Differing levels of clinical evidence: exploring communication challenges in shared decision making. Introduction.

The near ubiquitous access to information is transforming the roles and relationships among clinical professionals, patients, and their care givers in nearly all aspects of healthcare. Informed patients engage their physicians in conversations about their conditions, options and the tradeoffs among diagnostic and therapeutic benefits and harms. The processes of care today increasingly and explicitly integrate exploration of patient values and preferences as patients and clinicians jointly engage in reaching decisions about care.

What the Joint Admission Medical Program (JAMP) can do for Texas physicians; what Texas physicians can do for JAMP.

Texas faces health challenges requiring a physician workforce with understanding of a broad range of issues -- including the role of culture, income level, and health beliefs -- that affect the health of individuals and communities. Building on previous successful physician workforce "pipeline" efforts, Texas established the Joint Admission Medical Program (JAMP), a first-of-its-kind program to encourage access to medical education by Texans who are economically disadvantaged. The program benefits those from racial and ethnic minority groups and involves all 31 public and 34 private Texas undergraduate colleges and universities offering life science degrees, as well as all 9 medical schools.

Educating physician assistants as agents in cancer control: issues and opportunities.

Background: Lifestyle factors (eg, smoking, diet) and compliance with screening recommendations play a role in cancer risk, and emerging technologies (eg, new vaccines, genetic testing) hold promise for improved risk management.

Methods: However, optimal outcomes from cancer control efforts require better preparation of health professionals in risk assessment, risk communication, and implementing health behavioral change strategies that are vitally important to cancer control.

Results And Conclusion: Although physician assistants (PAs) are substantively engaged in cancer-related service delivery in primary care settings, few models exist to facilitate integration of cancer control learning experiences into the curricula used in intense, fast-paced, 24- to 30-month PA training programs.

Differential effects of messages for breast and cervical cancer screening.

The aim of this study was to compare responses to two interventions (personalized-form [PF] letter messages versus personalized-tailored [PT] letter messages) using medical record data for promoting appointment scheduling and screening for breast and cervical cancer among urban low-income women from three ethnic groups: African-American, Mexican-American, and non-Hispanic white women. The 1,574 women participating in the randomized controlled trial were assigned to one of three groups: (1) PF letter, (2) PT letter, (3) control (no letter). Logistic regression analyses show that (1) personalized-tailored letters containing individualized references to recipients' cancer risk factors failed to increase rates of recommended cancer screening behaviors, especially among non-Hispanic white women; and that (2) in contrast, a personalized-form letter with general breast and cervical cancer screening messages increased cancer screening rates in this population, especially among non-Hispanic white and Mexican-American women.

Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data.

Barriers to screening and early detection often result in cancers in low-income and minority women diagnosed at stages too advanced for optimal treatment. This randomized controlled trial examined whether a personalized form (PF) letter containing generic cancer information and a personalized tailored (PT) letter containing minimally tailored individualized risk factor information based on medical records data affected breast and cervical cancer screening among 1574 urban low-income and minority women. The personalized form-letter group was significantly more likely to schedule a screening appointment and to have undergone a Pap test and mammography within 1 year after the intervention than were the tailored letter and control groups (P<0.