age eligible within the next five years, utilization of a novel variable such as dietary habits to correlate with screening behavior and intent, extracting differences by gender, and extracting differences by ethnicity. Future work of this study will be concerned with gathering qualitative data around the interrelationship of culture and diet as it pertains to screening behavior and intent, and the multiple variations of that interrelationship by ethnicity. Results of this significant study can provide health educators, providers and policy makers information that is critically necessary in an effort to create culturally relevant health promotion materials within the diverse Black community. Citation Format: Cicely K. Johnson. Dietary and cultural practices of minorities in New York City as an indicator of colorectal cancer screening behavior and screening intent [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D018.

Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia

ObjectiveTo assess different strategies for communicating to older adults about stopping cancer screening.Design4 (recommendation statement about stopping screening)×(2; time) online survey-based randomised controlled trial.SettingAustralia.Participants271 English-speaking participants, aged 65–90, screened for...

Abstract B054: Development of a decisional values measure for lung cancer screening among long-term African American smokers

Abstract Introduction: The burden of lung cancer is significant for African Americans, especially African American men, who have the highest lung cancer death rates compared to all other racial and ethnic groups. There is mounting evidence that lung cancer screening via low-dose computed tomography (LDCT) reduces lung cancer-specific mortality. However, due to the limitations and possible harms associated with LDCT, most medical organizations are endorsing the process of informed and shared decision-making. To promote informed decision-making in this context, individuals’ decisional needs must be met, including addressing any gaps in knowledge about lung cancer and lung cancer screening, considering personal values related to screening, and the role the patient wants to play in the decision-making process. To avoid racial disparities in screening rates for LDCT, which will ultimately increase the racial disparity in lung cancer mortality, it is important to uncover any considerations unique to patients who are eligible for LDCT. Methods: Key informant interviews (N=9) identified factors important to African American smokers’ screening decisions. Based on these interviews, we developed decisional values items for LDCT and report initial psychometric properties. The pool of items was administered to a convenience sample of 119 African American smokers. Results: An exploratory factor analysis revealed two components explaining 64% of the variance. The components were Cons of Screening (e.g., ‘…screening will not find all lung cancers or all lung cancer early’) and Pros of Screening (e.g., ‘lowering your risk of dying from lung cancer’). The final 12-item measure had very good internal consistency (α=.89 overall; α=.86 and .88 for subscales, respectively). To determine whether the decisional values items predicted participants’ intention to be screened for lung cancer via LDCT in the next six months, linear regression analyses were conducted with the sub-scales. The Pros of Screening sub-scale significantly predicted screening intentions such that higher reported pros were associated with greater likelihood of screening intention (B=.10, SE=.04, p&amp;lt;.05). The Cons of Screening sub-scale was not significantly associated with likelihood of screening. Conclusion: Values may be specific to the type of decision and the characteristics of those making the decision. This tool provides a promising values measure for lung cancer screening among African Americans and could inform future values clarification tools promoting informed decision-making. Our next steps in this line of research will include conducting cognitive testing of the items and assessing the reliability of this tool in sub-groups. Citation Format: Randi M. Williams, Kathryn L. Taylor, Cheryl L. Knott. Development of a decisional values measure for lung cancer screening among long-term African American smokers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B054.

Health Belief, Behavior Intention, and Health Behaviors Related to Colorectal Cancer Screening in Taiwan.

Health belief and behavior intention affect subsequent health behaviors. The purpose of this study was to assess the levels of health belief, behavior intention, and health behavior, and to identify the factors related to health behaviors in adults receiving colorectal cancer (CRC) screening in Taiwan. This cross-sectional study recruited patients receiving a CRC screening from the cancer screening outpatient department of a teaching hospital in northern Taiwan. Demographic and health characteristics were recorded, and participants were assessed using Champion’s health belief model scale, cancer screening intention scale, and the health protective behavior scale. Of the 125 subjects (aged 49–75 years), 27.2% reported active screening; the rest passively received screening after doctor referral. Those who were doctor-referred had lower levels of health behavior, including general behavior, self-knowledge, and health care. Positive health behaviors related to CRC screening were associated with not smoking, greater seriousness in health belief, more confidence in health belief, consuming the recommended amount of fruits and vegetables, and motivation for CRC screening; these factors explained 35.0% of the variance in positive health behaviors related to CRC screening. A comprehensive education program encouraging CRC cancer screening should include access to available resources and encourage positive health belief and behavior intention related to this important cancer screening activity.

Abstract B049: Psychological underpinnings of cervical cancer screening intentions among the underserved: An examination of the influence of cancer fatalistic notions and associated cognitions

Abstract Cervical cancer screening participation is squarely determined by judgment and decision-making, but research examining the influence of cognitive biases on screening decisions remains scant. For instance, the implications of fatalistic views of cancer has been studied in the past, but no other research has furthered explored the psychological underpinnings of cancer fatalism and related constructs in relation to cervical cancer screening intentions. Critically important, however, is to explore the nature of the relationship between cancer fatalism and two related cognitions—cancer information overload (confusion and overwhelming feelings toward cancer information) and cancer information avoidance—for the development of effective psychological interventions. Another wrinkle is added when considering the social demographics of potential screening-seekers due to the health disparities of cervical cancer (Bazargan, Bazargan, Farooq &amp; Baker, 2004) and high endorsement of cancer fatalism among minorities and other disadvantaged groups (for a review, see Espinosa de los Monteros &amp; Gallo, 2011). Another chief aim of this current work was to examine the relationships between the constructs of interest in relation to the three components implicated by the theory of planned behavior (see Ajzen &amp; Madden, 1986) as most predictive of behavioral intent. That is, attitude toward cervical cancer screening, subjective norms about cancer screening (what person believes others think she should do), and perceived behavioral control over getting cancer screening were the outcome variables. I recruited 90 community women from an online subject recruitment forum and presented them with the measures of interest in random order. Results showed that cancer fatalism and cancer information overload predicted negative attitudes toward cervical cancer screening. Cancer fatalism also predicted subjective norms but not perceived behavioral control. Educational attainment and access to health insurance were also associated with cancer fatalistic thoughts, but not minority status. Lastly, cancer information avoidance (effect modifier) interacted with cancer fatalistic thoughts in predicting attitudes toward cervical cancer screening and intentions to adhere to Pap exam recommendations. Theoretical and practical implications to public health promotion are discussed. Citation Format: Carlos O Garrido. Psychological underpinnings of cervical cancer screening intentions among the underserved: An examination of the influence of cancer fatalistic notions and associated cognitions [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B049.

The ties that bind: Cancer history, communication, and screening intention associations among diverse families.

Breast and cervical cancers are screen-detectable; yet, challenges exist with ensuring uptake of mammography and Pap smear. Family, a central factor in developing knowledge to carry out health promotion behaviors, may be an asset to improving intention to screen among non-adherent women from underrepresented minority groups. We explored familial cancer; communication; and breast and cervical screening intention among non-adherent Black, Latina, and Arab women in the United States who participated in a randomized controlled trial of the Kin KeeperSM Cancer Prevention Intervention study. The intervention was a culturally-targeted breast and cervical cancer literacy tool for Black, Latina, and Arab women, consisting of two family-focused education sessions on the cancers, their screening guidelines, and risk-reducing health-related behaviors. For this secondary analysis, we assessed family cancer history, family communication, and screening intention for breast and cervical cancer in age-eligible, non-adherent participants. Descriptive statistics examined sample characteristics of the intervention and control groups. Odds ratios were estimated from logistic regression modeling to assess the intervention and sample characteristic effects on screening intention. Of the 516 participants, 123 and 98 were non-adherent to breast and cervical cancer screening, respectively. The intervention (OR = 1.95 for mammography; OR = 1.62 for Pap smear) and highly communicative (OR = 2.57 for mammography; OR = 3.68 for Pap smear) families reported greater screening intention. Family history of cancer only increased screening intention for mammography (OR = 2.25). Family-focused approaches supporting communication may increase breast and cervical cancer screening intention among non-adherent, underrepresented minority groups.

Effect of a Mammography Screening Decision Aid for Women 75 Years and Older

Guidelines recommend that women 75 years and older be informed of the benefits and harms of mammography before screening. To test the effects of receipt of a paper-based mammography screening decision aid (DA) for women 75 years and older on their screening decisions. A cluster randomized clinical trial with clinician as the unit of randomization. All analyses were completed on an intent-to-treat basis. The setting was 11 primary care practices in Massachusetts or North Carolina. Of 1247 eligible women reached, 546 aged 75 to 89 years without breast cancer or dementia who had a mammogram within 24 months but not within 6 months and saw 1 of 137 clinicians (herein referred to as PCPs) from November 3, 2014, to January 26, 2017, participated. A research assistant (RA) administered a previsit questionnaire on each participant's health, breast cancer risk factors, sociodemographic characteristics, and screening intentions. After the visit, the RA administered a postvisit questionnaire on screening intentions and knowledge. Receipt of the DA (DA arm) or a home safety (HS) pamphlet (control arm) before a PCP visit. Participants were followed up for 18 months for receipt of mammography screening (primary outcome). To examine the effects of the DA, marginal logistic regression models were fit using generalized estimating equations to allow for clustering by PCP. Adjusted probabilities and risk differences were estimated to account for clustering by PCP. Of 546 women in the study, 283 (51.8%) received the DA. Patients in each arm were well matched; their mean (SD) age was 79.8 (3.7) years, 428 (78.4%) were non-Hispanic white, 321 (of 543 [59.1%]) had completed college, and 192 (35.2%) had less than a 10-year life expectancy. After 18 months, 9.1% (95% CI, 1.2%-16.9%) fewer women in the DA arm than in the control arm had undergone mammography screening (51.3% vs 60.4%; adjusted risk ratio, 0.84; 95% CI, 0.75-0.95; P = .006). Women in the DA arm were more likely than those in the control arm to rate their screening intentions lower from previsit to postvisit (69 of 283 [adjusted %, 24.5%] vs 47 of 263 [adjusted %, 15.3%]), to be more knowledgeable about the benefits and harms of screening (86 [adjusted %, 25.5%] vs 32 [adjusted %, 11.7%]), and to have a documented discussion about mammography with their PCP (146 [adjusted %, 47.4%] vs 111 [adjusted %, 38.9%]). Almost all women in the DA arm (94.9%) would recommend the DA. Providing women 75 years and older with a mammography screening DA before a PCP visit helps them make more informed screening decisions and leads to fewer women choosing to be screened, suggesting that the DA may help reduce overscreening. ClinicalTrials.gov Identifier: NCT02198690.

Mobile Technologies and Cervical Cancer Screening in Low- and Middle-Income Countries: A Systematic Review.

PURPOSECervical cancer screening is not well implemented in many low- and middle-income countries (LMICs). Mobile health (mHealth) refers to utilization of mobile technologies in health promotion and disease management. We aimed to qualitatively synthesize published articles reporting the impact of mHealth on cervical cancer screening–related health behaviors.METHODSThree reviewers independently reviewed articles with the following criteria: the exposure or intervention of interest was mHealth, including messages or educational information sent via mobile telephone or e-mail; the comparison was people not using mHealth technology to receive screening-related information, and studies comparing multiple different mHealth interventional strategies were also eligible; the primary outcome was cervical cancer screening uptake, and secondary outcomes included awareness, intention, and knowledge of screening; appropriate research designs included randomized controlled trials and quasi-experimental or observational research; and the study was conducted in an LMIC.RESULTSOf the 8 selected studies, 5 treated mobile telephone or message reminders as the exposure or intervention, and 3 compared the effects of different messages on screening uptake. The outcomes were diverse, including screening uptake (n = 4); health beliefs regarding the Papanicolaou (Pap) test (n = 1); knowledge of, attitude toward, and adherence to colpocytologic examination (n = 1); interest in receiving messages about Pap test results or appointment (n = 1); and return for Pap test reports (n = 1).CONCLUSION Overall, our systematic review suggests that mobile technologies, particularly telephone reminders or messages, lead to increased Pap test uptake; additional work is needed to unequivocally verify whether mhealth interventions can improve knowledge regarding cervical cancer. Our study will inform mHealth-based interventions for cervical cancer screening promotion in LMICs.

Testing a Culturally Adapted Colorectal Cancer Screening Decision Aid Among American Indians: Results from a Pre-Post Trial.

Purpose: American Indian adults have not experienced decreases in colorectal cancer (CRC) incidence and mortality observed in other races or ethnic groups and their screening rates are low. Decision aids that explain available CRC screening options are one potential strategy to promote screening. The goal of this study was to test the effect of a culturally adapted decision aid on CRC-related outcomes among American Indian adults, including screening-related knowledge, attitudes, self-efficacy, intentions, and screening modality preferences.Methods: We recruited American Indian adults aged 50–75 years who were not current with CRC screening. Participants viewed a 9-min multimedia decision aid that used narrative vignettes to provide educational information about screening along with messages to address culturally specific barriers and values uncovered in formative research. We conducted a single-arm (pre–post) study and assessed screening-related outcomes at baseline and immediately after viewing the decision aid.Results: Among n=104 participants, knowledge scores increased from a mean of 36% correct to 76% correct. Participants also had statistically significant increases in positive attitudes, perceived social norms, self-efficacy, and intent. The proportion of participants who identified a preference for a specific CRC screening modality rose from 81% identified at pre-intervention to 93% post-intervention (p=0.013).Conclusion: Our study provides promising new findings that our culturally adapted decision aid is efficacious in educating American Indian adults about CRC screening and increases their screening intentions and ability to state modality preferences. Future research is needed to test the decision aid as a component of CRC screening interventions with American Indian adults.