Perceptions of Survivorship Care among Latina Women with Breast Cancer in Los Angeles County.

Objectives: Cancer "survivorship" is a distinct and important aspect of the cancer experience. More research is needed about survivorship care in underserved populations such as Latinas. This study examined issues of breast cancer survivorship care among Latinas to understand their experiences and needs, to inform the design of future programs.

Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer.

Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer.

Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer.

Methods: This was a retrospective cohort study.

Patient perceptions regarding the likelihood of cure after surgical resection of lung and colorectal cancer.

Background: The objective of the current study was to characterize the prevalence of the expectation that surgical resection of lung or colorectal cancer might be curative. The authors sought to assess patient-level, tumor-level, and communication-level factors associated with the perception of cure.

Methods: Between 2003 and 2005, a total of 3954 patients who underwent cancer-directed surgery for lung (30.

Developing and testing a decision aid for use by providers in making recommendations: about mammography screening in older women.

Breast cancer incidence increases with age, but many older women do not receive appropriate mammography screening. A tool to support provider decision making holds potential to help providers and patients reach the best-informed decisions possible. We developed and tested a decision aid (DA) for healthcare providers to use in mammography screening recommendations in older women.

Physician-reported barriers to referring cancer patients to specialists: prevalence, factors, and association with career satisfaction.

Background: Quality care for patients with cancer often requires access to specialty providers, but little is known about barriers to referring cancer patients for specialized care. Referral barriers may also lessen physician career satisfaction. The study was aimed at determining what factors are associated with these barriers and whether greater barriers are associated with low career satisfaction.

Evaluating the quality of supportive oncology using patient-reported data.

Purpose: Patient-reported data may provide valuable information for oncology quality measurement. We evaluated applying patient-reported data from the Cancer Care Outcomes Research and Surveillance Consortium national study to quality indicators addressing supportive oncology domains.

Methods: We analyzed surveys including validated instruments for symptoms and care planning from 4,174 patients newly diagnosed with lung or colorectal cancer.

Prevalence, predictors, and patient outcomes associated with physician co-management: findings from the Los Angeles Women's Health Study.

Background: Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes.

Objectives: To describe physician practice style using breast cancer as a model.

Physician and Practice Characteristics Influencing Tumor Board Attendance: Results From the Provider Survey of the Los Angeles Women's Health Study.

Background: Coordination of care has grown in importance with the advent of new modalities of treatment that require specialized expertise. In cancer care, multidisciplinary approaches have shown improvements in quality of care. Tumor boards may provide a mechanism for improving coordination of care.

A Case Study in Chamorro Community and Academic Engagement for a Community-Partnered Research Approach.

Objective: We describe the development of a community and academic research partnership, share reflections on processes for collaborations, and identify key factors for establishing strong and effective relationships to foster high-quality research.

Background: A community-based participatory research (CBPR) effort evaluating a community-based patient navigation program assisting Chamorro women to access breast cancer services in Southern California served as the foundation for the development of the community-academic partnership.

Methods: Using a CBPR approach focusing on active involvement of community members, organizational representatives, and academic researchers in all aspects of research process, faculty from a research university and a local community-based organization were brought together to build a partnership.

Assessing the Effectiveness of Breast Cancer Education Workshops among Samoan and Pacific Islander Women in Southern California.

Background: Samoans experience among the worst five-year breast cancer survival rates in the U.S., largely due to late stage diagnosis.

Development of the Tongan American Health Professionals Association: Sharing, Mentoring and Networking for Community Health.

Introduction: Tongan-Americans face severe disparities in health including diabetes, cardiovascular disease, and cancer. Educational disparities also affect health opportunities and well-being, influencing health status and community capacity to address disparities. Few resources have been identified within the Tongan-American community to address these concerns.

Use of interpreters by physicians treating limited English proficient women with breast cancer: results from the provider survey of the Los Angeles Women's Health Study.

Objective: Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters.

Data Sources: A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients.

The structural landscape of the health care system for breast cancer care: results from the Los Angeles Women's Health Study.

The structure of health care has been rapidly evolving in response to financial pressures and demands to improve quality. Little work has documented the structure of care and its impact in the context of breast cancer care. We conducted a survey to characterize Los Angeles physicians caring for breast cancer patients and the structural landscape of the healthcare system in which they practice.

Financial incentives for quality in breast cancer care.

Objectives: To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers.

Study Design: Cross-sectional observational study.

Methods: Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%).

Symptom management after breast cancer treatment: is it influenced by patient characteristics?

Purpose: With improved patient survival from breast cancer, more interest has evolved regarding the symptoms women experience in association with breast cancer treatments. We studied the extent to which symptoms for women with incident breast cancer are addressed by their physicians and how symptom management varies with patient characteristics.

Methods: As part of the Los Angeles Women's (LAW) Study, we categorized women from a population-based study of incident breast cancer (n = 1,219) as having an unmet need if she had at least one severe symptom (any of the following: nausea/vomiting, arm problems, hot flashes, vaginal dryness, difficulty sleeping) for which she did not receive the help she wanted.

Does concordance between data sources vary by medical organization type?

Objective: Little is known about how concordance between patient self-report and medical record data varies with medical organization type. Given discrepancies in quality of care received across patient cohorts and organizations, it is important to understand the degree to which concordance metrics are robust across organization types. We tested whether concordance between patient selfreport and medical record data would vary with medical organization type, controlling for patient demographic characteristics, health status, and domain of medical care.

Symptoms after breast cancer treatment: are they influenced by patient characteristics?

Purpose: This study examines the burden of symptoms by treatment type and patient characteristics in a population-based sample of newly diagnosed breast cancer patients.

Methods: Using the Los Angeles County SEER Registry Rapid Case Ascertainment, we identified a cohort of breast cancer patients in 2000 and conducted telephone surveys in English and Spanish among participants.

Results: We completed interviews of 1,219 breast cancer patients and found almost half (46%) had at least one severe symptom (any of the following: nausea/vomiting, arm problems, hot flashes, vaginal dryness, difficulty sleeping) that interfered with her daily functioning or mood.

Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease?

Objective: The validity of quality of care measurement has important implications for practicing clinicians, their patients, and all involved with health care delivery. We used empirical data from managed care patients enrolled in west coast physician organizations to test the hypothesis that observed changes in health-related quality of life across a 2.5-year window reflecting process of care.

What is the concordance between the medical record and patient self-report as data sources for ambulatory care?

Background: The validity of quality of care assessments relies upon data quality, yet little is known about the relative completeness and validity of data sources for evaluating the quality of care.

Objectives: We evaluated concordance between ambulatory medical record and patient survey data. Levels of concordance, variations by type of item, sources of disagreement between data sources, and implications for quality of care assessment efforts are discussed.

Methodological challenges associated with patient responses to follow-up longitudinal surveys regarding quality of care.

Objective: To illustrate, using empirical data, methodological challenges associated with patient responses to longitudinal surveys regarding the quality of process of care and health status, including overall response rate, differential response rate, and stability of responses with time.

Data Sources/study Setting: Primary patient self-report data were collected from 30,308 patients in 1996 and 13,438 patients in 1998 as part of a two-year longitudinal study of quality of care and health status of patients receiving care delivered by 63 physician organizations (physician groups) across three West Coast states.

Study Design: We analyzed longitudinal, observational data collected by Pacific Business Group on Health (PBGH) from patients aged 18-70 using a four-page survey in 1996 and a similar survey in 1998 to assess health status, satisfaction, use of services, and self-reported process of care.