Search

Background Breast cancer patients and their informal caregivers often report unmet psychosocial, relational, and physical health needs. Dyadic interventions may improve patient and caregiver outcomes, but few have been integrated into clinical care or designed for Black breast cancer patients and their female caregivers. We used the Health Equity Implementation Framework to design for dissemination by identifying facilitators and barriers to implementing a dyadic survivorship intervention delivered via video teleconferencing (e.g., Zoom). Methods We conducted semi-structured interviews with a purposive sample of 18 collaborators with roles at a comprehensive cancer center and community organizations to understand facilitators and barriers to implementing a dyadic intervention for Black breast cancer patients and their caregivers. We used rapid qualitative analysis (templated summaries synthesized in matrices) to conduct a directed content analysis. We identified patterns in responses to interview guide questions and developed cross-cutting themes. Results Collaborators’ roles fell into four domains: patient-facing mental health (33%), patient-facing physical health (28%), research/administration (28%), and cancer-focused community groups (11%). Participants were supportive of a dyadic intervention for Black women with breast cancer and female caregivers. Collaborators noted that psychosocial care at the cancer center was already being delivered via Zoom and saw benefits to including caregivers. Overarching themes include the need to address gaps in care (for caregivers, Black women, and long-term breast cancer survivors); the importance of representation in building trust and mitigating stigma; and the challenges within the healthcare system around providing care services to dyads. Conclusion Application of these findings can help address the challenges of implementing a dyadic survivorship intervention for Black women with breast cancer and their caregivers in clinical settings. Expanding models such as the Health Equity Implementation Framework to include caregivers may help focus dissemination and implementation efforts on both members of a dyad and improve outcomes for both.

Introduction State tobacco quitlines are the most commonly available smoking cessation programmes; however, they have low reach and typically only enrol people who are ready to quit in the next 30 days. Expanding quitline services may increase the total number of people engaged in tobacco control efforts and the number who eventually quit. In this randomised controlled trial, we offered both arms a tobacco quitline intervention. In arm 2, if they declined the quitline, we then offered a smoke-free home (SFH) intervention. We examined the number of participants who accepted each intervention offer at baseline and whether acceptance varied by participant characteristics.Methods We recruited 1982 people who called 211, a social services helpline for social needs; mean age=50, 68% female; 45% white, 41% black and 14% other race/ethnicity; 68% reported an annual household income

Summary: Background: Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods: Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings: Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported

Introduction: Rural women with cancer are at heightened risk of financial toxicity. Financial assistance is an important, yet underexamined, aspect of how patients with cancer cope with financial toxicity. This study aims to examine the types of financial assistance rural women with cancer received during cancer treatment and how they described the impact of that assistance. Material and methods: Using data from interviews with 36 rural women with cancer histories, this study used a qualitative descriptive design to explore the types of financial assistance participants received during cancer treatment. Results: Participants described two forms of financial assistance they received: informal and formal financial assistance. Informal financial assistance was provided by social networks and local communities and included cash support, community fundraisers, and in-kind donations. Formal financial assistance was provided by healthcare systems and charitable organizations and included resource navigation and cash grants. Both forms of financial assistance were helpful for many patients with cancer; however, not all participants who needed financial assistance received it. Discussion: Informal and formal financial assistance are significant forms of support for some rural women undergoing cancer treatment. However, such support is unequally distributed and may exacerbate existing inequalities. Financial assistance is not an adequate substitute for public policy that reduces the economic toll of cancer treatment on patients.

Introduction: Informal caregivers such as spouses, family members, and friends provide important support to breast cancer patients, but caregivers themselves often need support as well. We interviewed caregivers for Black breast cancer patients to understand caregiver experiences, perspectives on patient/caregiver resources, experiences of racism/discrimination during the patient's cancer treatment, and reactions to a sample survivorship care plan. Methods: Focus groups and interviews were conducted with 24 caregivers in a Midwestern U.S. metropolitan area. In this directed thematic analysis, a form of content analysis, recordings were transcribed and coded using deductively and inductively derived codes. The study team developed and refined the themes. Results: All caregivers self-identified as Black/African American. Most were female (79%) and a family member other than spouse/partner (63%). Themes included inconsistent knowledge of and access to resources for patients and caregivers; facing racism or other discrimination during the patient's treatment; positive reactions to survivorship care plans, as well as suggestions for improvement; and desiring empathy, flexibility, and fun when it came to caregiver resources, especially resources for Black caregivers. Discussion: Systematic screening and referral for caregivers may help social workers, nurse navigators, and other members of the health care team identify and address caregivers' needs, especially given many caregivers’ tendency to focus on the patient. Caregiver-specific resources should be flexible and acknowledge the range of relationships caregivers have with patients. Multilevel interventions to address racism and other forms of discrimination may provide benefits both within the context of cancer care and as well as in broader settings.

Background: Low-income Americans smoke cigarettes at higher rates and quit less than other groups. Methods: To increase their engagement in and success using evidence-based cessation methods, we tested two interventions using a 2x2 randomized factorial design: (1) telephone navigation to reduce financial strain and address social needs such as food, rent and utility payment; and (2) a specialized tobacco quitline designed for low-income smokers. From June 2017 to November 2020, we enrolled 1,944 low-income smokers in Missouri, USA, recruited through the Missouri 2-1-1 helpline, into the trial. This paper describes recruitment, key characteristics and life circumstances of this high-risk population. Results: After eligibility screening, 1,944 participants completed baseline and were randomized. Participants were racially diverse (58% African American), poor (51%

Little is known about the acceptability and use of remote biochemical verification of self-reported cessation among low-income and racially diverse smokers. We compared responses to an in-person carbon monoxide breath test and in-home urine cotinine test among 270 adults who reported 7-day continuous abstinence at 6-month follow-up in a community-based randomized cessation trial. Half of participants (50%) reported annual household income below $10,000, one in four (28%) had not completed high school, and 69% were Black or African American. Regardless of whether the two tests were offered separately, sequentially, or as a head-to-head choice, participants were more likely to accept an offer to take the urine test than the breath test (89% vs. 32%), and complete it (46% vs. 13%). The proportion of participants completing the urine test and returning a digital photo of the test result is comparable to several studies completed with less disadvantaged samples. Self-report was confirmed by urine test for 74% of participants with a conclusive test result, although a high percentage (39%) of test results were inconclusive. In-home urine testing appears both acceptable and feasible for many low-income smokers, but challenges with testing technology and response rates currently limit its value to increase confidence in self-reports.

Purpose of Study: Managed care organizations (MCOs) provide case management services to address unmet health and social needs among their members. Few studies have examined factors influencing members' decision to participate in these programs. The purpose of the present study was to describe the life circumstances of Medicaid members offered case management, what they wanted from their MCO, and their perceptions of case management and barriers to participation. Results will inform practice to raise the awareness, engagement, and impact of case management programs., Primary Practice Settings: Case management offered through a Midwestern Medicaid MCO., Methodology and Sample: Adult members who had been offered case management services in the 6 months preceding the study were eligible for the study. Fifteen people from each strata were recruited: members who engaged with case management, declined it, or declined it initially but later engaged ( N = 45). Participants completed a qualitative interview by phone and a brief health survey online., Results: Across strata, only 22 participants recalled engagement with case management. Members described a variety of life challenges (e.g., chronic health conditions, caregiver responsibilities, and limited finances) and services they desired from their MCO (e.g., stipends for over-the-counter health expenses, improved transportation services, and caregiver assistance). Participants identified direct communication, emotional support, and referrals for resources as benefits of case management., Competing Interests: The authors declare no conflicts of interest. The research was supported by funding from the Centene Center for Health Transformation, a partnership between Centene Corp., Washington University in St. Louis, and Duke University Center for Advanced Hindsight., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Health care providers are increasingly screening low-income patients for social needs and making referrals to social services agencies to assist in resolving them. A major assumption of this approach is that local social services providers have the capacity and resources to help. To explore this assumption, we examined 711,613 requests related to fifty different social needs received from callers to 211 helplines in seven states during 2018. Our analyses focused on the proportion of requests for which referrals could not be made because of low capacity in the social services system. We examined the extent to which the capacity of this system varied by type of social need, ZIP code, and time of year, and we classified social needs in a new typology based on prevalence and system capacity. It is clear that health care's current screening and referral approach is appropriate for some social needs but not others.