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Objective: Lung cancer screening (LCS) efficacy is highly dependent on adherence to annual screening, but little is known about real-world adherence determinants. We used insurance claims data to examine associations between LCS annual adherence and demographic, comorbidity, health care usage, and geographic factors.Materials and Methods: Insurance claims data for all individuals with an LCS low-dose CT scan were obtained from the Colorado All Payer Claims Dataset. Adherence was defined as a second claim for a screening CT 10 to 18 months after the index claim. Cox proportional hazards regression was used to define the relationship between annual adherence and age, gender, insurance type, residence location, outpatient health care usage, and comorbidity burden.Results: After exclusions, the final data set consisted of 9,056 records with 3,072 adherent, 3,570 nonadherent, and 2,414 censored (unclassifiable) individuals. Less adherence was associated with ages 55 to 59 (hazard ratio [HR] = 0.80, 99% confidence interval [CI] = 0.67-0.94), 60 to 64 (HR = 0.83, 99% CI = 0.71-0.97), and 75 to 79 (HR = 0.79, 99% CI = 0.65-0.97); rural residence (HR = 0.56, 99% CI = 0.43-0.73); Medicare fee-for-service (HR = 0.45, 99% CI = 0.39-0.51), and Medicaid (HR = 0.50, 99% CI = 0.40-0.62). A significant interaction between outpatient health care usage and comorbidity was also observed. Increased outpatient usage was associated with increased adherence and was most pronounced for individuals without comorbidities.Conclusions: This population-based description of LCS adherence determinants provides insight into populations that might benefit from specific interventions targeted toward improving adherence and maximizing LCS benefit. Quantifying population-based adherence rates and understanding factors associated with annual adherence are critical to improving screening adherence and reducing lung cancer death. [ABSTRACT FROM AUTHOR]

Purpose: Annual low-dose CT (LDCT) screening in high-risk individuals has been recommended to detect lung cancer earlier and reduce mortality. The objective of this study was to identify demographic, financial, and health care factors associated with screening uptake in a population-based survey.Methods: Data from the Lung Cancer Screening Module and core modules of the 2017 Behavioral Risk Factor Surveillance System, a population-based survey administered via cell phone and landline, were analyzed to examine demographic, health, and financial factors associated with screening uptake among the 10 states that administered the screening module. Weighted frequencies and confidence intervals (CIs) were produced, and weighted Wald χ2 tests were used to compare differences in screening utilization by patient characteristics. A multivariate logistic mixed-effects model was constructed, in which participant clustering by state was accounted for with a random intercept.Results: The uninsured were less likely to undergo LDCT screening (odds ratio [OR], 0.28; 95% CI, 0.12-0.65). LDCT screening uptake was higher for participants with chronic respiratory conditions (OR, 4.14; 95% CI, 2.33-7.35); those who were divorced, separated, widowed, or refused to answer (OR, 1.41; 95% CI, 1.05-1.86); those who had previous cancer diagnoses (OR, 1.90; 95% CI, 1.40-2.56); and those aged 65 to 69 years (OR, 1.23; 95% CI, 1.06-1.44) or 70 to 74 years (OR, 1.17; 95% CI, 1.00-1.37). Utilization also varied significantly across states.Conclusions: Having a related health condition whereby participants were sensitized to the benefits of early screening (ie, another cancer diagnosis, presence of chronic respiratory conditions) and having insurance coverage were associated with higher LDCT screening uptake. Providers should engage LDCT-eligible patients through informed and shared decision making to increase preference-sensitive screening decisions. [ABSTRACT FROM AUTHOR]

Purpose: Despite compelling support for the benefits of low-dose CT (LDCT) screening for lung cancer among high-risk individuals, awareness of LDCT screening and uptake remain low. The aim of this project was to explore the perspectives of ACR mammography screening program directors (MPDs) regarding efforts to raise LDCT screening awareness and appropriate referrals by identifying high-risk individuals participating in routine mammography.Methods: MPDs were recruited from ACR-accredited mammography facilities to participate in semistructured interviews after the completion of an online survey. Interviews were conducted over the telephone, recorded, transcribed, and subsequently reviewed for accuracy. Twenty MPDs were interviewed, and 18 interviews were transcribed and included in the thematic analysis. A theme codebook was developed, and all interviews were coded using NVivo by two trained reviewers.Results: Key themes were organized into four broad domains: (1) general attitudes toward the integration of LDCT screening, (2) identifying mammography patients at high risk for lung cancer, (3) counseling about LDCT screening, and (4) strategies to identify high-risk women and increase awareness and knowledge of LDCT screening. Overall, MPDs recognized the benefits of integrating mammography and LDCT screening and were receptive to educating and referring women for LDCT screening. However, training and workflow changes are needed to ensure successful implementation.Conclusions: Qualitative data suggest that MPDs are amenable to leveraging the mammography setting to engage women about LDCT screening; however, additional tools, training, and/or staffing may be necessary to leverage the full potential of reaching women at high risk for lung cancer within the context of mammographic screening. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this project was to describe and evaluate the levels of lung cancer communication across the cancer prevention and control continuum for content posted to Twitter during a 10-day period (September 30 to October 9) in 2016.Methods: Descriptive and inferential statistics were used to identify relationships between tweet characteristics in lung cancer communication on Twitter and user-level data. Overall, 3,000 tweets published between September 30 and October 9 were assessed by a team of three coders. Lung cancer-specific tweets by user type (individuals, media, and organizations) were examined to identify content and structural message features. The study also assessed differences by user type in the use of hashtags, directed messages, health topic focus, and lung cancer-specific focus across the cancer control continuum.Results: Across the universe of lung cancer tweets, the majority of tweets focused on treatment and the use of pharmaceutical and research interventions, followed by awareness and prevention and risk topics. Among all lung cancer tweets, messages were most consistently tweeted by individual users, and personal behavioral mobilizing cues to action were rare.Conclusions: Lung cancer advocates, as well as patient and medical advocacy organizations, with an interest in expanding the reach and effectiveness of social media efforts should monitor the topical nature of public tweets across the cancer continuum and consider integrating cues to action as a strategy to increase engagement and behavioral activation pertaining to lung cancer reduction efforts. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is growing recognition regarding the clinical importance of integrating smoking cessation services, such as nicotine replacement therapy (NRT), within programs that treat substance use disorders (SUDs) since the majority of individuals receiving treatment also smoke. Previous research has not examined the organizational characteristics associated with NRT availability over time in SUD treatment programs. Method: Using longitudinal data collected from administrators of 868 SUD treatment programs over a four-year period, the availability of NRT in the forms of the nicotine patch or nicotine gum was measured. Associations between organizational covariates and NRT adoption were estimated using multinomial logistic regression. Results: The rate of NRT availability significantly decreased over time from 38.0% of SUD programs at baseline to 33.8% at follow-up. The multinomial logistic regression model indicated programs that sustained adoption of NRT over time were more medically oriented, as measured by location in a hospital setting and access to physicians, and were less likely to offer outpatient services. Sustained and recent adopters of NRT were more likely to offer other smoking cessation interventions at follow- up than NRT discontinuers or NRT non-adopters. Conclusions: These findings suggest that patients’ access to NRT varies across different types of treatment organizations. Future research should continue to measure the availability of NRT and other smoking cessation interventions in SUD treatment since these services may help patients to quit smoking and reduce the likelihood of SUD relapse. [Copyright &y& Elsevier]

Abstract: Objective: To systematically review the literature regarding the effects of menopausal symptom management decision aids. Methods: Using pre-designated inclusion and exclusion criteria, relevant articles were located using the PubMed.gov online search engine and reviewing reference lists of relevant articles. Full-text, English-language, peer-reviewed articles relevant to testing decision aids in uncontrolled trials (UCT) and randomized controlled trials (RCT) were reviewed. Results: The 18 articles represented 15 trials focused on natural health products decision aids (1 UCT, 1 RCT) or hormone therapy decision aids (1 UCT, 12 RCT). Whereas the natural health products aid was intended for women deciding about menopausal symptom management strategies, decision aids for hormone therapy were intended for a broader group of menopausal women and included indications for symptom management, prevention of heart disease, and prevention of osteoporosis. Many trials occurred prior to two pivotal events: the 2002 announcement of the Women''s Health Initiative findings and the 2006 publication of the International Patient Decision Aids Standards. Study limitations may help explain contradictory findings for outcomes such as decisional conflict, decisional confidence, decisional satisfaction, knowledge and values, and decisions. Conclusions: There is a relatively scant contemporary literature related to menopausal symptom management decision aids. Additional methodologically sound studies are needed to develop and subsequently test decision aids that are based on (a) contemporary knowledge regarding the wide array of available therapies and (b) international standards for decision aids that include consideration of women''s values and preferences. [Copyright &y& Elsevier]

Abstract: Most individuals receiving substance abuse treatment also use tobacco, which suggests that smoking cessation is an important clinical target for most clients. Few studies have measured the extent to which addiction treatment counselors address clients'' tobacco use. In this study, we examined counselors'' implementation of brief interventions that are consistent with the U.S. Public Health Service''s (PHS) clinical practice guideline, Treating Tobacco Use and Dependence, when counselors are engaging new clients in treatment. We hypothesized that counselors'' implementation of tobacco-related brief interventions is associated with organizational and counselor-level factors. Data were collected from 2,067 counselors via mailed surveys. Implementation of recommended brief interventions during intake was significantly lower among counselors reporting greater barriers to smoking cessation services within their organizational context. Perceived managerial support for smoking cessation services was positively associated with implementation. Counselors with greater knowledge of the PHS guideline and who believed in the positive impact of smoking cessation interventions on sobriety reported greater implementation. Relative to counselors who have never been tobacco users, current tobacco users reported significantly lower implementation of these brief interventions. These findings suggest that attempts to increase the implementation of best practices in substance abuse treatment may require attention to organizational contexts and the individuals responsible for implementation. [Copyright &y& Elsevier]

Abstract: This article describes knowledge, attitudes, and clinical practices regarding treatment of tobacco use and dependence reported by nurse practitioners (NPs) interested in learning about evidence-based practices. Researchers analyzed baseline data from 193 licensed NPs prior to participating in Providers Practice Prevention: Treating Tobacco Use and Dependence. Results revealed domains where participants practiced in accordance with clinical practice guidelines and some areas where additional education and support may be necessary. NPs have a tremendous opportunity to reduce tobacco-related morbidity and mortality by addressing tobacco use, making it vitally important to support their implementation of evidence-based strategies. [Copyright &y& Elsevier]

The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes stress-reduction applications of mindfulness meditation predominantly in medical settings, as originally conceived and developed by Kabat-Zinn and colleagues. It describes process factors associated with the time-limited, group-based formal favored by this model, and presents in tabular form results of both early and more recent outcome studies. [Copyright &y& Elsevier]

Prior research demonstrates that nearly all (95 %) people with lung cancer (PwLC) report stigma, and approximately half (48 %) PwLC experience stigma during clinical encounters with oncology care providers (OCPs). When stigma is experienced in a medical context, it can have undesirable consequences including patients' delaying and underreporting of symptoms, misreporting of smoking behavior, and avoiding help-seeking such as psychosocial support and cessation counseling. Multi-level interventions are needed to prevent and mitigate lung cancer stigma. One promising intervention for reducing patient perception and experience of stigma is to train OCPs in responding empathically to patient emotions and promoting empathic communication within clinical encounters. This paper describes the study protocol for a cluster randomized trial comparing Usual Care (waitlist control group) with Empathic Communication Skills (ECS) training (intervention group). For this study, we will recruit 16 community oncology practice sites, 9–11 OCPs per site, and 6 PwLCs per OCP. The goal of this trial is to investigate the effect of the ECS training on (a) OCP primary outcomes (communication and empathic skill uptake) and secondary outcomes (ECS training appraisal – relevance, novelty, clarity; self-efficacy, attitude towards communication with patients); and (b) patient-reported primary outcomes (lung cancer stigma), and secondary outcomes (perceived clinician empathy, satisfaction with OCP communication, psychological distress, social isolation, and appraisal of care). Findings from this trial will advance understanding of the effectiveness of the ECS training intervention and inform future provider-level training interventions that may reduce lung cancer stigma and improve cancer care delivery. ClinicalTrials.gov Identifier : NCT05456841 [ABSTRACT FROM AUTHOR]

Abstract: Objective: To systematically review the literature regarding factors related to women''s menopausal symptom management decision making. Methods: The PubMed.gov online search engine was queried using pre-selected inclusion and exclusion criteria. Reference lists of articles were also reviewed to identify potentially missed articles. Full-text, English-language, peer-reviewed articles on factors related to menopausal symptom management decisions were reviewed. Results: A total of 16 articles (15 data-based, 1 review of literature) from 6 different countries were reviewed. Most articles were related to decisions about one class of therapies and did not take into account all available therapeutic options. In the 15 data-based articles, diverse methods were used: qualitative (47%), quantitative (47%), and mixed (6%), with most being cross-sectional (93%). Very few of the data-based articles were based on a conceptual model (20%) and none used findings to derive an explanatory or predictive model. Most samples were not representative of special populations, such as women with breast cancer. Factors fell into four broad categories: (1) individual characteristics (demographics, menopause experience, symptomatology); (2) values, attitudes, beliefs, and preferences (attitudes and beliefs about menopause and treatments, preferred modalities, tolerance for risks/side effects); (3) facts and information about menopause and symptom management (amount, type, source, credibility, availability); and (4) health care context (health care provider communication, trust, availability/time, knowledge, relationship). Conclusions: Additional descriptive studies are needed understand women''s menopausal symptom management decisions in the context of all available therapies so that a comprehensive model of menopausal symptom management decision making can be specified. Additional understanding is needed regarding decisions in special populations of menopausal women such as breast cancer survivors, a group for whom menopausal symptom management can be particularly complex. [Copyright &y& Elsevier]

Abstract: Voluntary nurse turnover, which is costly and disrupts patient care, has not been studied as an organizational phenomenon within substance abuse treatment organizations. In this exploratory study, we examined the frequency and correlates of nurse turnover within treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. During face-to-face interviews conducted in 2005–2006, 215 program administrators reported the number of nurses currently employed. Leaders of programs with nursing staff then described the number of nurses who had voluntarily quit in the past year, the degree to which filling vacant nursing positions was difficult, and the average number of days to fill a vacant position. About two thirds of these programs had at least one nurse on staff. In programs with nurses, the average rate of voluntary turnover was 15.0%. Turnover was significantly lower in hospital-based programs and programs offering adolescent treatment but higher in facilities offering residential treatment. Most of the administrators indicated that filling vacant nurse positions was difficult and took more than 2 months to complete. These findings suggest that nurse turnover is a significant issue facing many substance abuse treatment facilities. Efforts to improve retention of the addiction treatment workforce should be expanded to include nursing professionals. [Copyright &y& Elsevier]