Assessing the Inner Setting among Massachusetts Community Health Centers: Opportunities for Multilevel Investigation and Expansion of Influences on Health Equity.

Background: Implementation science increasingly aims to improve equity in delivery of evidence-based interventions. It is important to expand the conceptualization of the inner setting, organizations like community health centers where interventions are put into place, accordingly. Taking a comprehensive, partnered approach to measuring the inner setting among a network of community health centers engaged in implementation research ensures assessment of the variability among sites and generates centralized contextual data that can be applied across studies.

See Me, Hear Me: Racial Discrimination Among Women Seeking Breast Cancer Care.

Discrimination can contribute to worse health outcomes, but its prevalence in breast cancer is not well studied. We aimed to understand how women with stage I-III breast cancer faced discrimination in health care and everyday settings through a cross-sectional survey. 296 women, 178 (60%) Non-Hispanic White (NHW), 76 (26%) Non-Hispanic Black (NHB), and 42 (14%) Hispanic participated.

Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors.

Purpose: Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors.

Methods: During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York.

Clonal hematopoiesis in older patients with breast cancer receiving chemotherapy.

Background: The expansion of hematopoietic stem cells carrying recurrent somatic mutations, termed clonal hematopoiesis (CH), is common in elderly individuals and is associated with increased risk of myeloid malignancy and all-cause mortality. Though chemotherapy is a known risk factor for developing CH, how myelosuppressive therapies affect the short-term dynamics of CH remains incompletely understood. Most studies have been limited by retrospective design, heterogeneous patient populations, varied techniques to identifying CH, and analysis of single timepoints.

Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors.

Purpose: The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care.

Methods: We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013-2017 and received care at one of three centers in Boston, MA, and New York, NY.

'ADVANCE' (a pilot trial) ADjuVANt chemotherapy in the elderly: Developing and evaluating lower-toxicity chemotherapy options for older patients with breast cancer.

Introduction: Older adults with breast cancer receiving neo/adjuvant chemotherapy are at high risk for poor outcomes and are underrepresented in clinical trials. The ADVANCE (ADjuVANt Chemotherapy in the Elderly) trial evaluated the feasibility of two neo/adjuvant chemotherapy regimens in parallel-enrolling cohorts of older patients with human epidermal growth factor receptor 2-negative breast cancer: cohort 1-triple-negative; cohort 2-hormone receptor-positive.

Materials And Methods: Adults age ≥ 70 years with stage I-III breast cancer warranting neo/adjuvant chemotherapy were enrolled.

Perceptions of patients and medical oncologists toward biospecimen donation in the setting of abnormal breast imaging findings.

Purpose: We sought to understand the attitudes of individuals with abnormal breast imaging findings prompting a diagnostic breast biopsy toward donation of blood, excised tissue, or percutaneous biospecimens for research, and to understand medical oncologists' attitudes toward research biospecimen collection in this population.

Methods: We included individuals who presented to a single academic medical center for a clinically indicated, image-guided, percutaneous breast biopsy. We administered a survey prior to knowledge of biopsy results to assess willingness to consider, entirely for research purposes, donating blood or excess excised breast tissue, or having additional biospecimens (AB) obtained during a clinically indicated percutaneous biopsy.

Perceptions of patients with early stage breast cancer toward research biopsies.

Background: The objective of this study was to describe the perspective of patients with early breast cancer toward research biopsies. The authors hypothesized that more patients at academic sites than at community-based sites would be willing to consider these procedures.

Methods: In total, 198 patients with early stage breast cancer were recruited from 3 academic centers (n = 102) and from 1 community oncology practice (n = 96).

Barriers to Clinical Trial Accrual: Perspectives of Community-Based Providers.

Background: Only a small proportion of patients with cancer enroll onto clinical trials. Previous studies have explored patient-related barriers to trial participation; however, few studies have focused on the provider perspective. We aimed to describe referral practices and barriers to referrals of patients with breast cancer for clinical trials, including the utilization of web-based trial-matching tools.

Development and testing of the KnowGene scale to assess general cancer genetic knowledge related to multigene panel testing.

Purpose: To develop and evaluate a measure of cancer genetics knowledge relevant to multigene panel testing.

Methods: The instrument was developed using systematic input from a national panel of genetics experts, acceptability evaluation by patient advocates, and cognitive testing. Twenty-four candidate items were completed by 591 breast or gynecological patients who had undergone genetic counseling and multigene panel testing in the past 18 months.

Development, Evaluation, and Implementation of a Pan-African Cancer Research Network: Men of African Descent and Carcinoma of the Prostate.

Purpose: Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA.

Methods: We established the Men of African Descent and Carcinoma of the Prostate Network, which includes seven SSA centers partnering with five US centers to study the genetics and epidemiology of CaP in SSA.

Perceptions of Oncologists About Sharing Clinic Notes with Patients.

In a large survey ( = 809) conducted to understand how oncologists differ from nononcologists regarding routinely sharing visit notes with patients, oncologists were less likely to agree patient safety would improve ( = .03) or that patients would be offended after reading notes ( = .01); however, they agreed with nononcologists that sharing notes would lead to less candid documentation (69% vs.

The Grief of Mothers After the Sudden Unexpected Death of Their Infants.

Unlabelled: : media-1vid110.1542/5741323271001PEDS-VA_2017-3651 BACKGROUND: The loss of a child is associated with elevated grief severity, and sudden infant death syndrome (SIDS) is the leading cause of postneonatal mortality in the United States. The diagnosis of prolonged grief disorder (PGD) has gained broader acceptance and use.

Interactive or static reports to guide clinical interpretation of cancer genomics.

Objective: Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation.

Materials And Methods: We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians' genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0-18 and 1-4, respectively, higher score corresponding with improved endpoints).

Delayed Workup of Rectal Bleeding in Adult Primary Care: Examining Process-of-Care Failures.

Background: Although delayed colorectal cancer diagnoses figure prominently in medical malpractice claims, little is known about the quality of primary care clinicians' workup of rectal bleeding.

Methods: In this study, 438 patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for rectal bleeding, hemorrhoids, and blood in the stool at 10 Boston adult primary care practices. Following nurse chart abstraction, physician reviewers assessed the overall quality of care and key care processes.

Working up rectal bleeding in adult primary care practices.

Rationale, Aims And Objectives: Variation in the workup of rectal bleeding may result in guideline-discordant care and delayed diagnosis of colorectal cancer. Accordingly, we undertook this study to characterize primary care clinicians' initial rectal bleeding evaluation.

Methods: We studied 438 patients at 10 adult primary care practices affiliated with three Boston, Massachusetts, academic medical centres and a multispecialty group practice, performing medical record reviews of subjects with visit codes for rectal bleeding, haemorrhoids or bloody stool.

Variation in the Attitudes of Medical Oncologists Toward Research Biopsies in Patients With Metastatic Breast Cancer.

Background: Tissue from research biopsies provides access to insights into tumor biology. We aimed to determine medical oncologists' (MOs') attitudes toward research biopsies in patients with metastatic breast cancer (MBC).

Materials And Methods: A total of 309 breast MOs from National Cancer Institute (NCI)-designated cancer centers were invited to complete a self-administered survey about their attitudes toward approaching patients for research purpose-only biopsies (RPOBs), performed as a standalone procedure, or additional biopsies, performed with a clinically indicated biopsy.

Disparities in evaluation of patients with rectal bleeding 40 years and older.

Background & Aims: Rectal bleeding is associated with colorectal cancer. We characterized the evaluation of patients aged 40 years and older with rectal bleeding and identified characteristics associated with inadequate evaluation.

Methods: We conducted a retrospective review of records of outpatient visits that contained reports of rectal bleeding for patients aged 40 years and older (N = 480).

Dissemination of a tobacco cessation program for unionized workers.

Many multilevel, contextually relevant, evidenced-based health promotion programs are not disseminated widely. The purpose of this study is to describe the adaptation of a published effective tobacco-use cessation intervention, which was implemented and evaluated in a broader population of unionized workers partnering with a health and welfare fund health benefits carrier. 68 tobacco users enrolled.

Elements of external validity of tools for health: an intervention for construction laborers.

Purpose: To examine the external validity of an efficacious tailored smoking cessation and nutrition improvement telephone intervention.

Design: Comparison of characteristics of participants and nonparticipants (representativeness); examination of the extent of intervention implementation.

Setting: Cancer center collaboration with a labor union.

Process evaluation results from the Healthy Directions-Small Business study.

The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards.

Recruiting small manufacturing worksites that employ multiethnic, low-wage workforces into a cancer prevention research trial.

Introduction: Worksites, including those that employ multiethnic, low-wage workforces, represent a strategic venue for reaching populations at risk for developing cancer.

Methods: We surveyed 197 small manufacturing worksites prior to an effort to recruit their workforces into a randomized clinical trial designed to test the effectiveness of a cancer prevention intervention among multiethnic, low-wage manufacturing workers. This paper assesses the external validity of the trial based on three factors: the percentage of potential trial sites excluded from consideration, the percentage of eligible worksites that adopted the trial, and worksite characteristics associated with adoption.

Process evaluation of an integrated health promotion/occupational health model in WellWorks-2.

Disparities in chronic disease risk by occupation call for new approaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations.