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Introduction: Smoking after a cancer diagnosis represents a modifiable health risk. It is recommended that oncology clinicians address tobacco use among their patients using the 5As brief model: Asking about use, Advising users to quit, Assessing willingness to quit, Assisting in quit attempts (counseling and medication), and Arranging follow-up. However, cross-sectional studies have found limited adoption of 5As (especially Assist and Arrange) in oncology settings. Further investigation is needed to understand changes in, and factors associated with, 5As delivery over time. Methods: Patients recently diagnosed with cancer and reporting current smoking (N = 303) enrolled in a smoking cessation clinical trial and completed three longitudinal surveys; at pre-intervention baseline and 3- and 6-month follow-up post-enrollment. Patient-level correlates of 5As receipt at baseline, 3 months, and 6 months were identified using multilevel regression models. Results: At baseline, patient-reported rates of 5As receipt from oncology clinicians ranged from 85.17% (Ask) to 32.24% (Arrange). Delivery declined from baseline to 6-month follow-up for all 5As, with the largest declines observed for Ask, Advise, Assess, and Assist-Counseling. Diagnosis of a smoking-related cancer was associated with greater odds of 5As receipt at baseline but lower odds at 6-month follow-up. At each time point, female gender, religiosity, advanced disease, cancer-related stigma, and smoking abstinence were associated with lower odds of 5As receipt, while reporting a recent quit attempt prior to enrollment was associated with higher odds of 5As receipt. Conclusion: Oncology clinicians’ 5As delivery declined over time. Clinician delivery of the 5As varied based on patients’ sociodemographics, clinical and smoking characteristics, and psychosocial factors.

The US Preventive Services Task Force recommends lung cancer screening (LCS) to promote early lung cancer detection, and tobacco cessation services are strongly recommended in adjunct. Screen ASSIST (NCT03611881) is a randomized factorial trial to ascertain the best tobacco treatment intervention for smokers undergoing LCS; trial outreach is conducted during 3 recruitment points (RPs): when LCS is ordered (RP1), at screening (RP2), and following results (RP3). Among 177 enrollees enrolled from April 2019 to March 2020, 31.6% enrolled at RP1, 13.0% at RP2, and 55.4% at RP3. The average number of enrollees (per 1000 recruitment days) was 2.26 in RP1, 3.37 in RP2, and 1.04 in RP3. LCS provides an opportunity to offer tobacco treatment at multiple clinical timepoints. Repeated and proactive outreach throughout the LCS experience was beneficial to enrolling patients in tobacco cessation services.

Significance Increased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer. The NCI’s Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings. Methods We included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining. Results Of 6285 trial- and LCS-eligible individuals, 3897 (62%) declined and 2388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to “NRT Only” trials, those approached for “NRT + prescription medication” trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using “Phone + In Person” methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using “Phone Only” methods. Some of the reasons for declining enrollment included “too busy” (36.6%), “not ready to quit” (8.2%), “not interested in research” (7.7%), and “not interested in the intervention offered” (6.2%). Conclusion Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers. Implications We explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites. The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.

Background Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet an evidence-based tobacco use intervention has not been well-integrated into cancer care in community oncology settings. This paper describes the protocol of a nation-wide clinical trial conducted by the ECOG-ACRIN National Cancer Institute (NCI) Community Oncology Research Program (NCORP) Research Base to assess the effectiveness of a virtual tobacco treatment intervention and the process of implementing tobacco treatment in NCORP community oncology settings. Methods/design This two-arm, multisite (n: 49 NCORP sites) hybrid type 1 effectiveness-implementation randomized controlled trial compares the effectiveness of a Virtual Intervention Treatment (VIT) versus an Enhanced Usual Control (EUC) among English and Spanish speaking patients recently diagnosed with cancer, reporting current smoking and receiving care at a participating NCORP Community or Minority/Underserved Site. The VIT includes up to 11 virtual counseling sessions with a tobacco treatment specialist and up to 12 weeks of nicotine replacement therapy (NRT). The EUC arm receives a referral to the NCI Quitline. The primary study outcome is biochemically confirmed 7-day point prevalence smoking abstinence. Moderators of treatment effect will be assessed. The study evaluates implementation processes from participating NCORP site staff via survey, administrative, and focus group data, including reach, acceptability, appropriateness, fidelity, feasibility, adoption, cost and sustainability outcomes. Discussion This trial will generate findings about the effectiveness of an evidence-based virtual tobacco treatment intervention targeting patients diagnosed with cancer and illuminate barriers and facilitators that influence implementing tobacco treatment into community oncology settings nationally. In the era of COVID-19, virtual care solutions are vital for maximizing access and utilization of tobacco treatment delivery. Trial registration ClinicalTrials.gov (NCT03808818) on January 18th, 2019; Last update posted: May 21st, 2020.

It is unclear whether patients and providers have started to knowingly request lung cancer screening (LCS) outside US guidelines and insurance coverage for risk factors besides a history of heavy smoking. The authors analyzed their institution's best practices advisory (BPA) clinical decision support system to determine whether providers knowingly order guideline-discordant LCS and the indications given.CT examinations ordered for LCS at an academic medical center that triggered BPA alerts from November 2018 to December 2019 were reviewed. Alerts were triggered by attempts to order examinations outside Medicare coverage, which resembles most US guidelines. Providers can override alerts to order the examinations. Primary outcomes were the number of examinations performed using orders with overridden BPA alerts and indications given. Qualitative exploratory and directed content analyses identified motivators and decision-making processes that drove guideline-discordant screening use.Forty-two patients underwent guideline-discordant LCS, constituting 1.9% of all patients screened (42 of 2,248): 42.9% (18 of 42) were54 or77 years old, 14.3% (6 of 42) had never smoked, 40.5% (17 of 42) had quit15 years earlier, and 31% (13 of 42) had smoked30 pack-years; 45.2% (19 of 42) fell outside all US guidelines. The most common indication was a family history of lung cancer (21.4% [9 of 42]). Perceptions of elevated cancer risk from both patients and referring providers drove guideline-discordant screening use.Referring providers knowingly ordered screening CT examinations outside Medicare coverage and US guidelines, including for never smokers, for indications including a family history of lung cancer. LCS programs may need tailored strategies to guide these patients and providers, such as help with cancer risk assessment.

BackgroundSmoking urges and negative affect play important roles in daily cigarette smoking and smoking lapse during a cessation attempt. Traditionally, laboratory research has considered negative affect as a potential cause of smoking urges. A deeper understanding of momentary associations between negative affect and smoking urges during a smoking cessation attempt can inform treatment development efforts. This study examined whether the within-person association between negative affect and smoking urges differed before and after a quit attempt, and by intervention type.MethodsData are from a pilot randomized controlled trial comparing 3 smoking cessation interventions. Participants were randomly assigned to: (1) a novel, smartphone-based just-in-time adaptive intervention that tailored treatment content in real-time (Smart-T2; n = 24), (2) the National Cancer Institute QuitGuide app (n = 25), or (3) a clinic-based tobacco cessation program (TTRP; n = 23) that followed Clinical Practice Guidelines. All participants received up to 12 weeks of nicotine replacement therapy and completed up to 5 assessments per day (MPreQuit= 25.8 assessments, SD = 6.0; MPostQuit= 107.7 assessments, SD = 37.1) of their negative affect and smoking urges during the 7 days (M = 6.6 days, SD = 1.0) prior to their quit-date and the 29 days (M = 25.8 days, SD = 6.4) after their quit-date. Prior to analysis, repeated measures of smoking urges were decomposed into between-person and within-person components.ResultsAfter accounting for baseline nicotine dependence, Bayesian multilevel models indicated that the extent of within-person association between negative affect and smoking urges was stronger in the post-quit stage of the intervention than the pre-quit stage. Results also indicated that in the post-quit stage of the intervention, the within-person association between negative affect and smoking urges was weaker for those in the Smart-T2 and TTRP groups compared with those in the QuitGuide group. The extent of this within-person association did not differ between those in the Smart-T2 and TTRP groups.ConclusionsThese findings offer preliminary evidence that the momentary within-person association between negative affect and smoking urges increases following a quit attempt, and that the TTRP and Smart-T2 interventions may weaken this association. Research is needed to replicate and expand upon current findings in a fully powered randomized controlled trial.Clinical Trial RegistrationClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200.

BACKGROUND A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials (TTTs) offer evidence-based cessation resources but suffer from low accrual rates. Digital outreach through clinician-delivered videos may improve recruitment efforts. However, understanding of how best to frame trial information and promote participation among smokers with a recent diagnosis is limited. OBJECTIVE This study aimed to identify which message frames were most effective at promoting intent to talk to a doctor about participating in a TTT for smokers recently diagnosed with cancer. METHODS From February-April 2019, current smokers diagnosed within the past 24 months were recruited from a national online panel company to a multi-method pilot randomized trial (N=99). Participants were randomly assigned to 1 of 9 videos in a 2 x 3 plus control factorial design that tested 3 unique message frame: (1) proximal vs. distal threats of smoking, (2) costs of continued smoking vs. benefits of quitting, and (3) gains of participating vs. loss of not participating in a TTT. The primary outcome was self-assessed intent to talk to a doctor about participating in a TTT. Phase 1: Analysis of variance examined the main effect within each message factor level and compared to control condition. Other message evaluation and effectiveness measures were also collected. A multivariable model explored sociodemographic, smoking and cancer characteristics, and message measures associated with intent to talk to a doctor. Phase 2: Open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare prevalence of linguistic markers between message factors. RESULTS A total of 76 participants completed the intervention. Participants who received the cost of continued smoking message frame were significantly more likely to intend to talk to their doctor about participating in a TTT than those who received the benefits of quitting frame (Mcosts=5.13 vs. Mbenefits=4.23, P=.038). Participants who received the proximal risks of continued smoking message frame were significantly more likely to seek more information about participating (MDistal=4.83 vs. MProximal=5.55, P=.04), and those who received the losses of not participating frame reported significantly improved perceptions about smoking cessation research (MGain=3.98 vs. MLoss=4.38, P=.013). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their doctor. Participants’ perceptions about their smoking habits, as well as their motivation and readiness to quit smoking, were the most prevalent themes in the open-text data. Differences across message frames in the percentage of affective words were identified. CONCLUSIONS Multi-method approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future TTTs should evaluate the effectiveness of different message frames on smoker enrollment rates. CLINICALTRIAL

Introduction: Racial disparities in colorectal cancer (CRC) can be addressed through increased adherence to screening guidelines. In real-life encounters, patients may be more willing to follow screening recommendations delivered by a race concordant clinician. The growth of telehealth to deliver care provides an opportunity to explore whether these effects translate to a virtual setting. The primary purpose of this pilot study is to explore the relationships between virtual clinician (VC) characteristics and CRC screening intentions after engagement with a telehealth intervention leveraging technology to deliver tailored CRC prevention messaging. Methods: Using a posttest-only design with three factors (VC race-matching, VC gender, intervention type), participants (N = 2267) were randomised to one of eight intervention treatments. Participants self-reported perceptions and behavioral intentions. Results: The benefits of matching participants with a racially similar VC trended positive but did not reach statistical significance. Specifically, race-matching positively influenced screening intentions for Black participants but not for Whites (b = 0.29, p = 0.10). Importantly, perceptions of credibility, attractiveness, and message relevance significantly influenced screening intentions and the relationship with race-matching. Conclusions: To reduce racial CRC screening disparities, investments are needed to identify patient-focused interventions to address structural barriers to screening. This study suggests that telehealth interventions that match Black patients with a Black VC can enhance perceptions of credibility and message relevance, which may then improve screening intentions. Future research is needed to examine how to increase VC credibility and attractiveness, as well as message relevance without race-matching.

Background A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284

Background Integrating tobacco treatment services into lung cancer screening (LCS) has the potential to leverage a 'teachable moment' to promote cessation among long-term smokers and reduce disparities in tobacco treatment access. This protocol paper describes the Screen ASSIST (Aiding Screening Support in Stopping Tobacco) trial, which will identify how to best deliver evidence-driven tobacco treatment in the context of LCS. Methods Screen ASSIST is a randomized clinical trial with a 3-factor, fully crossed factorial design that enrolls current smokers (any cigarette use in the past 30 days) scheduled to attend LCS at multiple sites in the Mass General Brigham healthcare system. To maximize reach, recruitment is conducted at 3 time points: 1) at the time of LCS scheduling, 2) at the LCS visit, and 3) after the participant has received their LCS results. Participants are stratified by LCS study site and recruitment point and randomly assigned into 8 groups that test intervention components varying on telehealth counseling duration (4 weeks vs. 8 weeks), nicotine replacement therapy duration (2 weeks vs. 8 weeks), and systematic screening and referral for social determinants of health via a service named 'AuntBertha' (referral vs. no referral). The primary study outcome is self-reported past 7-day tobacco abstinence at 6-month follow-up. This trial will also assess systems integration and evaluate implementation of the intervention. Discussion Screen ASSIST will identify the most effective combination of tobacco cessation treatments within the LCS context, in order to improve the cost-effectiveness of LCS and quality of life among long-term heavy smokers.

In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black (

Purpose Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and changes in attitudes toward LCS (phase 2). Methods Phase 1: We conducted three focus groups with mental health, primary care, and radiology clinicians and utilized rapid qualitative analysis to adapt the LCS intervention (LCS walk-through video and smoking cessation handouts) tailored for individuals with SMI. Phase 2: We enrolled LCS-eligible patients with SMI (n = 15) and assessed the feasibility (>50% enrollment; >75% completion) and acceptability (>75% overall satisfaction) of an LCS educational intervention delivered by a radiologist and a mental health clinician at a community mental health clinic. We explored changes in participant attitudes about lung cancer, LCS, and smoking before and after the intervention. Results Phase 1: Focus groups with primary care (n = 5), radiologists (n = 9), and mental health clinicians (n = 6) recommended person-centered language and adapting a video demonstrating the process of LCS to address concerns specific to SMI, including paranoia and concrete thinking. Phase 2: Fifty percent (15 of 30) of eligible patients enrolled in the LCS intervention, 100% (15 of 15) completed the intervention, and 93% (14 of 15) were satisfied with the intervention. Participants reported a significantly greater worry about developing lung cancer postintervention, but there were no other significant differences. Conclusions Radiologists can partner with primary care and community mental health clinics to lead equity efforts in LCS among individuals with SMI.

Colorectal cancer (CRC) screening rates are suboptimal, partly due to poor communication about CRC risk. More effective methods are needed to educate patients, but little research has examined best practices for communicating CRC risk. This multi-method study tests whether tailoring CRC risk information increases screening intentions. Participants (N = 738) were randomized with a 2:2:1 allocation to tailored, targeted, and control message conditions. The primary outcome was intention to screen for CRC (yes/no). Additional variables include perceived message relevance, perceived susceptibility to CRC, and free-text comments evaluating the intervention. A chi-square test determined differences in the proportion of participants who intended to complete CRC screening by condition. A logistic-based path analysis explored mediation. Free-text comments were analyzed using advanced topic modeling analysis. CRC screening intentions were highest in the tailored intervention and significantly greater than control (P = 0.006). The tailored message condition significantly increased message relevance compared with control (P = 0.027) and targeted conditions (P = 0.002). The tailored condition also increased susceptibility (P

BACKGROUND Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. OBJECTIVE The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. METHODS Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. RESULTS A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (PPPbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). CONCLUSIONS This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.

BACKGROUND Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. OBJECTIVE The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. METHODS Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. RESULTS In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” CONCLUSIONS Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.

Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening.White and Black adults (N=1,363) aged 50-73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects.Participants assigned to the animated virtual healthcare assistant (p0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions.Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant‒assisted interventions to promote colorectal cancer screening within guidelines.

In 2017, Florida ranked 2nd nationally in prevalence and incidence rates of HIV infections in the United States. Due to the high burden of HIV and low viral suppression in Florida, it is of increased importance to study methods of HIV prevention such as preexposure prophylaxis(PrEP) in this state. Our study aimed to examine correlates of PrEP awareness among PLWH in Florida and describe patterns of PrEP awareness/information sources. Using data collected from the Florida Cohort study between 2014 and 2018, 530 PLWH answered items that were hypothesized to be correlated with PrEP awareness. Of our sample, 53.8% were aware of PrEP. Urban location of recruitment, sexual partner's use of PrEP, use of viral suppression as an HIV prevention strategy, and engagement in transactional sex were all significantly associated with higher odds of PrEP awareness. Care providers and HIV/AIDS support groups were the most frequently listed sources of PrEP awareness, sources of future PrEP information, and most trusted sources for PrEP information. Findings from this study could inform future interventions that aim to increase PrEP awareness among PLWH to increase PrEP awareness and uptake among their HIV-negative social and sexual networks.

Cancer decision-making interventions commonly utilize narratives as a persuasive strategy to increase identification with the message source, promote involvement with the topic, and elicit greater willingness to adopt recommended behaviors. However, there is little empirical research examining the mechanisms underlying the effectiveness of this strategy in the context of cancer research participation. Data for the current manuscript were collected as part of a larger study conducted with cancer patients (N = 413) from the USA, UK, and the Republic of Ireland. Participants viewed and evaluated video-recorded vignettes, illustrating different strategies for discussing clinical trials participation with family members. Results showed nationality was a significant predictor of identification with the main character (i.e., patient) in the vignette. Unexpectedly, these cross-national differences in identification disappeared when patients currently undergoing treatment had higher perceived susceptibility of their cancer. Identification with the main character in the vignettes was a significant predictor of intentions to participate in cancer research, but only when the mediating role of narrative transportation was considered. The findings demonstrate the importance of considering how individual and social identities influence identification with characters in cancer narratives and yield practical guidance for developing arts-based interventions to increase cancer research participation.

Background Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.

Purpose The purpose of this paper is to explore the linkages between public relations efforts and policymaking activity during a non-election setting. Design/methodology/approach Using a time-lag design, this study used content analysis to examine public relations materials and policymaking activity during the first six months of US President Barack Obama’s second term. The public relations data were collected from the official White House website and social media. The policymaking data were collected from congressional calendars of business. Findings The data revealed varying degrees of support across the three levels of agenda-building for issues, attributes, and issue/attribute co-occurrence. Contrary to the expected relationship that public relations drives policymaking activity, the data suggest that policymaking activity was a stronger predictor of public relations material. Research limitations/implications This study provides modest support for time-lag agenda-building effects across three levels. However, future experimental research is needed to truly assess causal relationships. Future research should also explore alternative sources of data for policymaking activity. Practical implications This study demonstrates that the efficacy of information subsidy types is not uniform and should be chosen strategically. Traditional subsidy types were most effective for driving issues, while digital subsidy types provided more useful outlets for driving issue attributes. Originality/value This study contributes to political public relations scholarship by exploring the temporal relationships between public relations efforts and policymaking activity in a non-election setting. The time-lag design serves as an exploratory inquiry into the agenda-building process.

One third of smokers diagnosed with cancer continue smoking, perhaps due to low perceived cancer–related benefits of cessation. To examine perceived cancer–related benefits of quitting among newly diagnosed cancer patients who smoke and associations with quit intentions, baseline measures from patients (N = 303) enrolled in a randomized controlled trial were analyzed using hierarchical regression models and bootstrapping. Higher perceived cancer–related benefits of quitting were associated with having a smoking-related cancer and less education. Perceived cancer–related benefits of quitting and quit intentions were positively correlated, particularly among patients with smoking-related cancers. For smokers with smoking-related cancers, perceived cancer–related benefits of quitting are correlated with quit intentions.

Effective communication is one of the most fundamental aspects of successful patient care, and it frequently depends on the nurses’ ability to empathize with patients while finding effective ways to translate medical science into personally relevant health information. Skilled nurses are expected to understand the patient’s experiences and feelings and be able to communicate this understanding to the patient, but language strategies used to achieve the goal of empathic communication can vary. In this article, we employed the model of message design logics to evaluate what strategies nursing students ( N = 343) used to express empathy during a simulated health history training. The results of this study advance our understanding of what constitutes a high-quality response to the disclosure of personal health history facts. In addition to providing a general framework for understanding empathic responses during health history assessment, the message design logic perspective highlights the differences in linguistic choices in simulated patient–provider conversations.

Effectively communicating how findings from population science inform patient-level decision-making about cancer prevention remains a challenge. Despite the substantial benefits associated with early detection of colorectal cancer, patient compliance with screening guidelines is suboptimal. One potential barrier to compliance is the language used by organizations to frame screening recommendations. Drawing on theory and research on verbal immediacy, the current study examines whether linguistically framing screening messages as being temporally immediate makes them more effective than non-immediate messages for encouraging people to adopt state-of-science screening recommendations. An online message design experiment was conducted with a sample of older adults ( N = 305). Results show temporally immediate frames are more effective at increasing behavioral intention to follow updated screening guidelines than temporally non-immediate frames. In addition, both response efficacy of a screening modality and perceived susceptibility to cancer moderate the relationship between message strategy and intention to screen.

Hydraulic fracturing, or fracking, is the process of extracting reserves of natural gas and oil from shale formations deep underground. This process, initially met with public support in the United Kingdom, has since become a highly contentious issue primarily debated between government, industry, and anti-fracking advocacy groups. Through the employment of three levels of agenda-building as a theoretical lens of examination (object, attribute, and network connections), this study investigated the political discourse between these stakeholder groups and national news media in the United Kingdom between 2012 and 2014. In total, 1354 unique messages were coded, with 840 information subsidies and 514 news media content analyzed. To determine the short-, mid-, and long-term effects of agenda-building, a time-lag analysis was conducted. The results suggest solid support for all three levels of agenda-building. Our findings indicate that anti-fracking advocacy groups were more successful at influencing news med...

The benefits of transdisciplinary collaboration for addressing complex health problems are widely accepted; however, acknowledging the bumps and twists along the road that are inherent in those collaborations is often considered taboo. Academic norms that prevent open discussion of these challenges can have counter-productive results. This essay describes the major education efforts, milestones, and footfalls in the development of an effective partnership between communication-trained researchers in a College of Journalism and Communications and medical researchers in a College of Medicine. We hope it can serve as “best practice” for understanding the value of team science and interdisciplinary research collaborations.

To investigate the role of strategic political communication in governing, this study comprehensively examined presidential agenda-building associations at three levels during the first six months of U.S. president Barack Obama’s second term. Multiple presidential information subsidies, national news content, and policymaking activity were monitored. The results revealed solid support for all three levels of agenda-building (i.e., object salience, attribute salience, and network associations among objects or attributes), but the linkages with media coverage and policymaking were not uniform across information subsidy types. Based on the analysis, presidential news releases, blog posts, and presidential speeches were the most effective all-around strategic agenda-building tools for media management and policymaking purposes during this time period. The theoretical and practical implications are discussed.

Strategic communication is an essential component in the science and practice of recruiting participants to clinical research studies. Unfortunately, many clinical research studies do not consider the role of communication in the recruitment process until efforts to enroll patients in a timely manner have failed. The field of communication is rich with theory and research that can inform the development of an effective recruitment plan from the inception of a clinical research study through informed consent. The recruitment context is distinct from many other health contexts in that there is often not a behavioral response that can be universally promoted to patients. The appropriateness of a clinical research study for an individual is based on a number of medical, psychological, and contextual factors, making it impossible to recommend that everyone who is eligible for a clinical research study enroll. Instead, clinical research study recruitment efforts must utilize strategic communication principles to ensure that messages promote awareness of clinical research, maximize personal relevance, minimize information overload, and facilitate informed choice. This can be accomplished through careful consideration of various aspects of the communication context described in this chapter, including audience segmentation, message content, message channels, and formative, process, and outcome evaluation, as well as the enrollment encounter.

Background: Improving informed consent to participate in randomized clinical trials (RCTs) is a key challenge in cancer communication. The current study examines strategies for enhancing randomization comprehension among patients with diverse levels of health literacy and identifies cognitive and affective predictors of intentions to participate in cancer RCTs. Methods: Using a post-test-only experimental design, cancer patients (n = 500) were randomly assigned to receive one of three message conditions for explaining randomization (ie, plain language condition, gambling metaphor, benign metaphor) or a control message. All statistical tests were two-sided. Results: Health literacy was a statistically significant moderator of randomization comprehension (P = .03). Among participants with the lowest levels of health literacy, the benign metaphor resulted in greater comprehension of randomization as compared with plain language (P = .04) and control (P = .004) messages. Among participants with the highest levels of health literacy, the gambling metaphor resulted in greater randomization comprehension as compared with the benign metaphor (P = .04). A serial mediation model showed a statistically significant negative indirect effect of comprehension on behavioral intention through personal relevance of RCTs and anxiety associated with participation in RCTs (P < .001). Conclusions: The effectiveness of metaphors for explaining randomization depends on health literacy, with a benign metaphor being particularly effective for patients at the lower end of the health literacy spectrum. The theoretical model demonstrates the cognitive and affective predictors of behavioral intention to participate in cancer RCTs and offers guidance on how future research should employ communication strategies to improve the informed consent processes.

Introduction: While the majority of retrievable inferior vena cava filters (rIVCFs) are candidates for retrieval once the risk of thrombosis or bleeding has subsided, only ~ 20% of IVCFs are retrieved. Lack of patient follow-up is cited as the primary contributor to low retrieval rates. However, studies have not examined patient-perceived factors that lead to poor follow-up. Methods: This is a single center cross-sectional mixed methods study. Adult patients who received a rIVCF at our institution from 2008-2011 were included. Patients were excluded if it was decided to leave the IVCF in permanently. Eligibles were dichotomized into IVCF retrieved (R) versus not-retrieved (NR). A random sample of 100 patients (50 per group) was contacted for an individual face-to face interview. Target enrollment was 35 patients per group until thematic saturation was reached. The healthcare decision maker (HCDM) was invited to the interview if he/she provided consent to have the IVCF placed. Individual interviews were conducted by a hematologist and a health communications expert. Interviews focused on predisposing, enabling, reinforcing, situational, and procedural-related factors that may have affected IVCF retrieval. Transcripts of the interviews were analyzed by a multi-disciplinary team to identify and consolidate impressions into a list of themes elucidating facilitators and barriers to IVCF retrieval. Transcripts were coded according to finalized themes utilizing a cross-platform application for analyzing qualitative data. Results: 808 adult patients who received an IVCF at our institution from 2008-2011 were identified (R= 146, NR= 658). Thematic saturation was reached after the first fifteen interviews (8R and 7NR). 33.3% of subjects had a HCDM that consented for IVCF placement. 66.7% were male; 60% of IVCFs were placed for primary VTE prophylaxis despite only 26.7% having a contraindication to anticoagulation at the time of placement, 53.3% were placed by interventional radiology and 46.7% by vascular surgery, 53.5% had an IVCF placed during an admission for trauma; 40% had a history of prior VTE. The average time from hospital admission to IVCF placement was 3.7 days. Of the 8 patients that had their IVCF retrieved, the average time to retrieval was 279 days. Commonly expressed themes associated with retrieval or non-retrieval are depicted in Table 1. Conclusion: This study is unique in that it explores patient-related facilitators and barriers to IVCF retrieval. Preliminary results indicate that differences in themes expressed by patients may contribute to likelihood of retrieval. Results from this study will be used to develop and prospectively pilot a patient-centered educational resource toolkit for patients with IVC filters to enhance shared-decision making and overcome obstacles to IVCF retrieval. Table 1 Table 1. Common patient-perceived themes and subthemes Disclosures Rajasekhar: Anticoagulation Forum/Boston University: Speakers Bureau; Alexion: Membership on an entity's Board of Directors or advisory committees; Baxter: Membership on an entity's Board of Directors or advisory committees; Octapharma: Membership on an entity's Board of Directors or advisory committees.