Head to head randomized trial of two decision aids for prostate cancer.

Background: While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient-provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer.

Methods: 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy.

Prioritizing Initiatives for Institutional Review Board (IRB) Quality Improvement.

Background: Institutional Review Boards (IRBs) have been criticized for inconsistency, delay, and bias, suggesting an opportunity for quality improvement. To aid such quality improvement, this study aimed at determining IRB members' and investigators' priorities regarding IRB review at 10 Veterans Affairs (VA) IRBs.

Methods: 680 anonymous internet surveys were sent to 252 IRB members and staff, and 428 principal investigators and project coordinators at 9 VA Medical Centers and the VA Central IRB.

Using the IRB Researcher Assessment Tool to Guide Quality Improvement.

Institutional Review Boards (IRBs) are intended to protect those who participate in research. However, because there is no established measure of IRB quality, it is unclear whether these committees achieve their goal. The IRB Researcher Assessment Tool is a previously validated, internally normed, proxy measure of IRB quality that assesses 45 distinct IRB activities and functions.

Time required for institutional review board review at one Veterans Affairs medical center.

Importance: Despite growing concern that institutional review boards (IRBs) impose burdensome delays on research, little is known about the time required for IRB review across different types of research.

Objective: To measure the overall and incremental process times for IRB review as a process of quality improvement.

Design, Setting, And Participants: After developing a detailed process flowchart of the IRB review process, 2 analysts abstracted temporal data from the records pertaining to all 103 protocols newly submitted to the IRB at a large urban Veterans Affairs medical center from June 1, 2009, through May 31, 2011.

An affective booster moderates the effect of gain- and loss-framed messages on behavioral intentions for colorectal cancer screening.

Previous research has demonstrated that loss-framed messages are more effective than gain-framed messages in motivating detection behaviors such as screening. The present study examined whether affective context moderates the degree to which message frame is associated with behavioral intentions to engage in colorectal cancer screening. In particular, we buttressed a framing manipulation with an "affective booster" to increase anticipated and anticipatory emotions associated with the framed messages.

Relationships among health perceptions vary depending on stage of readiness for colorectal cancer screening.

Objective: We explored whether relationships among health perceptions differ depending on individuals' stage of readiness for colorectal cancer screening (CRCS).

Methods: Data from the National Cancer Institute's Health Information National Trends Survey (HINTS) were used to stage adults over 50 years of age (N = 2324) using a modified version of the Precaution Adoption Process Model (PAPM) staging algorithm. Health perceptions examined included perceived risk of cancer, worry about cancer, fatalism, and beliefs about ambiguity of cancer prevention recommendations.

Orthopedic communication about osteoarthritis treatment: Does patient race matter?

Objective: To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee and hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs orthopedic clinics.

Methods: Audio recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision-Making model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider.

The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting.

Background: The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.

Objective: To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.

Design: Prospective, observational study.

Behind closed doors: physician-patient discussions about colorectal cancer screening.

Background: Despite the availability of multiple effective screening tests for colorectal cancer, screening rates remain suboptimal. The literature documents patient preferences for different test types and recommends a shared decision-making approach for physician-patient colorectal cancer screening (CRCS) discussions, but it is unknown whether such communication about CRCS preferences and options actually occurs in busy primary-care settings.

Objective: Describe physician-patient CRCS discussions during a wellness visit.

Physicians encouraging colorectal screening: a randomized controlled trial of enhanced office and patient management on compliance with colorectal cancer screening.

Background: Colorectal cancer screening is underused. Our objective was to evaluate methods for promoting colorectal cancer screening in primary care practice.

Methods: A 2 x 2 factorial randomized clinical trial measured the effects of a tailored vs nontailored physician recommendation letter and an enhanced vs nonenhanced physician office and patient management intervention on colorectal cancer screening adherence.

Informed decision-making and colorectal cancer screening: is it occurring in primary care?

Background: Current recommendations advise patients to participate in the decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known.

Objective: To assess the level of informed decision-making occurring during actual patient-provider communications on CRC screening and test for the association between informed decision-making and screening behavior.

When pregnant patients disclose substance use: missed opportunities for behavioral change counseling.

Objective: The first obstetric visit is an opportunity to provide counseling to women with substance abuse risks, including smoking, drug use, and alcohol use. Little is known about how obstetric care providers and patients discuss these issues. Our objective was to examine patient-provider communication about substance use behaviors during these visits.

Patients with Complex Chronic Diseases: perspectives on supporting self-management.

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking.

Relationship of communication and information measures to colorectal cancer screening utilization: results from HINTS.

Utilization of colorectal cancer screening tests is suboptimal. Knowledge of colorectal cancer screening has been associated with completion of screening. Thus, increasing awareness of colorectal cancer screening may lead to significant improvements in screening rates.

Using the transtheoretical model to stage screening behavior for colorectal cancer.

This study sought to describe the colorectal cancer (CRC)-screening behavior of a population of two lower income communities near Pittsburgh, Pennsylvania. The transtheoretical model was used to characterize individuals according to their stage of readiness to engage in one of two recommended CRC screening tests--the Fecal Occult Blood Test (FOBT) or Flexible Sigmoidoscopy (FSG) test. A telephone survey was conducted of 50- to 79-year-old men and women in Aliquippa and Clairton in the spring of 1999.

Adherence to repeat screening flexible sigmoidoscopy in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

Background: Acceptance of screening flexible sigmoidoscopy has been poor, in part because of providers' concerns regarding the acceptability of the procedure. In the current prospective study, the authors used adherence to repeat testing to assess the acceptability of screening flexible sigmoidoscopy.

Methods: The current study was a prospective study of a randomized clinical trial drawing volunteers from the community.

Family history and colorectal cancer screening: a survey of physician knowledge and practice patterns.

Objectives: Risk stratification is essential to effective implementation of colorectal cancer (CRC) screening strategies. The objectives of this study were to assess and compare the current knowledge and practice patterns of gastroenterologists and primary care physicians regarding familial risk of CRC.

Methods: We conducted a survey of regional gastroenterologists and a sample of university- and community-based primary care physicians.

A population-based, community estimate of total colon examination: the impact on compliance with screening for colorectal cancer.

Objective: Colorectal cancer screening is underutilized. Total colon examination (TCE), such as with colonoscopy, can have a significant effect on the measured compliance with screening, as colonoscopy may be able to be performed as infrequently as once every 10 yr. In a population-based survey we determined the prevalence and validated the self-reporting of TCE and assessed its impact on compliance with screening.