Underserved Groups Research Articles

Abstract 4871: Colorectal cancer incidence and overall survival by race, stage, and age: A SEER database analysis, 2009-2020

Abstract Introduction: In the United States, colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer-related deaths. Although incidence rates of CRC have been decreasing overall, recent studies suggest a shift in demographics, specifically an increase in the number of new CRC cases among younger individuals and a higher incidence among those who identify as non-Hispanic Native American/Alaska Native. To examine the latest trends in incidence and overall survival (OS) among adults with CRC in the United States, we conducted an observational study using the Surveillance, Epidemiology, and End Results (SEER) Program database. Methods: Patients aged ≥18 years with newly diagnosed CRC between January 1, 2009, and December 31, 2020 were identified in the SEER 17 database. Age-adjusted incidence rates for CRC were calculated by race/ethnicity and age groups (18-49, 50-64, and ≥65 years) from 2009 to 2020. Kaplan-Meier curves were generated to examine 5-year OS by race/ethnicity, stage, and age groups. Results: There were 429,218 CRC cases identified with a median age of 67 years. Most were male (52.4%) with stage 0-II CRC (51.4%). Most patients identified as non-Hispanic White (66.3%), followed by non-Hispanic Black (11.5%), non-Hispanic Asian/Pacific Islander (8.9%), non-Hispanic Native American/Alaska Native (0.7%), and Hispanic of any race (12.7%). The age-adjusted incidence rate between 2009 and 2020 was 51.9 per 100,000 persons; incidence decreased from 59.5 per 100,000 persons in 2009 to 44.2 per 100,000 persons in 2020, with male patients having a higher incidence rate than female patients. By 2020, non-Hispanic Native American/Alaska Native patients had the highest incidence rate (54.5 per 100,000 persons) followed by non-Hispanic Black patients (50.6 per 100,000 persons). CRC incidence rates increased slightly for age <50 years (10.5 to 12.9 per 100,000 persons) and decreased for ages 50-64 (74.6 to 63.9 per 100,000 persons) and ≥65 years (222.4 to 136.1 per 100,000 persons). Non-Hispanic Black patients (53%), age ≥65 years (47%), and those with stage III-IV CRC (41%) had a lower 5-year OS from 2015 to 2019 compared to patients who were non-Hispanic White (57%), aged 50-64 (68%) and <50 years (70%), and with stage 0-II CRC (77%). Conclusion: Our results confirm a slight increase in CRC incidence among younger (<50 years) individuals over the 2009-2020 time period. Patients who were non-Hispanic Native American/Alaska Native had the highest CRC incidence rate and patients who were non-Hispanic Black had the poorest OS. Targeted preventative efforts such as CRC screening programs in addition to improved access to care/treatment may be needed to reduce the number of new cases and improve outcomes among historically underserved groups. Citation Format: Alicia C. McDonald, Seongjung Joo, Jiemin Ma, Mayur M. Amonkar, Changxia Shao, Kaushal Desai, Anne C. Deitz. Colorectal cancer incidence and overall survival by race, stage, and age: A SEER database analysis, 2009-2020 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4871.

Abstract 1008: Pilot evaluation of an online course for primary care providers on preparing patients for cancer discussions with their oncologists

Abstract Introduction: Cancer clinical trial (CCT) accrual is only 5-8%, and barriers to participate can be more acute for underserved groups. Enrollment of racial/ethnic minorities, older adults, adolescents, and young adults is not adequate to understand treatment outcomes unique to these populations. Education before seeing an oncologist can increase patients’ willingness to ask and consider receiving treatment through a CCT. Because primary care providers (PCPs) interact with patients during diagnosis, provide ongoing care, and are a trusted source of information, they can educate and normalize inquiries about therapeutic CCTs. The aim of this study was to pilot test an innovative, tailored online CCT course for PCPs. Methods: To participate, PCPs (MD, DO, NP, or PA) had to provide care in an outpatient setting, refer patients to a cancer treatment specialist in the past year, and be an English speaker residing in the U.S. or its territories. PCPs were recruited from Clinical Directors Network, University of Pennsylvania, and University of Florida. The 1-hour online course includes four modules hosted by a PCP and radiation oncologist with video segments of a CCT expert who summarized CCT recruitment research. Participants interact with patient scenarios and learn about the patient’s cancer diagnosis and medical/personal background. Videos of actors playing the roles of patient and doctor demonstrate communication skills taught in the course. PCPs completed short surveys prior to and immediately after completing the course. Results: 28 PCPs participated. PCPs were mainly MDs (88.9%), residents (17, 60.7%), White (46.4%), non-Hispanic/Latino (92.9%), and 50% women. Mean knowledge of CCTs scores (0-100%) increased significantly from pre (M=56.7, SD=17.5) to post (M=82.1, SD=12; p<.001) indicating that PCPs answered more true/false statements about CCTs correctly after training. Using a 1-5 scale with 5=strongly agree, PCPs’ attitudes and beliefs scores also increased significantly from pre (M=4.2, SD=.6) to post (4.7, SD=.4, p<.001) indicating that PCPs were more likely to agree they have a role in their patients’ cancer treatment, including CCTs, after training. Using the same scale, PCPs’ willingness to communicate about CCTs increased significantly from pre (M=4.4, SD= .5) to post (M=4.7, SD=.5, p=.007), indicating that PCPs were more willing to engage with patients diagnosed with cancer before referring them to a cancer specialist after training. Conclusions: Significant pilot findings in knowledge, attitudes and beliefs, and communication scores demonstrate that the online course was effective at educating PCPs about CCTs, and improving PCPs’ attitudes about the CCT referral process, and their willingness to engage in their patients’ cancer care. Future research will include a larger sample and explore the course’s impact on PCP’s referral behavior. Citation Format: Alyssa Crowe, Elisa S. Weiss, Margo Michaels, Domenic Durante, Maria Sae-Hau, Andrea Cassells, Carla L. Fisher, Jason Arnold, Taylor Vasquez, Ana Natale-Pereira, Raymond Mailhot, Zhongyue Zhang, Carma L. Bylund. Pilot evaluation of an online course for primary care providers on preparing patients for cancer discussions with their oncologists [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1008.

Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: a PrEP-to-need ratio investigation

ObjectivesHIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. In England, NHS availability was limited to participants of the PrEP Impact Trial until late 2020. Some key populations...

Abstract P387: Research Participation Rates and Characteristics in Underrepresented Groups in a West Virginia-Based Pregnancy Cohort Study

Introduction: Individuals living in rural areas, identifying as underrepresented racial minorities, and with low socioeconomic status tend to be poorly represented in research. Each underrepresented group experiences unique barriers that may prevent them from participating in research. Objectives and Hypothesis: This study aimed to test the hypotheses that 1) in a West Virginia-based pregnancy cohort study, individuals identifying as rural, an underrepresented racial minority, or receiving Medicaid/Medicare (as a surrogate for socioeconomic status) would have lower participation rates than typically better represented populations; and 2) that people from each underrepresented group would have different characteristics associated with screening for and consenting to participate in the pregnancy cohort study. Methods: Potentially eligible participants were sent recruitment messages via MyChart, a patient facing app linked to their electronic medical record. Upon receiving the message, participants could express their interest to participate in the study by filling out an eligibility screening form and, eventually, consent to participate at a study visit. Screening and consenting rates were calculated, stratified by rurality (i.e., urban, micropolitan rural, small town rural), race (i.e., white, underrepresented racial minority), and insurance status (i.e., Medicaid/Medicare, private). Logistic regression was used to test which characteristics were associated with screening for and participating in the study in each group. Results: Between October 2022 - April 2023, 1024 potential participants were sent recruitment messages. Screening rates (7.3% urban, 7.6% micropolitan rural, 8.8% small town rural; 7.3% White, 10.1% underrepresented racial minorities; 7.9% private insurance, 7.1% Medicaid/Medicare) and consenting rates (2.5% urban, 2.1% micropolitan rural, 4.6% small town rural; 2.8% White, 1.4% underrepresented racial minorities; 3.6% private insurance, 1.9% Medicaid/Medicare) were similar between different underrepresented groups and their better represented counterparts. For small town rural participants, preterm births (OR 6.85 [2.04 - 33.7]) and number of children (OR .24 [.05 - .71]) were associated with participating in the study. Those who identified as an underrepresented racial minority were more likely to screen for the study if they had private health insurance (OR 16.81 [1.53 - 500]). People with Medicaid/Medicare were more likely to participate in the study if they lived in a small town rural area (OR 7.71 [1.57 - 58.97]). Conclusion: Differences in characteristics associated with research participation suggest that researchers may need to tailor recruitment strategies to better consider characteristics of different underserved groups.

Piloting a Community-Based, Culturally Adapted Health Promotion Program for Children with Autism Spectrum Disorder and Developmental Disabilities in First-Generation Korean Immigrant Families.

Children with autism spectrum disorder and developmental disabilities (ASD/DD) face barriers to participation in health promotion programs due to the lack of available and/or affordable programs and trained staff at recreation centers. Children with ASD/DD in Korean immigrant families are one of the most underserved minority groups due to language, racial/ethnic discrimination, and stigma and shame within their own ethnic community. However, little research is available on development, implementation, and evaluation of a culturally adapted community health promotion program in this population. The purpose of this study is to assess effectiveness of a pilot program for children with ASD/DD from first-generation Korean immigrant families. The pilot study used a quantitative, quasiexperimental design (one-group design with pre- and posttest) following a seven-week health promotion program. We recruited 15 children with ASD/DD, ages nine through 16, from first-generation Korean immigrant families. The findings of the study suggest that the pilot program was effective in gaining nutrition knowledge and increasing physical involvement among participants. Given the fact that Asian immigrants are a fast-growing population and that nearly 75 percent of them were born abroad, development and evaluation of a community-based, culturally adapted health promotion program is urgently needed.

Cost and economic evidence for asset-based approaches to health improvement and their evaluation methods: a systematic review

BackgroundAsset-based approaches (ABAs) tackle health inequalities by empowering people in more disadvantaged communities, or targeted populations, to better utilise pre-existing local community-based resources. Using existing resources supports individuals to better manage their own health and its determinants, potentially at low cost. Targeting individuals disengaged with traditional service delivery methods offers further potential for meaningful cost-savings, since these people often require costly care. Thus, improving prevention, and management, of ill-health in these groups may have considerable cost implications.AimTo systematically review the extent of current cost and economic evidence on ABAs, and methods used to develop it.MethodsSearch strategy terms encompassed: i) costing; ii) intervention detail; and iii) locality. Databases searched: Medline, CENTRAL and Wed of Science. Researchers screened 9,116 articles. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) tool. Narrative synthesis summarised findings.ResultsTwelve papers met inclusion criteria, representing eleven different ABAs. Within studies, methods varied widely, not only in design and comparators, but also in terms of included costs and outcome measures. Studies suggested economic efficiency, but lack of suitable comparators made more definitive conclusions difficult.ConclusionEconomic evidence around ABAs is limited. ABAs may be a promising way to engage underserved or minority groups, that may have lower net costs compared to alternative health and wellbeing improvement approaches. ABAs, an example of embedded services, suffer in the context of economic evaluation, which typically consider services as mutually exclusive alternatives. Economics of the surrounding services, mechanisms of information sharing, and collaboration underpin the success of assets and ABAs. The economic evidence, and evaluations in general, would benefit from increased context and detail to help ensure more nuanced and sophisticated understanding of the economics of ABAs. Further evidence is needed to reach conclusions about cost-effectiveness of ABAs.

Co-designing adult weight management services: a qualitative study exploring barriers, facilitators, and considerations for future commissioning

BackgroundWeight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning.MethodsWe selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis.ResultsWe interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships– with communities, individual community members, and with partner organisations– was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace “a different way of thinking” when commissioning for co-design.ConclusionsCo-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base.

In-clinic Versus Online Recruitment of Women With a History of Cervical Intraepithelial Neoplasia or Cervical Cancer to a Smoking Cessation Trial: A Post hoc Comparison of Participant Characteristics, Study Retention, and Cessation Outcomes.

Recruiting special populations to smoking cessation trials is challenging and approaches beyond in-clinic recruitment may be beneficial. This secondary analysis of data from a smoking cessation RCT for individuals with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) explored differences associated with in-clinic vs. online recruitment. Participants were recruited from clinics within a university-based NCI-designated cancer center (n = 87) and online nationally via Facebook (n = 115). Baseline measures included sociodemographics, smoking history, and cancer or CIN history. Study retention and smoking abstinence were assessed 12 months post-baseline. Group differences in baseline characteristics were evaluated. Retention and abstinence were evaluated while controlling for group differences and predictors. Participants recruited online (vs. in-clinic) had higher educational attainment (p = .01) and health literacy (p = .003). They were more likely to have CIN versus cancer, to be further from the time of diagnosis, and to have completed active treatment (p values < .001). While controlling for these group differences and independent predictors, retention was higher among participants recruited online (log-likelihood χ2(1) = 11.41, p < .001). There were no recruitment differences in self-reported (p = .90) or biochemically confirmed smoking abstinence (p = .18). Compared to individuals recruited in-person, individuals recruited online were more educated, had higher health literacy, and presented with a different clinical profile (ie, more likely to have CIN vs. cancer and to have completed active treatment). There were few differences in participant characteristics between recruitment approaches, and no differences on any smoking-related variables. Online recruitment has the potential to improve enrollment of cancer survivors in smoking cessation trials. People with a history of CIN or cervical cancer recruited to a smoking cessation RCT online (vs. in-clinic) were more likely to have a diagnosis of CIN versus cancer and were more educated and health literate. Participants recruited online were more likely to be retained in the study and there were no differences in smoking abstinence rates at 12 months. Incorporating online recruitment increased the reach of tobacco treatment efforts to a larger and more diverse sample. This could reduce the burden of tobacco-related disease, improve CIN and cancer treatment outcomes, and reduce secondary malignancies and morbidity among this underserved group.

Piloting a T-Shaped Approach to Develop Primary Students’ Close Reading and Writing of Literary Texts

The study was a pilot intervention to develop Year 5–8 students’ close reading and writing of literary texts using the T-Shape Literacy Model (Wilson and Jesson in Set Res Inf Teach 1:15–22, 2019). Students analysed text sets to explore how different authors use language to engender mood and atmosphere. The study used a single-subject design logic for repeated researcher-designed and a quasi-experimental, matched control group design for repeated standardised measures of reading and writing. Nine teachers and their classes participated. The schools were part of a large school improvement programme using digital tools and pedagogy to accelerate students’ learning participated that the authors were research-practice partners in. The schools all served low socio-economic status communities and the majority of students were Māori (51%) and Pacific (28%). There was a large effect size on the overall score for the researcher-designed measure (effect size = 1.00) and for the close reading of single texts sub-score (effect size = 0.90). There was a moderate-to-high effect for students’ identification of language features (effect size = 0.75) but no significant effect on their synthesis scores. Students in the intervention significantly outperformed matched control group students in the standardised writing post-test (effect size = 0.65) but differences for the standardized reading comprehension test were not significant (effect size = 0.15). Results overall suggest the approach has promise for improving the metalinguistic knowledge, literary analysis and creative writing of younger and historically underserved groups of students.

Participatory breeding in organic systems: Experiences from maize case studies in the United States

Participatory breeding and crop selection can satis­fy the needs of underserved groups of farmers (e.g., organic producers, farmers producing spe­cialty grain for niche markets) neglected by the modern global seed industry. Participatory research methods that value local knowledge and facilitate the active involvement of producers, researchers, and other actors involved in the agri-food system are tactics that can help us achieve sustainable agri­culture. Interest in the use of participatory methods to increase the value of U.S. land-grant universities to society has grown rapidly during the last decade. Interest includes re-engagement in the develop­ment of maize hybrids that perform well in a diverse range of heterogeneous growing environ­ments and that are better suited for sustainability-minded producers, buyers, and consumers. Sys­tems-based breeding aimed at protecting the envi­ronment and providing food, fiber, and energy while considering equity issues, has been proposed as a way to overcome the shortcomings of privat­ized approaches. In this article, we consider recent projects that use collaborative methods for hybrid maize breeding, cultivar testing, and genetic research to develop, identify, and deliver traits associated with crop performance, quality, and sus­tainability. Three case studies consider the efforts focused on developing non-GMO varieties for organic and specialty markets. We find that, unlike many successful efforts focused on the improve­ment of other crops, there are few promising mod­els for participatory breeding of hybrid maize. Even though many projects have sought to involve stakeholders with a variety of methods, all have struggled to meaningfully engage farmers in maize hybrid improvement. Still, our reflection of case studies calls for systems-based breeding and sug­gests a path forward. This route would seek to address the needs, perspectives, and values of a broader range of actors participating in the food system by leveraging technologies and infrastruc­ture in service of the public. Land-grant universities are well positioned to play a crucial role in coordi­nating efforts, facilitating partnerships, and sup­porting breeding programs that satisfy societal wants that include health, equity, and care.

Access to interventional psychiatric treatments in the United States: Disparities and proposed solutions

Interventional psychiatric treatments are a group of mental health procedures and monitored pharmacological interventions that are implemented when first-line therapies, such as psychotherapy and traditional pharmacotherapy, are ineffective or when there is a need for rapid symptom relief. Interventional treatments such as repetitive transcranial magnetic stimulation, esketamine, and electroconvulsive therapy are the United States Food and Drug Administration -approved treatments for major depressive disorder that has gained increased use and shows promise for improvement in efficacy and greater adoption. Despite the immense value and potential of interventional therapies, there are disparities in access to these treatments owing to economic, cultural, and geographical factors. When compounded with existing disparities in mental health care for racial and ethnic minorities, this interaction worsens inequities in access and may exacerbate the severity of disease in underserved groups. This review describes the factors contributing to these disparities, suggests strategies to ameliorate inequities, and broadens the impact of interventional therapies.

Patient and public involvementin the development of health services: Engagement of underserved populations in a quality improvement programme for inflammatory bowel disease using a community-based participatory approach.

Involving people with lived experience is fundamental to healthcare development and delivery. This is especially true for inflammatory bowel disease (IBD) services, where holistic and personalised models of care are becoming increasingly important. There is, however, a significant lack of representation of underserved and diverse groups in IBD research, and there are significant barriers to healthcare access and utilisation among minority groups in IBD. IBD centres need to be aware of these experiences to address barriers via service changes, improve interactions with local communities and promote meaningful engagement for improved health outcomes. A pragmatic community-based approach was taken to engage with leaders and members of underserved groups across 11 workshops representing Roma, Afro-Caribbean, people of African descent and the wider black, Asian and minority ethnic (BAME) communities, Muslim women, refugee community members, deprived areas of South Yorkshire, LGBTQ+ and deaf populations. Thematic analysis of field notes identified patterns of attention across the community groups and where improvements to services were most frequently suggested. Findings demonstrated several barriers experienced to healthcare access and utilisation, including language accessibility, staff attitudes and awareness, mental health and stigma, continuity of support, and practical factors such as ease of service use and safe spaces. These barriers acted as a lever to co-producing service changes that are responsive to the health and social care needs of these groups. Engaging with people from a range of communities is imperative for ensuring that service improvements in IBD are accessible and representative of individual needs and values. Local community leaders and members of community groups actively participated in the co-design and development of improvements to the IBDservice for a local hospital. Their contributions further informed a pilot process for quality improvement programmes in IBD centres.

Exploring the barriers to, and importance of, participant diversity in early-phase clinical trials: an interview-based qualitative study of professionals and patient and public representatives

ObjectivesTo explore the importance of, and barriers to achieving, diversity in early-phase clinical trials.DesignQualitative interviews analysed using thematic analysis.Setting and participantsFive professionals (clinical researchers and methodologists) and three patient and...

Interventions to improve latent and active tuberculosis treatment completion rates in underserved groups in low incidence countries: a scoping review

BackgroundPeople in underserved groups have higher rates of tuberculosis (TB) and poorer treatment outcomes compared with people with no social risk factors.ObjectivesThis scoping review aimed to identify interventions that improve...

The Role of Islamic Microfinance in Increasing Sustainable Financial Inclusion in Indonesia: A Systematic Literature Review

Sustainable financial inclusion is one of Indonesia's key economic development goals. Islamic microfinance is becoming an important tool to achieve this goal. The purpose of this study is to analyze the contribution of Islamic microfinance to increasing sustainable financial inclusion in Indonesia. The method in this study is through a qualitative approach by analyzing several articles, and related research. The result of this study is that Islamic microfinance, particularly in rural and remote areas, has significantly improved access to financial services for previously underserved groups. However, broader financial inclusion is still difficult to achieve due to issues such as complex regulations, lack of public knowledge about Islamic microfinance concepts, and program scalability.

The Medicare Care Choices Model was associated with reductions in disparities in the use of hospice care for Medicare beneficiaries with terminal illness.

To assess the effects of the Medicare Care Choices Model (MCCM) on disparities in hospice use and quality of end-of-life care for Medicare beneficiaries from underserved groups-those from racial and ethnic minority groups, dually eligible for Medicare and Medicaid, or living in rural areas. Medicare enrollment and claims data from 2013 to 2021 for terminally ill Medicare fee-for-service beneficiaries nationwide. Through MCCM, terminally ill enrolled Medicare beneficiaries received supportive and palliative care services from hospice providers concurrently with curative treatments. Using a matched comparison group, we estimated subgroup-specific effects on hospice use, days at home, and aggressive treatment and multiple emergency department visits in the last 30 days of life. The sample included decedent Medicare beneficiaries enrolled in MCCM and a matched comparison group from the same geographic areas who met model eligibility criteria at time of enrollment: having a diagnosis of cancer, congestive heart failure, chronic obstructive pulmonary disease, or HIV/AIDS; living in the community; not enrolled in the Medicare hospice benefit in the previous 30 days; and having at least one hospital stay and three office visits in the previous 12 months. Eligible beneficiaries from underserved groups were underrepresented in MCCM. MCCM increased enrollees' hospice use and the number of days at home and reduced aggressive treatment among all subgroups analyzed. MCCM also reduced disparities in hospice use by race and ethnicity and dual eligibility by 4.1 (90% credible interval [CI]: 1.3-6.1) and 2.4 (90% CI: 0.6-4.4) percentage points, respectively. It also reduced disparities in having multiple emergency department visits for rural enrollees by 1.3 (90% CI: 0.1-2.7) percentage points. MCCM increased hospice use and quality of end-of-life care for model enrollees from underserved groups and reduced disparities in hospice use and having multiple emergency department visits.

Integrating primary care, shared decision making, and community engagement to facilitate equitable access to multi-cancer early detection clinical trials.

Effective implementation of cancer screening programs can reduce disease-specific incidence and mortality. Screening is currently recommended for breast, cervical, colorectal and lung cancer. However, initial and repeat adherence to screening tests in accordance with current guidelines is sub-optimal, with the lowest rates observed in historically underserved groups. If used in concert with recommended cancer screening tests, new biospecimen-based multi-cancer early detection (MCED) tests could help to identify more cancers that may be amendable to effective treatment. Clinical trials designed to assess the safety and efficacy of MCED tests to assess their potential for reducing cancer mortality are needed and many are underway. In the conduct of MCED test trials, it is crucial that participant recruitment efforts successfully engage participants from diverse populations experiencing cancer disparities. Strategic partnerships involving health systems, clinical practices, and communities can increase the reach of MCED trial recruitment efforts among populations experiencing disparities. This goal can be achieved by developing health system-based learning communities that build understanding of and trust in biomedical research; and by applying innovative methods for identifying eligible trial patients, educating potential participants about research trials, and engaging eligible individuals in shared decision making (SDM) about trial participation. This article describes how a developing consortium of health systems has used this approach to encourage the uptake of cancer screening in a wide range of populations and how such a strategy can facilitate the enrollment of persons from diverse patient and community populations in MCED trials.

Asthma Academy for Family Caregivers: A Quality Improvement Project.

Background: Asthma affects one in every 12 children in United States with significant prevalence in underserved groups. Family caregiver education is essential to improve childhood asthma control. The literature suggests that family caregivers' lack of knowledge about asthma management affects their children's health outcomes. An evidence-based education program that improves caregivers' asthma knowledge may improve the family's well-being. Objectives: The goal of the Asthma Academy project is to improve the disease management of children with asthma by providing an in-person family caregiver education program. The main objectives are to (a) improve family caregivers' asthma knowledge, (b) enhance their confidence in asthma management, and (c) evaluate caregivers' satisfaction with the education program. Method: This quality improvement project used an in-person educational program with an asthma education video resource for caregivers of children with asthma. Results: The family caregivers' asthma knowledge improved significantly after the education. The confidence levels in caring for children with asthma increased. Caregivers' satisfaction with the Asthma Academy education session was favorable. Conclusions: The Asthma Academy was an acceptable and effective delivery method of education for family caregivers of children with asthma in the in-patient setting. Empowering family caregivers of vulnerable children through asthma education may improve child health outcomes and mitigate complications from asthma. Implications for Nursing Nurses and clinicians are steward of providing patient education. Individualized, patient-tailored education is recommended.

Beyond A New World in Space: Critical Astral Frontiers in Octavia Butler and Adam Garnet Jones

This paper explores two contemporary literary visions of space settlement to gauge their potential within an emancipatory feminist and antiracist imaginary of the future. In doing so, it engages with the broader question of whether literary interplanetary dreams are necessarily tied up in a colonial rhetoric of violent expansion, or if they can also be organized to serve the interests of oppressed and underserved groups in an Anthropocene context. The text examines and compares two recent narratives of space settlement, the one found in Octavia Butler’s ‘Earthseed’ series and Adam Garnet Jones’ short story ‘History of the New World.’ Based on a comparative close reading of both, this paper argues that both stories frame the project of resettling in space as a hopeful alternative to life within a collapsed natural world and the precarious socio-political framework that has arisen from it, albeit with distinctly different outcomes. This comparison focuses specifically on the organization of such utopian extraplanetary societies and the roles they fulfill in the present. Crucially, this paper considers how both stories evaluate the possibility of choosing not to leave for the astral frontier.

Telemedicine Reduces Missed Appointments but Disparities Persist

IntroductionMissed appointments also known as “no-shows” adversely affect clinical outcomes, clinic efficiency, and quality of care and have been attributed to barriers such as work schedule conflicts and lack of transportation. The widespread telemedicine implementation and adoption that has occurred as a consequence of the COVID-19 pandemic has the potential to address these barriers and improve missed appointment rates. This study aims to analyze the relationship between telemedicine and missed appointments. MethodsThis retrospective cohort study used electronic health records data from a safety-net academic health center with federally qualified clinics (March 2020 to December 2022). Bivariate and multivariable generalized estimating equations were used to analyze the relationship between no-show and appointment type (in-person versus telemedicine appointment). Stratified adjusted regression analyses were used to calculate the average change in the marginal effect of telemedicine appointments on no-shows across covariates. The data was analyzed from 09/2023-10/2023. ResultsHispanic patients accounted for 60% of the 474,212 appointments, followed by non-Hispanic White (22.5%), Non-Hispanic Black (13.3%), Asian (2.7%), Native American (1%) and “other race/ethnicity” patients (0.6%). The no-show rate for telemedicine appointments was 12% compared to 25% for in-person appointments. Multivariable analysis showed that telemedicine appointment was associated with a decreased likelihood of no-show compared to in-person appointments (OR:0.40; 95% CI:0.40, 0.41). The average change in the marginal effect of telemedicine appointments on the reduction of no-shows across race/ethnicity was greatest for Native American and non-Hispanic Black patients. ConclusionsTelemedicine appointments were associated with decreased likelihood of no-shows and the protective effect of telemedicine appointments on missed appointments was greatest for underserved groups. Strategies to increase telemedicine uptake especially for underserved groups are critical.