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Building upon prior work developing and pilot testing a provider-focused Empathic Communication Skills (ECS) training intervention, this study sought feedback from key invested partners who work with individuals with lung cancer (i.e. stakeholders including scientific and clinical advisors and patient advocates) on the ECS training intervention. The findings will be used to launch a national virtually-delivered multi-center clinical trial that will examine the effectiveness and implementation of the evidence-based ECS training intervention to reduce patients’ experience of lung cancer stigma. A 1-day, hybrid, key invested partners meeting was held in New York City in Fall 2021. We presented the ECS training intervention to all conference attendees (N= 25) to seek constructive feedback on modifications of the training content and platform for intervention delivery to maximize its impact. After participating in the immersive training, all participants engaged in a group discussion guided by semi-structured probes. A deductive thematic content analysis was conducted to code focus group responses into 12 distinct a priori content modification recommendations. Content refinement was suggested in 8 of the 12 content modification themes: tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engagement and feedback from key invested multi-sector partner is a valuable resource for intervention content modifications. Using a structured format for refining evidence-based interventions can facilitate efforts to understand the nature of modifications required for scaling up interventions and the impact of these modifications on outcomes of interest.ClinicalTrials.gov Identifier: NCT05456841.An evidence-based provider-focused Empathic Communication Skills (ECS) training intervention to reduce patient experience of lung cancer stigma was successfully adapted for a national, virtually-delivered multi-center clinical trial.This study was done to get feedback from people who are involved with patients with lung cancer (PwLCs) including scientists, clinicians, and patient advocates on training in Empathic Communication Skills (ECS). The training is intended to reduce PwLCs experience of lung cancer stigma. The feedback is being used to help prepare for launching the training program in multiple cancer centers across the USA to test how well the training will work to reduce the stigma felt by PwLCs. A one-day, hybrid (in-person and virtual attendees) meeting was held in New York City in October 2021. We presented the original version of the ECS training program to all conference attendees (N= 25) to get feedback on modifications to improve the training program for the larger study planned at many cancer centers. After the training, all meeting attendees participated in a semi-structured group discussion. The content of the discussion was analyzed and sorted into 12 distinct categories that were defined before the meeting. Changes to the content were suggested in 8 of the 12 categories. These changes included tailoring/tweaking/refining, adding elements, removing elements, shortening/condensing content, lengthening/extending content, substituting elements, re-ordering elements, and repeating elements. Engaging and getting feedback from people involved in a topic is a good way to improve content and delivery of training materials.

Background Multi-cancer early detection tests (MCEDs) have the potential to identify over 50 types of cancer from a blood sample, possibly transforming cancer screening paradigms. Studies on the safety and effectiveness of MCEDs are underway, but there is a paucity of research exploring public views on MCEDs. We sought to explore public perspectives and understanding on the use of MCEDs in patient care.Methods We conducted a cross-sectional, qualitative study using one-on-one, semi-structured interviews. Residents of the United States aged 45–70 years old were recruited through a survey panel and purposively sampled to maximize racial diversity. Interviews explored understanding of MCEDs and perspectives on their use. Interviews were analyzed using thematic analysis with deductive coding and semi-quantification.Results Among 27 participants, mean age was 62 years (range 48-70) and most (63%) were non-white. Most participants had completed at least one cancer screening (89%). Participants had a positive impression of MCEDs (85%) and found the concept easy to understand (88%). They were enthusiastic about the convenience of MCEDs (30%) and thought they would improve “cancer outcomes” by looking for multiple cancers (70%) and facilitating early detection (33%). Participants emphasized the need to balance these benefits against potential harms, including inaccuracy (96%), cost (92%), test-related anxiety (56%), and lack of evidence of effectiveness (22%). Participants favored that MCEDs be delivered in primary care (93%). Participants worried that the potential benefits of MCEDs might not be equitably distributed (44%).Conclusions Members of the US public in this study expressed an interest in using MCEDs but had concerns regarding cost, accuracy, and potential inequitable access to the tests. Findings suggest that MCEDs that are found to be safe and effective will be acceptable to patients as a part of primary care, and underscore public interest in improving this technology.

Introduction Effective communication and messaging strategies are crucial to raise awareness and support participants' efforts to adhere to lung cancer screening (LCS) guidelines. Health messages that incorporate images are processed more efficiently, and given the stigma surrounding lung cancer and cigarette smoking, emphasis must be placed on selecting imagery that is engaging to LCS-eligible individuals. This exploratory study aimed to identify person-centered themes surrounding LCS imagery.Materials and Methods This qualitative study leveraged a modified photovoice approach and interviews to define descriptive themes about LCS imagery. Study participants eligible for annual LCS who had a CT scan within 12 months were asked to select three images and participate in a semi-structured interview about photo selection, likes, and dislikes. Participants were also asked their opinions about images from current LCS communications featuring matches, smoke, and cigarettes. Data were analyzed using an inductive thematic approach.Results Data saturation was reached after thirteen individuals completed the photovoice activity; each participant selected three pictures resulting in a total of 39 images representing LCS. Over half (54%) of images selected contained lungs and only 4 (10%) contained smoking-related elements. Five main themes emerged: 1) images should focus on good news and early detection; 2) people should be relatable; 3) pictures with lungs can dually support lung health or invoke fear; 4) opportunity for education or awareness; and 5) should not be judgmental and induce stigma.Conclusions These findings suggest that LCS imagery should not contain negative or stigmatizing elements but instead be relatable and educational. This information can inform communication and messaging interventions and strategies for future LCS participation, awareness, and educational research.

Purpose: Dental hygienists have opportunities to take a substantive role in tobacco control efforts. Previous research has suggested that implementation of tobacco cessation strategies has been sub-optimal, but few studies have examined factors associated with dental hygienists' delivery of evidence-based tobacco cessation treatment. Among dental hygienists, the current study investigated tobacco-related knowledge and attitudes, as well as clinical practices consistent with evidence-based guidelines for tobacco cessation. Methods: Practicing dental hygienists in the state of Kentucky (n=308) responded to a paper and pencil questionnaire that collected information regarding their demographic, clinical characteristics and knowledge, attitudes and clinical practices regarding tobacco cessation treatment. Results: Participants were somewhat familiar with evidence-based clinical practice guidelines regarding tobacco cessation treatment, but reported infrequent implementation of the 5 A's (Ask, Advise, Assess, Assist, Arrange). While participants were well aware of health risks associated with tobacco use and the value of cessation, few reported comfort or confidence in their ability to employ evidence-based interventions. However, several key variables were associated with implementation of recommended clinical practices (guideline awareness, comfort with specific tobacco cessation activities and self-efficacy). Conclusion: Results identified potential deficiencies in areas of tobacco control knowledge and confidence among dental hygienists. Correlations with evidence-based tobacco control practices suggest that knowledge and attitudes could serve as targets for education and training programs to promote greater implementation. While dental hygienists have unique opportunities to reduce tobacco-related morbidity and mortality, more education and training is necessary to increase adoption, implementation and sustainability of these important interventions. Keywords: dental hygienists, evidence-based practice, smoking cessation, public health This study supports the NDHRA priority area, Clinical Dental Hygiene Care: Studies in this category address the dental hygiene process of care (assessment, diagnosis, treatment planning, implementation and evaluation); decision-making and clinical reasoning; and data management systems., Introduction Cigarette smoking continues to be the number one preventable cause of death in the United States, with approximately 20% of deaths annually due to smoking-related diseases. (1,2) In addition [...]

Translating outcomes from randomized trials of lung cancer screening into community practice settings has been challenging. We developed a framework—the Engaged Approach to Lung Cancer Screening (EA-LCS)—for improving adherence and individual and population health outcomes in LCS.

In 2021, the International Association for the Study of Lung Cancer (IASLC) published the IASLC Language Guide as guidance on preferred language and phrasing in oral and written communications, including presentations at conferences. This study analyzed presentations from the 2022 IASLC World Conference on Lung Cancer (WCLC) one year after implementation of the Language Guide to identify adoption rates of non-stigmatizing language and to determine correlations with presenter characteristics.

Background

The public health imperative to reduce the burden of lung cancer has seen unprecedented progress in recent years. Fully realizing the advances in lung cancer treatment and control requires attention to potential barriers in their momentum and implementation. In this analysis, we present and evaluate the argument that stigma is a highly significant barrier to fulfilling the clinical promise of advanced care and reduced lung cancer burden. This evaluation of the stigma of lung cancer is based on a multilevel perspective that incorporates the individual, persons in the individual's immediate environment, the health care system, and the larger societal structure that shapes perceptions and decisions. We also consider current interventions and interventional needs within and across aspects of the lung cancer continuum, including prevention, screening, diagnosis, treatment, and survivorship. Current evidence suggests that stigma detrimentally affects psychosocial, communication, and behavioral outcomes over the entire lung cancer control continuum and across multiple levels. Interventional efforts to alleviate stigma in the context of lung cancer show promise, yet more work is needed to evaluate their impact. Understanding and addressing the multilevel role of stigma is a crucial area for future study to realize the full benefits offered by lung cancer prevention, control, and treatment. Coordinated, interdisciplinary, and well-conceptualized efforts have the potential to reduce the barrier of stigma in the context of lung cancer and facilitate demonstrable improvements in clinical care and quality of life.

Stigma thwarts progress in lung cancer risk reduction and control and adversely impacts patients across the entire lung cancer care continuum. In developing and disseminating patient and public-facing interventions to increase lung screening, we must be cognizant of how communications have the potential for further stigmatization of at-risk populations. Creation of the Lung Cancer Stigma Communications Assessment Tool (LCS-CAT) Version 1 was supported by the American Cancer Society’s National Lung Cancer Roundtable to help content developers identify, remove, and replace potentially stigmatizing language and imagery from materials designed to engage individuals across the lung cancer continuum.

The Society of Behavioral Medicine (SBM) supports the United States Preventive Services Task Force (USPSTF) recommendation of low-dose computed tomography (LDCT) screening of the chest for eligible populations to reduce lung cancer mortality. Consistent with efforts to translate research findings into real-world settings, SBM encourages health-care providers and health-care systems to (1) integrate evidence-based tobacco treatment as an essential component of LDCT-based lung cancer screening, (2) examine the structural barriers that may impact screening uptake, and (3) incorporate shared decision-making as a clinical platform to facilitate consultations and engagement with individuals at high risk for lung cancer about the potential benefits and harms associated with participation in a lung cancer screening program. We advise policy makers and legislators to support screening in high-risk populations by continuing to (1) expand access to high quality LDCT-based screening among underserved high-risk populations, (2) enhance cost-effectiveness by integrating evidence-based tobacco treatments into screening in high-risk populations, and (3) increase funding for research that explores implementation science and increased public awareness and access of diverse populations to participate in clinical and translational research.

For decades, investigators have conducted innovative research on shared decision-making (SDM), helping patients and clinicians to discuss health decisions and balance evidence with patients preferences for possible outcomes of options. In addition, investigators have developed and used rigorous methods for conducting comparative effectiveness research (CER), comparing the benefits and risks of different interventions in real-world settings with outcomes that matter to patients and other stakeholders. However, incorporating CER findings into clinical practice presents numerous challenges. In March 2012, we organized a conference at Washington University in St Louis (MO, USA) aimed at developing a network of researchers to collaborate in developing, conducting and disseminating research about the implementation of CER through SDM. Meeting attendees discussed conceptual similarities and differences between CER and SDM, challenges in implementing CER and SDM in practice, specific challenges when engaging SDM with unique populations and examples of ways to overcome these challenges. CER and SDM are related processes that emphasize examining the best clinical evidence and how it applies to real patients in real practice settings. SDM can provide one opportunity for clinicians to discuss CER findings with patients and engage in a dialog about how to manage uncertainty about evidence in order to make decisions on an individual patient level. This meeting highlighted key challenges and suggested avenues to pursue such that CER and SDM can be implemented into routine clinical practice.

High rates of tobacco use prompted the development of a provider education program in Kentucky to promote implementation of evidence‐based tobacco cessation treatment among registered dental hygienists (R.D.H.s). All R.D.H.s throughout the state were notified of the program and invited to participate. Participants were asked to complete a pre‐program survey and post‐program evaluation. A follow‐up survey was administered one year following program participation. Two hundred and ninety‐four R.D.H.s completed the pre‐ and post‐program surveys, and the follow‐up survey was completed by 53 percent (N=156) of the initial sample. Analyses exploring the immediate effect (from pre‐ to post‐program) found the program to have had a universally positive impact (p<.05) across knowledge, attitudes, and intended clinical practices regarding tobacco use and treatment. Regarding the program's durable effects (from pre‐program to follow‐up), statistically significant (p<.05) and positive effects were realized for most of the outcomes, including subjective knowledge, attitudes, and practices. It was concluded that the program serves as an effective introduction to the Treating Tobacco Use and Dependence: Clinical Practice Guideline. Additional intervention might enhance the durability of the program's efficacy and promote more complete adoption of evidence‐based tobacco cessation strategies by dental hygienists, leading to an even broader impact on cancer prevention and control of tobacco‐related malignancy.

Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy.

Depressive symptoms are common among patients with fibromyalgia, and behavioral intervention has been recommended as a major treatment component for this illness. The objective of this study was to test the effects of the Mindfulness‐Based Stress Reduction (MBSR) intervention on depressive symptoms in patients with fibromyalgia.This randomized controlled trial examined effects of the 8‐week MBSR intervention on depressive symptoms in 91 women with fibromyalgia who were randomly assigned to treatment (n = 51) or a waiting‐list control group (n = 40). Eligible patients were at least 18 years old, willing to participate in a weekly group, and able to provide physician verification of a fibromyalgia diagnosis. Of 166 eligible participants who responded to local television news publicizing, 49 did not appear for a scheduled intake, 24 enrolled but did not provide baseline data, and 2 were excluded due to severe mental illness, leaving 91 participants. The sample averaged 48 years of age and had 14.7 years of education. The typical participant was white, married, and employed. Patients randomly assigned to treatment received MBSR. Eight weekly 2.5‐hour sessions were led by a licensed clinical psychologist with mindfulness training. Somatic and cognitive symptoms of depression were assessed using the Beck Depression Inventory administered at baseline, immediately postprogram, and at followup 2 months after the conclusion of the intervention.Change in depressive symptoms was assessed using slopes analyses of intervention effects over time. Depressive symptoms improved significantly in treatment versus control participants over the 3 assessments.This meditation‐based intervention alleviated depressive symptoms among patients with fibromyalgia.

Background.Previous studies have reported high interest in genetic testing for risk for colon or breast–ovarian cancer. These studies, however, have used samples which might be atypical with regard to level of interest evident among the general U.S. population.Methods.As part of an annual statewide telephone health survey, adults’ (n= 649) interest in learning about their personal genetic predisposition for cancer was assessed.Results.High levels of interest in learning about a personal genetic predisposition for cancer in general (87%) and breast cancer in particular (93%) were expressed. Logistic regression analysis indicated that lack of interest was associated with less education, minority status, and less performance of other health-protective behaviors. Only 53% of respondents reported their understanding of genetics was “good” or “excellent.”Conclusion.While interest in learning of one's personal genetic predisposition for cancer was high, many individuals requesting testing may have a less than good understanding of genetics and the implications of test results. Furthermore, variables associated with lack of interest in learning about personal genetic risk for cancer in this study were similar to those which have been previously found to be associated with poor utilization of other cancer control activities such as breast or cervical cancer screening.