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This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation.

Government policy affects virtually every topic of interest to health behavior researchers, from research funding to reimbursement for clinical services to application of evidence to impact health outcomes. This paper provides a 6-year update on the expansion of Society of Behavioral Medicine's (SBM) public policy and advocacy agenda and proposed future directions. SBM's Health Policy Council is responsible for ensuring coordination of the policy-related activities of the Health Policy Committee (HPC), the Civic and Public Engagement Committee (CPEC), and the Scientific and Professional Liaison Council (SPLC). These committees and councils have written letters to Congress, signed onto advocacy letters with hundreds of organizations, and developed and disseminated 15 health policy briefs, the majority of which have been presented to legislative staffers on Capitol Hill. With the assistance of the SPLC, SBM has collaborated on policy efforts with like-minded organizations to increase the impact of the Society's policy work. Moving forward, SBM plans to continue to increase efforts to disseminate policy work more broadly and develop long-term relationships with Congressional staffers. SBM leadership realizes that to remain relevant, demonstrate impact, and advance the role of behavioral medicine, we must advance a policy agenda that reflects our mission of better health through behavior change.

Objective. Human Papillomavirus (HPV) is the most common sexually transmitted infection and the leading cause of cervical and oropharyngeal cancers. Vaccination can prevent over 90% of HPV-attributed cancers among those aged 9-26. Rural populations are less likely to receive the complete HPV protocol than urban; rates have further declined post-COVID. The aim of this scoping review is to evaluate multilevel (patient/young person, parent/caregiver, physician/team, healthcare organization, community, and policy) influences on HPV vaccine hesitancy in rural communities. Study Design and Analysis. An informationist conducted a systematic search of published empirical studies between 20102021 across 7 databases, resulting in 915 publications. Using pre-specified criteria, the team reviewed 33 full texts. With a standard codebook, two reviewers independently coded the studies; discrepancies were resolved by a third reviewer. A mixed methods analysis was conducted to integrate quantitative and qualitative data. Setting. Rural US communities. Population Studied. Empirical studies of rural HPV vaccination hesitancy. Instrument. Standard codebook. Outcome Measures. By the frequency cited, HPV vaccine prevalence, awareness, knowledge, attitudes/beliefs toward HPV vaccine hesitancy. Results. The modal publication year was 2020 (N=7 studies). Primary care provider recommendation strongly influenced parents' decisions to vaccinate their children. Prescriptive provider communication approaches were less common but more influential than consultative. Multilevel interventions, although rarely applied, were effective in reducing HPV vaccine hesitancy. Adolescents themselves were the most common foci of change. Barriers to rural HPV uptake included; limited vaccine awareness, few primary care sites, the stigma of STI's, and strict religious values. Most studies were observational (85% of studies); interventions included; educational materials or training (75%), media (12.5%), and a free HPV vaccine (12.5%). Conclusions. Tailored interventions to rural parents/caregivers, particularly of marginalized youth (e.g., LGBT+) could increase awareness and knowledge about the vaccine. Provider training increases HPV vaccine recommendations; programs should also be targeted to rural school nurses and dental care providers. Linking primary care practices and public health dissemination strategies on college campuses, secondary schools, and community sites, are key., Presenters Sherri Sheinfeld Gorin, PhD, FSBM, Angela Kuznia, MD, MPH, Meghann Lewis, Cornelius Jamison, MD, MS, MSPH, Rebecca [...]

This issue of Annals presents an important article proposing guidelines for the reporting of primary care research. (1) Written by a team of international family medicine researchers and editors representing [...]

Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults.

BackgroundCommunity social and economic resources influence colorectal (CRC) screening decisions by physicians and patients. The aim of this study is to systematically assess the differences in screening recommendations of primary care physicians within two urban communities that are distinct in socioeconomic characteristics.MethodsTwo-hundred-sixty-four primary care community (i.e., not hospital-based) physicians were stratified by community. Using self-report questionnaires, we examined primary care physicians' CRC screening practices, knowledge of risk factors and perceived physician and patient barriers to screening, Physicians practicing in upper-socioeconomic status (SES) communities were compared with those of participants practicing in lower SES communities.ResultsPhysicians practicing in low-SES urban communities were significantly more likely to screen with fecal occult blood test than were physicians in upper-SES areas. Alternatively, upper-SES physicians were significantly more likely to recommend screening colonoscopy than were lower-SES physicians. The number of physicians (N=11) who screened for CRC using the double-contrast barium enema were few.ConclusionsCommunity-level SES influences physician cancer screening practices. Further understanding of these relationships may guide the development of interventions targeted to specific neighborhoods within urban areas.

ObjectivesWe used data from the National Health Interview Survey to compare health care access among individuals involved in same-sex versus opposite-sex relationships.MethodsWe conducted descriptive and logistic regression analyses from pooled data on 614 individuals in same-sex relationships and 93418 individuals in opposite-sex relationships.ResultsWomen in same-sex relationships (adjusted odds ratio [OR]=0.60; 95% confidence interval [CI]=0.39, 0.92) were significantly less likely than women in opposite-sex relationships to have health insurance coverage, to have seen a medical provider in the previous 12 months (OR=0.66; 95% CI=0.46, 0.95), and to have a usual source of health care (OR=0.50; 95% CI=0.35, 0.71); they were more likely to have unmet medical needs as a result of cost issues (OR=1.85; 95% CI=1.16, 2.96). In contrast, health care access among men in same-sex relationships was equivalent to or greater than that among men in opposite-sex relationships.ConclusionsIn this study involving a nationwide probability sample, we found some important differences in access to health care between individuals in same-sex and opposite-sex relationships, particularly women.

In this article, author discusses about the care of cancer survivors, along with mentions that cancer survivors experience significant emotional distress and frequently develop depression and anxiety. It mentions that survivors of different types of cancers, such as prostate and colorectal cancers, experience posttreatment problems specific to those cancers.

Purpose: The aims of this paper are to: briefly review the long-term or late effects of cancer diagnosis and treatment on children and youth; examine the implications of these effects on the educational needs of the child or youth; explore the implications of childhood cancer survivorship on the school, particularly for female students. Over the last 25 years, treatments for childhood cancers have increased survival rates by 45 per cent, to nearly 77 per cent. It is estimated that one in 900 people aged 15-44 years in the USA is a childhood cancer survivor; 80 per cent of children diagnosed with cancer in 1990 will survive into adulthood. Design/methodology/approach: A comprehensive literature review of studies relevant to female childhood cancer survivorship and education over the past ten years was conducted, having been collected through searches of MEDLINE, CINAHL, PSYCINFO, and EMBASE. Findings: Long-term and late effects of cancer have been observed in neurocognition, cardiopulmonary symptoms, second cancers, reproductive organs, and hearing loss. Other health effects, such as impaired growth, osteopenia, hepatitis C infection, oral and dental malformations, and behavioral risk factors such as fatigue, obesity, and smoking have also been reported among childhood cancer survivors. These longer-term treatment sequelae, particularly on neurological systems, have implications for changed student educational needs, including the provision of specialized instruction, classroom adaptations, as well as ancillary health services. Research limitations/implications: Based on the ecologic model, a research agenda is proposed for better integrating the increasing numbers of childhood cancer survivors into the educational environment. Practical implications: Practical interventions for survivors who are experiencing difficulties in school are listed. Originality/value: To the best of one's knowledge, this is the first comprehensive review on the implications of childhood cancer survivors in schools. (Contains 2 tables, 2 figures and 1 note.)

Breast cancer represents a serious health concern for women. It is estimated that hereditary breast cancer accounts for approximately 5-10% of all breast cancer cases and as many as 25% of early-onset cases. We conducted a qualitative study of 26 first degree relatives of women with breast cancer (FDRs) in order to gain a deeper understanding of the effect of risk perception on their screening adherence. The method relied upon semi-structured, in-depth, face-to-face interviews with first degree relatives of women with breast cancer. We characterized FDRs by their response to a single query about their perceived risk. 'Risk adopters' (N = 13) were defined as those who expressed a lifetime risk of breast cancer of 50% or more, and 'normalizers' (N = 13) were those who indicated a lifetime risk of 49% or less. We conducted content analysis on the responses to the open-ended queries concerning perceived risk for breast cancer, searching for consistent themes among the responses. Surveillance behaviors were high among these FDRs relative to population-based comparisons. The difference between perceived and objective risk for breast cancer was significantly greater among risk adopters than normalizers (p < .0001). Three themes, derived from a content analysis of the FDR's natural language, further distinguish the two groups of women from one another: (1) causal attributions; (2) acceptance of labeling by the physician or other health care provider; and (3) current or remembered surveillance reminders from salient members of the social support network. We suggest different health care provider approaches to FDRs who are normalizers and those who are risk adopters, as well as additional studies of the impact of risk status (as manifest in the FDR's natural language) and surveillance behaviors, over time, among more diverse subgroups. KEYWORDS. Breast cancer, risk, first degree relatives, ethnographic analysis

The article offers information on the multilevel approaches to reducing diagnostic and treatment delay in colorectal cancer (CRC). It discusses the role of the routine CRC screening in identification precursor lesions at an earlier stage and reduces the risk of death from CRC. It mentions the need to deliver diagnostic follow-up for a positive screening and subsequent treatment, called the total diagnostic interval in the patients.

This perspective paper seeks to lay out an efficient approach for health care providers, researchers, and other stakeholders involved in interventions aimed at improving care coordination to partner in locating and using applicable care coordination theory. The objective is to learn from relevant theory-based literature about fit between intervention options and coordination needs, thereby bringing insights from theory to enhance intervention design, implementation, and troubleshooting. To take this idea from an abstract notion to tangible application, our workgroup on models and measures from the Veterans Health Administration (VA) State of the Art (SOTA) conference on care coordination first summarizes our distillation of care coordination theoretical frameworks (models) into three common conceptual domains-context of an intervention, locus in which an intervention is applied, and specific design features of the intervention. Then we apply these three conceptual domains to four cases of care coordination interventions ("use cases") chosen to represent various scopes and stages of interventions to improve care coordination for veterans. Taken together, these examples make theory more accessible and practical by demonstrating how it can be applied to specific cases. Drawing from theory offers one method to anticipate which intervention options match a particular coordination situation. [ABSTRACT FROM AUTHOR]

Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults. [ABSTRACT FROM AUTHOR]