Trust In Medical Professionals Research Articles

'I wish my body was stronger': A qualitative study of attitudes and behaviours regarding treatment of hypertensive disorders of pregnancy.

Objectives:To investigate pregnant women’s attitudes and behaviours towards hypertensive disorders of pregnancy and their treatment.Methods:Face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for hypertensive disorders of pregnancy to investigate attitudes and behaviours regarding the conditions and their treatment. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 minutes. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data.Results:Four major themes emerged around beliefs and behaviours of pregnant women regarding treatment of their hypertension: understanding of hypertensive disorders of pregnancy and their implications, risks versus benefits of antihypertensive medication during pregnancy, trust in medical professionals and adherence to medication. The women’s level of understanding of hypertensive disorders of pregnancy and their implications determined whether they were able to make informed decisions about their treatment. Prior experiences and concern for preservation of the pregnancy played major roles in the perception of the risk/benefit balance of using antihypertensive medication during pregnancy. The degree of trust in the treating medical professionals varied according to the perception of their confidence and knowledge.Conclusions:Sound understanding of the condition, a positive risk/benefit balance regarding antihypertensive medication use during pregnancy, and trust in medical professionals contributed to adherence to medication. Good communication with healthcare professionals is important to achieve optimal treatment.

О НОВЫХ МЕТОДАХ ОЦЕНКИ ДОВЕРИЯ ИНОСТРАННЫХПОТРЕБИТЕЛЕЙ МЕДИЦИНСКИХ УСЛУГ БЕЛОРУССКИМВРАЧАМ

Background. To date, there are no evidence-based ways to assess patients ' trust in medical professionals. The relevance of searching for such methods for studying the level of social trust of foreign consumers of medical services in Belarusian doctors is not in doubt due to the annual increase in the export of medical services. Objective: to develop a new method for assessing the confidence of foreign patients in Belarusian doctors. Material and methods. Based on the Russian and foreign experience in studying trust in the provision of non-medical services and using the principles of sociology of medicine, an approach to the mathematical assessment of the level of trust of foreign consumers of medical services in Belarusian doctors has been developed. Results. The method includes a sociological survey with subsequent calculation of the index of trust in Belarusian doctors, determined on the basis of generalized trust indices (three types), the values of which are calculated based on the values of two indicators: the indicator of generalized trust of foreign consumers in Belarusian doctors and the indicator of the measure of personal trust of foreign consumers in Belarusian doctors. Conclusions. The method of calculating confidence indices needs to be implemented and further tested, the survey of foreign patients is planned to be conducted after each case of receiving medical care in the Grodno region.

Acculturation and Cancer Risk Behaviors among Pacific Islanders in Hawaii.

To communicate research to the public, the National Cancer Institute developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance, including the Behavioral Risk Factor Surveillance System, HINTS data are not sufficient to address unique demographic subpopulations such as US Pacific Islanders (PIs). National sampling methods do not adequately reach participants from small, medically underserved populations. This study aims to document the cancer-relevant knowledge, attitudes, behaviors, and information-seeking practices of PIs in Hawaii (HI). We conducted a cross-sectional survey during 2017-2018 of Native Hawaiians, Chuukese, and Marshallese in HI using Respondent Driven Sampling (RDS) to recruit these geographically diffuse groups. The modified HINTS survey included questions about cancer knowledge, attitudes and behaviors, health communications, and cultural practices. A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer-related attitudes, knowledge, and behaviors. These groups also differed regarding acculturation, health locus of control, and trust in medical professionals. Native Hawaiians were significantly more acculturated (P=.0001) than Chuukese or Marshallese and more likely to smoke cigarettes (P=.0001). Among participants aged >50 years, we found no significant differences across ethnic groups (P=.30) for those completing a colon cancer screening (37%). However, only 27% were referred to screening by a physician. Cancer prevention programs are greatly needed for PIs in HI. This study provides knowledge concerning the efficiency of RDS to recruit participants, and the role of culture in communications influencing cancer risk behaviors, which may be generalizable to migrant PIs in the United States.

Public Disclosure on Social Media of Identifiable Patient Information by Health Professionals: Content Analysis of Twitter Data.

BackgroundRespecting patient privacy and confidentiality is critical for doctor-patient relationships and public trust in medical professionals. The frequency of potentially identifiable disclosures online during periods of active engagement is unknown.ObjectiveThe objective of this study was to quantify potentially identifiable content shared on social media by physicians and other health care providers using the hashtag #ShareAStoryInOneTweet.MethodsWe accessed and searched Twitter’s API using Symplur software for tweets that included the hashtag #ShareAStoryInOneTweet. We identified 1206 tweets by doctors, nurses, and other health professionals out of 43,374 tweets shared in May 2018. Tweet content was evaluated in January 2019 to determine the incidence of instances where names or potentially identifiable information about patients were shared; content analysis of tweets in which information about others had been disclosed was performed. The study also evaluated whether participants raised concerns about privacy breaches and estimated the frequency of deleted tweets. The study used dual, blinded coding for a 10% sample to estimate intercoder reliability using Cohen κ statistic for identifying the potential identifiability of tweet content.ResultsHealth care professionals (n=656) disclosing information about others included 486 doctors (74.1%) and 98 nurses (14.9%). Health care professionals sharing stories about patient care disclosed the time frame in 95 tweets (95/754, 12.6%) and included patient names in 15 tweets (15/754, 2.0%). It is estimated that friends or families could likely identify the clinical scenario described in 242 of the 754 tweets (32.1%). Among 348 tweets about potentially living patients, it was estimated that 162 (46.6%) were likely identifiable by patients. Intercoder reliability in rating the potential identifiability demonstrated 86.8% agreement, with a Cohen κ of 0.8 suggesting substantial agreement. We also identified 78 out of 754 tweets (6.5%) that had been deleted on the website but were still viewable in the analytics software data set.ConclusionsDuring periods of active sharing online, nurses, physicians, and other health professionals may sometimes share more information than patients or families might expect. More study is needed to determine whether similar events arise frequently and to understand how to best ensure that patients’ rights are adequately respected.

Crowdsourcing contests to facilitate community engagement in HIV cure research: a qualitative evaluation of facilitators and barriers of participation

BackgroundAs HIV cure research advances, there is an increasing need for community engagement in health research, especially in low- and middle-income countries with ongoing clinical trials. Crowdsourcing contests provide an innovative bottom-up way to solicit community feedback on clinical trials in order to enhance community engagement. The objective of this study was to identify facilitators and barriers to participating in crowdsourcing contests about HIV cure research in a city with ongoing HIV cure clinical trials.MethodsWe conducted in-depth interviews to evaluate facilitators and barriers to participating in crowdsourcing contests in Guangzhou, China. Contests included the following activities: organizing a call for entries, promoting the call, evaluating entries, celebrating exceptional entries, and sharing entries. We interviewed 31 individuals, including nine HIV cure clinical trial participants, 17 contest participants, and five contest organizers. Our sample included men who have sex with men (20), people living with HIV (14), and people who inject drugs (5). We audio-recorded, transcribed, and thematically analyzed the data using inductive and deductive coding techniques.ResultsFacilitators of crowdsourcing contest participation included responsiveness to lived experiences, strong community interest in HIV research, and community trust in medical professionals and related groups. Contests had more participants if they responded to the lived experiences, challenges, and opportunities of living with HIV in China. Strong community interest in HIV research helped to drive the formulation and execution of HIV cure contests, building support and momentum for these activities. Finally, participant trust in medical professionals and related groups (community-based organizations and contest organizers) further strengthened the ties between community members and researchers. Barriers to participating in crowdsourcing contests included persistent HIV stigma and myths about HIV. Stigma associated with discussing HIV made promotion difficult in certain contexts (e.g., city squares and schools). Myths and misperceptions about HIV science confused participants.ConclusionsOur data identified facilitators and barriers of participation in HIV cure crowdsourcing contests in China. Our findings could complement existing HIV community engagement strategies and help to design HIV contests for community engagement in other settings, particularly in low- and middle-income countries.

MEDICAL ERRORS: PATIENTS’ OPINION, LAWYERS’ STANDPOINT, MEDICAL DOCTRINE AND PRACTICE OF THE EUROPEAN COURT OF HUMAN RIGHTS

Introduction: The problem of medical errors is always relevant in medical literature and law. Meanwhile, it is understood diametrically opposite by doctors, patients, and lawyers. This has a negative impact on patients' trust in medical professionals, and sometimes leads to criminal prosecution for a so-called "medical error", which in fact is conscientious deception, not a crime, and should exclude criminal liability. The aim: The aim of this work is the illustration of diametrically opposed approaches to understanding the essence of the concept of "medical error" from patients', doctors', and lawyers' views that are often generated by subjective approaches and results in distrust between doctors and patients, medical professionals and lawyers. The aim of the article is also to realize the ECHR's approach to understanding the essence of a medical error and distinguishing it from the negligence that should lead to liability of the medical professionals. Materials and methods: In this research a legal doctrine, scientific works, provisions of international legal acts, in particular, the Convention for the Protection of Human Rights and Fundamental Freedoms were used, as well as the practice of the ECHR (12 relevant ECHR decisions), where the Court considered cases related to "medical errors" and formulated positive obligations of the state in the field of health care were analyzed. A complex set of general and special methods of cognition was used to achieve the aim, they are comparative legal method, systemic and structural method, methods of generalization, analysis and synthesis, sociological method, hermeneutical method, etc. Results: A survey of patients, medical professionals and lawyers conducted by the authors (300 persons), analysis of doctrinal approaches are illustrated the gap between the doctrinal approaches existing in the understanding of the essence of the "medical error" phenomenon and the perceptions of the medical services recipients, which indicates the need of understanding the essence of the phenomenon of medical error in order to increase the confidence in the medical profession, the inadmissibility of doctors liability for a medical error. Conclusions: The research gave the authors a reason to conclude that both medical and legal sciences are still far from the unity of views on the concept of "medical error". Medical errors significantly affect the authority of a medical institution, a particular doctor, or the state as a whole, and have severe consequences for patients. An analysis of the medical literature and ECHR practices has led to the conclusion that a medical error occurs when it is possible to completely exclude the guilt of medical professionals in the form of intent or negligence. In case of a medical error the criminal liability of the doctor is excluded.

Trust in Physicians and Regional Brain Volumes: A Population-Based Study.

Trust, a fundamental part of human interpersonal relationships, is known to be associated with specific brain regions and demographic characteristics. Level of trust in medical professionals can alter population health outcomes and influence the nature of the doctor-patient relationship. This study utilized structural magnetic resonance imaging (MRI) and trust data from the Dallas Heart Study (DHS), a large community-based study, to determine brain regions associated with degree of trust in physicians and the medical profession. The first phase of the DHS was conducted from 2000 to 2002 and the second phase from 2007 to 2009. The MRI data were analyzed as part of the DHS using automated FreeSurfer software. Forward stepwise binary logistic regression was performed to investigate the association between measures of trust and bilateral brain region volumes and thickness followed by confirmatory multiple regressions of significant brain regions. A total of 1,596 participants were included in the final analysis. Left caudal anterior cingulate cortex (ACC) thickness was inversely correlated with trust of physicians (P < .01). There were no significant associations between trust in physicians and age, race or ethnicity, or education. The ACC is an integral part of the salience network, the brain network responsible for communication and social behavior. Trust in physicians did not appear to be influenced by demographic characteristics. The findings suggest there are neuroanatomical correlates of trust in physicians.

Psychological Aspects of Congenital Hypogonadotropic Hypogonadism.

Congenital hypogonadotropic hypogonadism/Kallmann syndrome (CHH/KS) is a rare, treatable form of infertility. Like other rare disease patients, individuals with CHH/KS frequently experience feelings of isolation, shame, and alienation. Unlike many rare diseases, CHH/KS is not life threatening and effective treatments are available. Nevertheless, it remains a profoundly life-altering condition with psychosocial distress on a par with untreatable or life-limiting disease. Patients with CHH/KS frequently express lasting adverse psychological, emotional, social, and psychosexual effects resulting from disrupted puberty. They also frequently experience a “diagnostic odyssey,” characterized by distressing and convoluted medical referral pathways, lack-of-information, misinformation, and sometimes-incorrect diagnoses. Unnecessary delays in diagnosis and treatment-initiation can significantly contribute to poor body image and self-esteem. Such experiences can erode confidence and trust in medical professionals as well as undermine long-term adherence to treatment–with negative sequelae on health and wellbeing. This review provides a summary of the psychological aspects of CHH/KS and outlines an approach to comprehensive care that spans medical management as well as appropriate attention, care and referrals to peer-to-peer support and mental health services to ameliorate the psychological aspects of CHH/KS.

Understanding vaccine knowledge, attitudes, and decision-making through college student interviews

Objective: We aimed to explore knowledge, attitudes, and beliefs about vaccines required for college-entry and vaccine-related behaviors among college students. Participants: Thirty-three full-time undergraduate students, ≥ 18 years old, enrolled at public (2) and private (3) colleges and universities in metropolitan Philadelphia in fall 2016. Methods: We conducted semistructured interviews, which were double-coded with 5,015 comments overall and 99.3% intercoder reliability (κ = 0.779) using NVivo 11 software. Results: Six key themes emerged: (1) low knowledge about vaccines and requirements; (2) mixed attitudes about required vs. recommended vaccines; (3) high trust in medical professionals; (4) low perceived risk for vaccine-preventable disease outbreaks; (5) substantial parental influence on students’ decision-making; and (6) low utilization of Student Health Services. Conclusions: This study revealed lack of knowledge about and low prioritization of vaccination despite overall positive attitudes towards vaccines. Prematriculation education of college students is critical to increasing vaccine knowledge and use.

Understanding variation in men’s help-seeking for cancer symptoms: A semistructured interview study.

Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men’s experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men’s help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semi-structured interviews were conducted with men recently diagnosed with cancer (n=13). Participants’ partners (n=8) were recruited to enable data triangulation. Interview schedules addressed participants’ pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behaviour was similar for participants residing in urban and rural areas. Five key themes and one sub-theme were identified, including: symptom factors, traditional masculine norms (sub-theme: women’s health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors.

It Is All About Control: Understanding Reluctance to Register for Organ Donation

This article tests the theory that anxiety about death causes feelings of lack of control, which, with other factors, results in reluctance to donate organs, despite endorsement of the act. Using a survey of U.S. and U.K. registered organ donors and unregistered adults ( N = 777), we tested the impact of trust in medical professionals, perceived importance of information on the transplant processes, anxiety regarding loss of control at one’s end-of-life, and a prosocial view of organ donation on willingness to register as donor. Structural analyses show that control mediated the associations of trust and information with willingness, while prosocial did not predict willingness. The findings explain the gap between stated attitudes and actual behavior, and suggest that framing donor card registration and organ donation as a way to gain control over the loss of agency in death and dying may encourage organ donation.

Culture, Communication, and Cancer Risk Behaviors Among Pacific Islanders in Hawaii

Background: A priority of the National Cancer Institute (NCI) is to acquire, aggregate and integrate cancer control data that facilitates collaborations to address health disparities and communication inequalities. To better communicate cancer research to the public, the NCI developed the Health Information National Trends Survey (HINTS). However, as with most national health surveillance systems, HINTS nationally obtained data are not sufficient to address the behaviors of unique demographic and geographic subpopulations. US Pacific Islanders are one of the fastest growing population groups in the US, and cancer is the leading cause of death in this group. Limited knowledge about the cancer communication practices and risk behaviors of US Pacific Islanders drive the poor implementation of effective cancer prevention interventions. Aim: This study aims to document the prevalence and differences in the cancer relevant knowledge, attitudes, and information seeking practices of Pacific Islander populations residing in Hawaii. Specifically, we aim to expand HINTS assessment to native Hawaiians and recent migrant Marshallese and Chuukese populations in Hawaii. Methods: We conducted surveys with 352 native Hawaiians, 282 Chuukese, and 129 Marshallese residing in HI. We used Respondent Driven Sampling method (RDS) to recruit these geographically diffuse populations in HI. The survey included questions about basic knowledge, attitude and behavior about various cancers, detailed communication behaviors about health information, and cultural beliefs and practices. Results: Data show there are clear differences among the three ethnic groups across a variety of cancer-related attitudes, knowledge, behaviors and risk factors. For example, a larger proportion of Chuukese have BMIs that can be described as obese or morbidly obese compared with native Hawaiians. On the other hand, native Hawaiians are significantly more likely to smoke than Marshallese and Chuukese. These groups also differ significantly regarding the level of acculturation, religiosity, fatalism about cancer, and trust in medical professionals. Regarding communication, cell phone use was common with 75% of native Hawaiians, 80% of Marshallese and 88% of Chuukese having cell phones. This use of cellphone technology was in stark contrast to Internet use with only 45% of native Hawaiians, 49% of Marshallese and 27% of Chuukese reporting access to the Web. Conclusion: There is a need for cancer prevention programs for Pacific Islanders in Hawaii. An effective health program has to address their unique cultural beliefs and practices, and fit their unique communication ecology. This study provides new knowledge concerning the use of nonprobability based study sampling methods, and the role of culture in cancer-related communications in influencing cancer risk behaviors that may be generalizable to the growing number of migrant Pacific Islander populations living in the US.

Patient perceptions of chlorhexidine bathing: A pilot study using the health belief model

Many studies investigating daily chlorhexidine gluconate (CHG) bathing as an infection control intervention to decrease health care-associated infections have focused on reduction of infection and colonization; few studies have assessed CHG bathing compliance, work system factors, facilitators, and barriers to implementation. This is a combination retrospective/prospective pilot study conducted at a large academic teaching hospital that implemented daily CHG bathing across all inpatient units. CHG compliance and patient refusal were calculated on the basis of documentation in the electronic medical record. We used the health belief model to guide semistructured interviews with patients about knowledge and barriers related to CHG bathing. Of the 31 patients interviewed, 74% reported using CHG soap during their stay. Average compliance documented in the electronic medical record was 78% with a range of 57%-91% among all hospital units. Sixteen percent of patients declined CHG bathing, and refusal ranged from 3%-29% among all units. Major themes about CHG bathing from patient interviews include low perceived susceptibility to infection, high degree of trust in medical professionals, low knowledge of benefits of CHG, and low perceived self-efficacy in preventing HAIs. Educating patients about CHG bathing appears to be a critical factor in decreasing patient refusal of CHG bathing.

Improving health literacy in a Japanese community population-A pilot study to develop an educational programme.

ObjectiveAlthough a growing number of interventional studies on health literacy have been conducted recently, the majority were designed in clinical settings, focusing mainly on functional health literacy. This study evaluated a programme designed to improve health literacy in a community population, with a scope of going beyond functional health literacy.MethodsIn collaboration with an Approved Specified Nonprofit organization (NPO), we evaluated a five‐session programme designed to provide basic knowledge on health‐care policy and systems, current issues in health care in Japan, patient roles and relationships with health‐care providers and interpersonal skills. In total, 67 of 81 programme participants agreed to participate in the study, and 54 returned the completed questionnaires at baseline and at follow‐up. Health literacy and trust in the medical profession were measured at baseline and at follow‐up. Participants’ learning through the programme was qualitatively analysed by thematic analysis.ResultsQuantitative examinations of the changes in health literacy and degree of trust in medical professionals between the baseline and follow‐up suggested that health literacy significantly improved after implementing the programme. The thematic analysis of participants’ learning throughout the programme suggested that they not only acquired knowledge and skills but also experienced a shift in their beliefs and behaviours.DiscussionProviding individuals who are motivated to learn about health‐care systems and collaborate with health‐care providers with the necessary knowledge and skills may improve their health literacy, which could enable them to maintain and promote their health and that of their family and other people around them.

\u201cUntil people start dying in droves, no actions will be taken\u201d: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia

BackgroundThe HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia.MethodsPurposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions.ResultsThe main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: “personal fatalism” - uselessness of HIV prevention efforts, if one uses drugs; “prevention-related fatalism” - prevention programs are low effective, because people do not pay attention to them before they get infected; “state-related fatalism” – the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are “really working” with risk groups.ConclusionsAs HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.

What sort of medical care is ideal? Differences in thoughts on medical care among residents of urban and rural/remote Japanese communities.

Studies of aspirational ideals of medical care generally focus on patients rather than on ordinary people receiving or not receiving medications at the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medical care as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20years or more in one of the four types of communities classified as either 'metropolitan area', 'provincial city', 'mountain/fishing village' or 'remote island' in Japan. Interviews were transcribed from digital audio recordings and then analysed (in tandem with non-verbal data including participants' appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medical care. The common themes observed among the four community types included 'peace of mind because of the availability of medical care' and 'trust in medical professionals'. Themes that were characteristic of urban communities were the tendency to focus on the content of medical care, including 'high-level medical care', 'elimination of unnecessary medical care' and 'faster, cheaper medical care', whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medical care such as 'support for local lifestyles', 'locally appropriate standards of medical care' and 'being free from dependence on medical care'. The sense of ideal medical care in urban communities tended to centre around the satisfaction with the content of medical care, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medical care from the geographical point of view, we found out the significant relationship between communities and perceptions of medical care ideals.

Perceived discrimination, patient trust, and adherence to medical recommendations among persons with sickle cell disease.

Adults with sickle cell disease (SCD) report experiencing discriminatory behavior from some healthcare providers. The impact of discrimination on health outcomes in SCD, including adherence to physician recommendations, is not known. Our aim was to evaluate the association between perceived discrimination from healthcare providers and nonadherence to physician recommendations among persons with SCD, and to test the potentially mediating role of patient trust. Patients with SCD (age 15 years and older) participating in the Improving Patient Outcomes with Respect and Trust (IMPORT) Study. Perceived discrimination from healthcare providers and reported adherence to physician recommendations were assessed by patient self-report using items from the 2001 Commonwealth Fund Health Survey. Interpersonal trust in medical professionals was assessed using the short form of the Wake Forest Trust in Medical Professionals instrument. We used a cross-sectional analysis of IMPORT participant data. Multivariable Poisson regression models were used to test the independent association of discrimination with adherence and to test patient trust as a potential mediator. Among 273 SCD patients with complete data on all variables of interest, patients reporting experiences of discrimination in the healthcare system were 53% more likely to also report being nonadherent to physician recommendations. Trust in medical professionals appeared to mediate the discrimination/nonadherence relationship, accounting for 50% of the excess prevalence of nonadherence among those experiencing discrimination. SCD patient perceptions of discriminatory experiences from healthcare providers are associated with greater nonadherence to physician recommendations, and may be a potential factor contributing to disparities in health and health quality among this patient population. Perceived discrimination appears to affect adherence behaviors through the pathway of patient trust. Improving relationships between healthcare providers and SCD patients may improve the trust that SCD patients have in medical professionals, which in turn may improve other outcomes among this underserved patient population.

G158 Recruiting Ethnic Minority Participants to a Clinical Trial: Qualitative Study

ObjectivesTo compare the motives and experiences of different ethnic groups participating in a randomised double blind placebo-controlled trial of montelukast in preschool wheeze, and to assess parents’ or guardians’ understanding...

The Application of Abductive and Retroductive Inference for the Design and Analysis of Theory-Driven Sociological Research

Abductive and retroductive inference are innovative tools of analysis which enable researchers to refine and redevelop social theory. This paper describes and demonstrates how to apply these tools to strengthen sociological theory-driven empirical research outputs. To illustrate how abductive and retroductive inference work for the benefit of enhanced qualitative analysis we present the findings of a qualitative study that investigated heart disease patients’ trust in medical professionals (n=37). We outline the research process using a six-stage model developed by Danermark et al. (1997) that will guide researchers doing exploratory research in how to use abductive and retroductive inference in qualitative research design and analysis. A snapshot of the study findings are provided for illustration purposes. The reader will learn how the application of these under-utilized methodological tools provides a novel way of analyzing sociological research.

Abstract P2-11-03: Randomized, single blind trial comparing limited and intensive survivorship interventions following adjuvant therapy in a multiethnic cohort of breast cancer survivors

Abstract Background: In 2005, the Institute of Medicine released a report citing the importance of comprehensive treatment summaries or “survivorship plans” for cancer patients completing adjuvant therapy. However, little is known about the best approach or the impact of these interventions on patient well-being. We compared quality of life, treatment satisfaction and cancer impact measures between a minimal or more intensive intervention. Methods: The study was conducted at a single-institution academic breast cancer practice. Women with non-metastatic breast cancer were randomized within six weeks of completing adjuvant therapy (chemotherapy/radiation therapy) to a minimal intervention group (MG) or intensive intervention group (IG). The MG group was given the NCI publication, “Facing Forward: Life after Cancer Treatment” by lay research staff. The intensive group received the same NCI publication; met in person for 1 hour with a nurse practitioner who provided a treatment summary, surveillance and screening recommendations, and information on risk for late effects; and met in person for 1 hour with a nutritionist to review lifestyle recommendations. Subjects were informed that they were in a study of cancer survivors but unaware they were being randomized. The randomization was stratified by ethnicity (Hispanic/non-Hispanic). Both groups completed the 81-item impact of cancer instrument (IOC), functional assessment of chronic illness therapy-treatment satisfaction-patient satisfaction questionnaire (FACIT-TS-PS) and assessment of survivor concerns (AOC) at baseline, 3 and 6 months. Group t-tests and between group linear regression analyses were performed controlling for ethnicity. Results: Of 140 patients who signed consent, 126 women (66 non-Hispanic, 60 Hispanic) completed baseline questionnaires, 109 completed 3 month, and 109 completed 6 month assessments. The groups were well balanced with regard to age (mean = 54), race, marital status, income and employment status. There were no statistically significant differences between the MG and IG on the 8 domains that comprise the FACIT-TS-PS at 3 and 6 months. The health worry scale of the AOC was lower in the IG (p = 0.006) compared to MG, indicating less health worry and the negative outlook score of the IOC was higher in the MG (p = 0.043) compared to IG at 3 months. At baseline, 3 and 6 months, Hispanic women compared to non-Hispanic women had significantly higher (worse) ACS and IOC health worry (p &amp;lt; 0.001), social life interference (p = 0.01) and meaning of cancer scales (p = 0.0004), but also had greater trust in medical professionals (p = 0.029). Conclusions: We did not observe a difference in most of the IOC or treatment satisfaction scores between the MG and IG interventions at 3 or 6 months, nor did we find any significant change from baseline in either group. However, less health worry and less negative outlook were seen in the IG compared to the MG. At baseline and follow-up, Hispanic women in both interventions compared to non-Hispanic women had more extreme scores on most measures. Despite minimal difference between the interventions, the intensive intervention was more time-consuming and used more health care resources. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-03.