Browsing by Subject "Patient Acceptance of Health Care"
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Item Effect of Fragmentation of Cancer Care on Treatment Use and Survival in Hepatocellular Carcinoma(2020-05-01T05:00:00.000Z) Karbhari, Nishika; Yopp, Adam; Mansour, John; Porembka, Matthew R.BACKGROUND: Fragmentation of care (FC) refers to treatment received at multiple facilities. Implications of FC include increased health care costs and amplification of existing healthcare disparities. This study aimed to identify patient and hospital-level factors associated with FC and analyze the effect of FC on patient outcome measures (overall survival and time to treatment). OBJECTIVE: Fragmented care in HCC patients is associated with worse overall survival and increased time to treatment compared to patients receiving non-fragmented care. METHODS: The Texas Cancer Registry (TCR) was queried from 2004-2015 for a 12-year study span. Patient- and hospital-level factors were characterized within 2 groups: patients receiving fragmented care (FC) and those receiving non-fragmented care (NFC). Cox proportional hazards regression models were used to identify those factors that were independently and significantly associated with overall survival and time to treatment. Kaplan-Meier curves were generated to evaluate differences in overall survival between the FC and NFC groups, as well as between every type of transition within the FC group (stratified on the basis of safety net hospital status or volume status). All statistical analyses were performed with SPSS. RESULTS: Of our cohort (n = 4329), 72.6% received NFC, and 27.4% received FC. In comparison to patients receiving NFC, patients receiving FC had larger median tumor sizes at diagnosis (≥4 cm, 52.6% vs 35.2%; p < .001). NFC patients also tended to present with regional or metastatic disease (35.9% vs 26.7%; P < .001). A subset analysis of patients with localized stage HCC who received curative therapy showed that FC was associated with decreased odds of curative therapy (odds ratio, 0.83; 95% confidence interval [CI], 0.7-0.9). In this subgroup analysis, FC was associated with worse OS (median survival, 67 vs 43 months; HR, 1.2; 95% CI, 1.0-1.4) and increased TTT (HR, 0.74; 95% CI, 0.7-0.8). Ultimately, in our global cohort, FC was associated with worse OS (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24) and increased TTT (HR, 0.76; 95% CI, 0.7-0.8). CONCLUSION: Patients receiving FC had worse OS and increased TTT compared to patients receiving NFC. Several patient and hospital-level factors were found to be associated with FC, including age, insurance, non-safety net hospital status, accreditation, and disease stage. This work has implications for encouraging initiatives geared toward increasing care coordination, especially when managing cancer. Future work may aim to elucidate the reasons for the associations described and delineate steps by which to mitigate FC in the context of these factors.Item Guarding your gut: understanding colon cancer screening(2023-08-18) Lo, AmyItem Health Literacy, Spiritual Coping & the Completion of Advance Directives Following a Culturally Sensitive Educational Intervention(2018-07-25) Knox-Rice, Tori; Robinson, Richard C.; Rhodes, Ramona; Hynan, Linda S.; Robbins, Mona; Merlin, StaceyBased the prior investigations into disparities in advance care planning (ACP) among the African American population, it appears there is a need to identify culturally sensitive educational tools to increase knowledge and awareness within these areas of deficit. This study intended to test a culturally sensitive intervention designed to increase engagement in ACP, and examine variables impacting the completion of advance directives. Health literacy and religious coping were evaluated to determine their impact on intention to engage in advance care planning. It was predicted that religious coping would serve as a barrier to completion of advance directives. The sample consisted of 56 African American breast, lung, prostate, and colon cancer patients. The primary outcome measure was the Transtheoretical Stages of Change Model. Results found that the intervention was successful in increasing change in intention to complete ADs at the 1-month time point (B = -0.83, t(47) = -2.79, p = .007). However, the intervention was not found to be effective for increasing change in intention to assign an MPOA at the 1-month time point (B = -0.24, t(52) = -0.65, p = .522). Health literacy did not predict change in intent. Although positive religious coping was highly prevalent within the current study sample, results of the moderator analysis yielded a non-significant regression equation for both AD and MPOA consideration. The results of this study further highlight the importance of continued efforts towards addressing preferences in ACP.Item Improving the HIV care continuum in 2021(2021-06-25) Chow, JeremyItem Knowledge and Perception of Cervical Cancer and Screening Programs of Women Seeking Care at Monduli Hospital in Tanzania and St. Paul Hospital in Addis Ababa, Ethiopia(2015-04-03) Ghidei, Luwam; Lea, JayanthiAlthough a 2010 survey assessing Tanzanian women's knowledge and attitude towards cervical cancer demonstrated over 75% of respondents correctly identified early marriage and multiparty, other studies demonstrated a lack of knowledge about cervical cancer screening and HPV transmission among patients and nurses. Additionally, many women in Tanzania are not readily represented in such questionnaires. Women who are able to attend clinics with screening programs are generally from higher socioeconomic backgrounds, younger, and more knowledgeable about cervical cancer.15 Educational programs focused on the importance of cervical screening in rural remote areas of Tanzania may have a positive impact on the early detection and identification of patients at early disease stage. Considering both Tanzania and Ethiopia had established VIA programs in 2011 (Figure 5), I developed a questionnaire to assess the knowledge and perception of cervical cancer and cervical cancer screening programs of women in Tanzania and Ethiopia to guide future cervical cancer prevention and screening educational programs in communities.Item Patient Perspectives on Barriers to Hepatitis C Treatment: Qualitative Analysis of Patient Focus Groups(2013-01-17) Devereaux, Robert Logan; North, Carol S.Much of the research to date on barriers to treatment for patients with hepatitis C (HCV) has approached the problem from either the perspective of either the medical provider or healthcare system. To better understand these barriers from the patients' perspectives, exploratory focus groups were conducted with both mono-infected HCV and coinfected HCV/HIV patients. Nine focus groups with a total of 48 patients were conducted in 2008 and 2009. Transcribed focus group passages were categorized using qualitative analysis software. The category with the most passages was treatment knowledge (24%), which contained patients' expressions of their personal understanding as well as requests for additional information. The category with the fewest passages was desire for treatment (6%). The treatment barriers category included frustration with medical provider communication and difficulty with physician-patient relationships as well as social stigma and lack of accurate disease knowledge. These areas of concern expressed by patients in focus groups have highlighted underexplored areas that may warrant future investigation as potential opportunities for development of intervention.Item Tools to improve survival in dialysis: doing the most with a half-way technology(2019-10-04) Concepcion, MichaelItem Vaccine hesitancy(2021-05-21) DuVal, Tara