Publications by authors named "Nancy Kressin"
Article Synopsis
- A study examined women's discussions about breast density with clinicians, focusing on variations based on age, income, race, and other sociodemographic factors.
- Most women reported that their clinicians actively discussed breast cancer risk and mammography results, with many also answering questions about breast density.
- However, fewer clinicians inquired about women's concerns regarding breast density or future cancer risks, indicating a gap in communication.
Article Synopsis
- A study examined how women react to receiving information about their breast density and how this affects their future mammogram plans.
- Most women (86%) felt informed, but some reported anxiety (15%) or confusion (11%), with racial and literacy differences affecting these reactions.
- Non-Hispanic Black, Asian, and Hispanic women, as well as women with low literacy, were more likely to feel anxious and confused, impacting their likelihood of future mammograms, highlighting the need for accessible education on breast density.
Importance: Breast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density.
Objective: To assess women's perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction.
Introduction: Health policy leaders recommend screening and referral (S&R) for unmet social needs (eg, food) in clinical settings, and the American Heart Association recently concluded that the most significant opportunities for reducing cardiovascular disease (CVD) death and disability lie with addressing the social determinants of CVD outcomes. A limited but promising evidence base supports these recommendations, but more rigorous research is needed to guide health care-based S&R efforts. Funded by the Veteran Health Administration (VA), the study described in this paper will assess the efficacy of S&R on Veterans' connections to new resources to address social needs, reduction of unmet needs and health-related outcomes (adherence, utilisation and clinical outcomes).
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- A study examined how diverse women prefer to learn about breast density (BD) and their experiences with it, focusing on racial, ethnic, and literacy differences.
- Results showed that 80% of women wanted to receive BD information from healthcare providers, with preferences varying by race and literacy levels; for instance, 85% of Non-Hispanic Black women preferred this method compared to just 72% of Asian women.
- The study concluded that educational approaches need to be tailored, as women have different preferences for how they receive information about BD, suggesting that relying solely on written notifications is insufficient.
Article Synopsis
- Deprescribing is the process of intentionally reducing or stopping medications to prevent harm from inappropriate use, particularly in older patients at risk of complications.* -
- A study tested the effect of sending patient-centered EMPOWER brochures before healthcare appointments on discussing and reducing potentially inappropriate medications among chronic medication users and those at hypoglycemia risk.* -
- Results showed that patients who received the brochures had significantly higher rates of both discussions about and actual deprescribing of their medications compared to those who didn't receive the brochures.*
Article Synopsis
- Many states in the U.S. require women to be notified about their breast density after mammograms, but the impact of these notifications on women's understanding varies.
- A study with 754 women, combining surveys and interviews, found mixed results: while most recognized that breast density is visually identified on mammograms, only 47% understood the increased cancer risk associated with it.
- Misunderstandings were common, with some women incorrectly believing breast density could be felt or confused it with characteristics of healthy tissue, highlighting the need for better education to improve overall knowledge and reduce misconceptions.
Background: Prior studies have identified lower mortality in Black Veterans compared with White Veterans after hospitalization for common medical conditions, but these studies adjusted for comorbid conditions identified in administrative claims.
Objectives: The objectives of this study were to compare mortality for non-Hispanic White (hereafter, "White"), non-Hispanic Black (hereafter, "Black"), and Hispanic Veterans hospitalized for heart failure (HF) and pneumonia and determine whether observed mortality differences varied according to whether claims-based comorbid conditions and/or clinical variables were included in risk-adjustment models.
Research Design: This was an observational study.
Article Synopsis
- Stakeholders involved in mammography screening, including experts, primary care providers (PCPs), and patients with limited health literacy (LHL), have differing opinions on prioritizing information for decision aids (DAs) aimed at younger women.
- A study utilized a modified Delphi panel of experts and conducted interviews with patients and PCPs to identify convergent and divergent themes related to informational needs about mammography.
- Key themes included different perspectives on the benefits and harms of screening, the importance of various screening modalities, the experience of undergoing mammography, and the need for clear communication regarding breast cancer risk.
Article Synopsis
- The study evaluated a computerized Relational Agent designed to deliver alcohol screening, brief interventions, and referrals, comparing its effectiveness with standard treatment practices in primary care for veterans.
- 178 veterans participated, with some receiving standard care (TAU) and others receiving the Relational Agent along with TAU, assessed at baseline and 3 months later.
- While both groups reduced drinking, those using the Relational Agent showed greater improvements in addressing negative alcohol consequences and had higher rates of receiving brief interventions and referrals to specialized care.
Racial/ethnic disparities in glycemic control-a key diabetes outcome measure-continue to widen, even though the overall prevalence of glycemic control in the US has improved. Health insurance coverage may be associated with improved glycemic control, but few studies examine effects during a period of policy change. We assessed changes in glycemic control by racial/ethnic groups following the Massachusetts Health Insurance Reform for patients at two urban safety-net academic health systems between January 2005 and December 2013.
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- The study highlights the importance of understanding patients' life contexts, particularly for those living with HIV and complex health needs, as this could enhance approaches to Social Determinants of Health (SDoH).
- Researchers conducted narrative interviews with aging HIV patients to gather insights into their life experiences and compared these with data from their electronic medical records (EMRs).
- Key findings revealed that while EMRs included numerous medical diagnoses and medications, they often lacked vital social context, with patients' narratives focusing on significant past events, present challenges, and future health concerns.
Article Synopsis
- The study aimed to investigate how consistent health insurance impacts the management of type 2 diabetes and whether it reduces racial and ethnic health gaps.
- Data from two urban health systems over eight years was analyzed, revealing that stable insurance leads to better diabetes control, especially in glycemic levels, but disparities still existed between racial groups.
- While stable insurance improved diabetes outcomes for all groups, non-Hispanic Blacks and Hispanics still faced greater challenges in managing their diabetes compared to non-Hispanic Whites and Asians.
Article Synopsis
- The study investigates how discrimination-related stress affects PTSD symptoms among diverse military veterans, focusing on racial and gender differences.
- Black and Hispanic/Latino/a/x veterans showed higher levels of PTSD severity and discrimination stress compared to White veterans, with notable gender disparities.
- The findings suggest that PTSD severity increases are influenced by the combined effects of race, gender, and discrimination, emphasizing the importance of an intersectional approach in future research and interventions.
Article Synopsis
- - Starting breast cancer screening at age 40 may lead to more potential risks with only a slight benefit in reducing deaths, making decisions tricky for younger women; shared decision-making is encouraged for those under 50.
- - A study focused on women ages 40-54 with limited health literacy (LHL) to understand their experiences with mammography counseling from primary care providers (PCPs), revealing key themes in their communication.
- - The research highlighted that current counseling methods may not fully meet patient needs, suggesting that there is room for improvement in how mammography information is provided to enhance accessibility for women with varying health literacy.
Article Synopsis
- - The study aimed to assess the impact of state breast density notification laws on women's awareness and discussions about breast density and its associated cancer risks, focusing on sociodemographic differences within the population.
- - Out of 2,306 surveyed women, 57% received personal breast density information, with those in states with notification laws being 1.5 times more likely to receive such info; however, disparities existed, particularly for older Black and Asian women with lower income and health literacy.
- - The findings highlighted that while state laws had some positive outcomes, there were significant disparities in knowledge and discussions among certain groups, emphasizing the need for tailored communication strategies to ensure all women have equitable access to information regarding breast density.
Article Synopsis
- Socioeconomic factors significantly affect hospital outcomes, but existing systems like CMS and VA do not adjust mortality profiles based on these factors.
- The study analyzed data from 131 Veterans Affairs medical centers, focusing on 30-day mortality rates for veterans hospitalized with heart failure and pneumonia between 2012 and 2014.
- Adding socioeconomic variables to mortality models showed a slight improvement in predictive accuracy, but overall mortality rates remained closely correlated regardless of socioeconomic adjustments.
Article Synopsis
- Limited health literacy among women aged 40-54 impacts their understanding and participation in mammography screening decisions, leading to disparities in cancer care.
- In-depth interviews with both patients and primary care providers (PCPs) revealed that patients lack knowledge about mammography processes, while PCPs hesitate to engage in shared decision-making due to time constraints and concerns about overwhelming patients with information.
- Both patients and PCPs expressed a need for pre-visit education to improve understanding and facilitate better shared decision-making regarding mammography screening.
Article Synopsis
- - The study highlights a connection between insurance stability and chronic disease management, particularly in hypertension, with racial and ethnic disparities impacting health outcomes.
- - Researchers analyzed data from nearly 44,000 adults in Massachusetts with hypertension over a nine-year period, finding that uninsured black patients had the worst blood pressure control compared to other groups.
- - The findings suggest that having stable health insurance is crucial for better hypertension management, underscoring the need for policies that promote insurance stability, especially among racial and ethnic minorities.
Article Synopsis
- Social determinants of health (SDoH) refer to the living and working conditions that affect individuals’ access to essential resources, leading to health disparities.
- There is a growing movement in healthcare to address unmet social needs, but a clear framework to understand how these interventions can improve health outcomes is lacking.
- The OASIS (Outcomes from Addressing SDoH in Systems) framework has been developed to map how screening and referral interventions for social needs can impact health, aiming to assist policymakers and healthcare leaders in creating effective strategies for promoting health equity and improving population health.