Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.

Introduction: Asthma-related morbidity is increased in overweight patients, yet providers are given little guidance on how to discuss weight and asthma management with overweight teens.

Objective: We piloted an electronic medical record (EMR)-based tailored discussion guide (TDG) and a brief provider training, to address weight management in overweight teens with asthma. The primary outcome was intervention impact on patient-reported asthma outcomes (e.

Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees.

Background: Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population.

Overweight adolescents and asthma: Revealing motivations and challenges with adolescent-provider communication.

Objective: Among teens with asthma, challenges of disease management may be greater in those with a body mass index (BMI) >85th percentile compared to youth within the parameters for normal weight-for-age. This mixed-methods study assessed teens' awareness of the link between weight and asthma management, and perspectives on how medical providers might open a discussion about managing weight.

Method: Teens aged 13-18, having BMI >85 percentile and chronic asthma, identified using health system databases and a staff email message board, were invited to complete a semi-structured, in-depth phone interview.

Recruitment experience for a pragmatic randomized controlled trial: Using EMR initiatives and minimizing research infrastructure.

Context: Modernized approaches to multisite randomized controlled trials (RCT) include the use of electronic medical records (EMR) for recruitment, remote data capture (RDC) for multisite data collection, and strategies to reduce the need for research infrastructure. These features facilitate the conduct of pragmatic trials, or trials conducted in "real life" settings.

Objective: We describe the recruitment experience of an RCT to evaluate a clinic-based intervention targeting urban youth with asthma.

Knowledge about genomic recurrence risk testing among breast cancer survivors.

Genomic expression profiling of tumors is used to individualize early-stage breast cancer treatment. However, very little is known about patients' understanding of and desired information about these tests, such as Oncotype DX. We addressed these issues via a survey mailed to 130 early-stage breast cancer patients who received an Oncotype DX test result.

Satisfaction with physician recommendation for and information about genetic counseling among breast cancer patients.

To evaluate satisfaction with (a) the timing and strength of provider recommendation for and (b) information received prior to and during genetic counseling (GC) among breast cancer patients who attended GC before definitive surgery (BDS) or after definitive surgery (ADS). Satisfaction with provider recommendation for and information received about GC was evaluated among breast cancer patients who attended GC as part of their clinical care (n=51). There were no significant differences among breast cancer patients who attended GC BDS or ADS in satisfaction with when the physician referred them for GC, the strength of recommendation for GC, the amount of information provided about the GC, and the information received in GC.

Knowledge about hereditary colorectal cancer among colorectal cancer survivors.

Aim: Little is known about colorectal cancer (CRC) patients' knowledge regarding hereditary CRC (HCRC). The primary aim of this study was to evaluate CRC survivors' level of knowledge about HCRC and determine if this knowledge varies by demographic or clinical characteristics.

Methods: Data were obtained using a cross-sectional survey of CRC patients at low, moderate, and high risk for HCRC seen at a comprehensive cancer center over a 5-year period (n = 93).

High risk men's perceptions of pre-implantation genetic diagnosis for hereditary breast and ovarian cancer.

Background: Pre-implantation genetic diagnosis (PGD) is an assisted reproductive technology procedure which provides parents with the option of conducting genetic analyses to determine if a mutation is present in an embryo. Though studies have discussed perceptions of PGD from a general population, couples or high-risk women, no studies to date have specifically examined PGD usage among men. This study sought to explore perceptions and attitudes towards PGD among males who either carry a BRCA mutation or have a partner or first degree relative with a BRCA mutation.

BRCA carriers' thoughts on risk management in relation to preimplantation genetic diagnosis and childbearing: when too many choices are just as difficult as none.

Women with a BRCA mutation have unique concerns about childbearing and future fertility. In a focus group conducted among unaffected carriers, the majority of women held positive attitudes toward preimplantation genetic diagnosis to reduce transmission to future offspring and further identified unmet needs for education and support for decision making.

Impact of physicians' personal discomfort and patient prognosis on discussion of fertility preservation with young cancer patients.

Objective: This study sought to determine if physician's personal discomfort with the topic of FP and a patient's prognosis would have an impact on the likelihood of discussing FP with cancer patients.

Methods: Data from larger studies of qualitative semi-structured interviews with pediatric and adult oncologists were analyzed using grounded theory and crystallizing immersion method to examine the themes of "personal comfort" and "patient prognosis" in relation to discussion.

Results: Results showed that, across both physician types, the majority of respondents' personal comfort with the topic of FP was related to the likelihood of discussion.

Conflict between values and technology: perceptions of preimplantation genetic diagnosis among women at increased risk for hereditary breast and ovarian cancer.

Members of families affected by hereditary cancer are often concerned about passing on risk to offspring. Preimplantation genetic diagnosis is a procedure performed to identify embryos that inherit mutations placing them at risk for hereditary conditions. Little is known about attitudes toward the use of this technology among individuals at risk for hereditary breast and ovarian cancer.

Recall of and reactions to a surgeon referral letter for BRCA genetic counseling among high-risk breast cancer patients.

Background: The oncology care setting represents an important opportunity to identify and refer women at increased risk for hereditary breast and ovarian cancer. However, little is known about the effectiveness of provider approaches to inform patients of hereditary cancer risk or patient uptake of genetic counseling (GC). This qualitative study examined the impact of a surgeon referral letter on recently diagnosed breast cancer patients' uptake of BRCA GC.

Oncology social workers' perceptions of barriers to discussing fertility preservation with cancer patients.

Infertility is a common result of cancer treatment; however, opportunities exist that allow patients to preserve their fertility prior to treatment. Evidence suggests health care providers, including social workers, do not consistently discuss this topic with patients. This study used a qualitative, cross-sectional design using a focus group and in-depth interviews to explore knowledge, attitudes, barriers, and behaviors related to social workers' discussion of fertility preservation with cancer patients.

Experiences of genetic counseling for BRCA1/2 among recently diagnosed breast cancer patients: a qualitative inquiry.

For newly diagnosed breast cancer patients, BRCA1/2 genetic counseling (GC) and/or testing has the greatest potential to affect treatment choices if it occurs prior to definitive surgery. This qualitative study sought to examine recently diagnosed breast cancer patients' experiences with pretest GC (n = 9). Study results show the primary reason most women attended GC was due to a family history of cancer.

BRCA1/2 in high-risk African American women with breast cancer: providing genetic testing through various recruitment strategies.

Background: Due to the disproportionate numbers of African American women affected with early onset breast cancer, we sought to investigate mutation frequency of BRCA1 and BRCA2 (BRCA1/2) in a sample of African American women, recruited through a variety of methods.

Methods: We conducted a study investigating BRCA1/2 among 51 African American breast cancer patients with a personal or family history suggestive of hereditary predisposition to breast cancer. All individuals underwent genetic counseling and BRCA1/2 mutation analysis, through protein-truncation test on exon 11 of BRCA1 and exons 10 and 11 of BRCA2, which together account for approximately 50% of mutations observed within these genes.

Discussion of fertility preservation with newly diagnosed patients: oncologists' views.

Introduction: Although physician discussion with patients regarding fertility preservation (FP) options prior to cancer treatment can provide important information for survivors concerning their future fertility, little is known about the extent to which physicians discuss FP with patients. This qualitative study sought to identify current physician FP communication practices and determine factors that may impact communication efforts regarding FP.

Materials And Methods: Qualitative data were collected using semi structured interviews with 16 physicians practicing at a major cancer center in the South.

Oncology nurses' perceptions of barriers to discussion of fertility preservation with patients with cancer.

Infertility is a common result of cancer treatment; however, opportunities exist for patients to preserve fertility prior to treatment. Recent evidence suggests that healthcare providers, including nurses, do not consistently discuss fertility preservation (FP) with patients. This qualitative, cross-sectional pilot study used a focus group and in-depth interviews to explore knowledge, attitudes, and practice behaviors related to nurses' discussion of FP with patients with cancer.

Attitudes of high-risk women toward preimplantation genetic diagnosis.

Objective: To explore the knowledge and attitudes toward preimplantation genetic diagnosis (PGD) of women who have been personally affected by hereditary breast and ovarian cancer.

Design: A 33-item quantitative survey covering five domains, including demographics, knowledge and attitudes about PGD, usage of PGD, and informational needs.

Setting: Attendees of a national conference for individuals and families affected by hereditary breast and ovarian cancer participated in the survey.

Trends in clinical practice and nurses' attitudes about fertility preservation for pediatric patients with cancer.

Purpose/objectives: To examine trends in fertility preservation attitudes and behaviors of pediatric oncology nurses and evaluate their awareness of fertility preservation guidelines published in June 2006 by the American Society of Clinical Oncology (ASCO).

Design: Cross-sectional surveys conducted in 2005 and 2006.

Setting: Annual meetings of the Florida Association of Pediatric Tumor Programs.

Psychosocial and behavioral impact of genetic counseling and testing.

Over a decade has passed since the clinical availability of BRCA1/2 mutation testing for Hereditary Breast and Ovarian Cancer (HBOC). The purpose of this article is to review key areas of psychosocial and behavioral research related to genetic counseling and testing for BRCA1/2 mutations. Special attention will be given to understudied issues within each of these key areas.

Factors associated with breast cancer clinical trials participation and enrollment at a large academic medical center.

Purpose: The practice patterns of medical oncologists at a large National Cancer Institute Comprehensive Cancer Center in Detroit, MI were evaluated to better understand factors associated with accrual to breast cancer clinical trials.

Patients And Methods: From 1996 to 1997, physicians completed surveys on 319 of 344 newly evaluated female breast cancer patients. The 19-item survey included clinical data, whether patients were offered clinical trial (CT) participation and enrollment, and when applicable, reasons why they were not.