Patient-Provider Communication and Colorectal Cancer Screening Completion Using Multi-target Stool DNA Testing.

Colorectal cancer (CRC) screening continues to be underutilized in the USA despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Understanding how patient-provider communication influences CRC screening can inform interventions to improve screening completion. We developed a behavioral theory-informed survey to identify patient-provider communication factors associated with multi-target stool DNA (mt-sDNA) screening completion. The survey was administered by RTI International between 03/2022 and 06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021 and 9/2021. Respondents completed an electronic or paper survey. Multivariable logistic regression was used to identify patient-provider communication factors associated with mt-sDNA test completion. A total of 2973 participants completed the survey (response rate, 21.7%) and 81.6% of them (n = 2427) reported having had a conversation with provider about mt-sDNA testing before the test was ordered. Having a conversation with the provider about the test, including discussions about costs, the need for follow-up testing and test instructions were associated with higher odds of test completion and being "very likely" to use the test in the future. Lack of discussion about advantages and disadvantages of available CRC screening options and lack of patient involvement in CRC screening decision-making were associated with reduced odds of test completion and likelihood of future use. Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control.

Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option.

Health Misinformation Exposure and Health Disparities: Observations and Opportunities.

The concepts of health misinformation and health disparities have been prominent in public health literature in recent years, in part because of the threat that each notion poses to public health. How exactly are misinformation proliferation and health disparities related, however? What roles might misinformation play in explaining the health disparities that we have documented in the United States and elsewhere? How might we mitigate the effects of misinformation exposure among people facing relatively poor health outcomes? In this review, we address such questions by first defining health disparities and misinformation as concepts and then considering how misinformation exposure might theoretically affect health decision-making and account for disparate health behavior and health outcomes. We alsoassess the potential for misinformation-focused interventions to address health disparities based on available literature and call for future research to address gaps in our current evidence base.

The impact of interactive advertising on consumer engagement, recall, and understanding: A scoping systematic review for informing regulatory science.

We conducted a scoping systematic review with respect to how consumer engagement with interactive advertising is evaluated and if interactive features influence consumer recall, awareness, or comprehension of product claims and risk disclosures for informing regulatory science. MEDLINE, PsycINFO, Business Source Corporate, and SCOPUS were searched for original research published from 1997 through February 2021. Two reviewers independently screened titles/abstracts and full-text articles for inclusion. Outcomes were abstracted into a structured abstraction form. We included 32 studies overall. The types of interactive ads evaluated included website banner and pop up ads, search engine ads, interactive TV ads, advergames, product websites, digital magazine ads, and ads on social network sites. Twenty-three studies reported objective measures of engagement using observational analyses or laboratory-based experiments. In nine studies evaluating the association between different interactivity features and outcomes, the evidence was mixed on whether more interactivity improves or worsens recall and comprehension. Studies vary with respect to populations, designs, ads evaluated, and outcomes assessed.

Alcohol and Cancer: Existing Knowledge and Evidence Gaps across the Cancer Continuum.

Alcoholic beverages are carcinogenic to humans. Globally, an estimated 4.1% of new cancer cases in 2020 were attributable to alcoholic beverages. However, the full cancer burden due to alcohol is uncertain because for many cancer (sub)types, associations remain inconclusive. Additionally, associations of consumption with therapeutic response, disease progression, and long-term cancer outcomes are not fully understood, public awareness of the alcohol-cancer link is low, and the interrelationships of alcohol control regulations and cancer risk are unclear. In December 2020, the U.S. NCI convened a workshop and public webinar that brought together a panel of scientific experts to review what is known about and identify knowledge gaps regarding alcohol and cancer. Examples of gaps identified include: (i) associations of alcohol consumption patterns across the life course with cancer risk; (ii) alcohol's systemic carcinogenic effects; (iii) alcohol's influence on treatment efficacy, patient-reported outcomes, and long-term prognosis; (iv) communication strategies to increase awareness of the alcohol-cancer link; and (v) the impact of alcohol control policies to reduce consumption on cancer incidence and mortality. Interdisciplinary research and implementation efforts are needed to increase relevant knowledge, and to develop effective interventions focused on improving awareness, and reducing harmful consumption to decrease the alcohol-related cancer burden.

Provider response and follow-up to parental declination of HPV vaccination.

OBJECTIVE: Parents often decline HPV vaccination, but little is known about how healthcare providers should promote vaccination at a later visit for secondary acceptance. We examined the associations of two factors, providers' response to declination during the visit and follow-up after the visit, with secondary acceptance. METHODS: We conducted a cross-sectional survey of US parents whose 9- to 17-year-old child had not yet completed the HPV vaccination series. Parents who declined HPV vaccination during an initial discussion with a provider (n = 447) reported whether their provider engaged in any active response during the visit (e.g., giving information, trying to change their mind) or any follow-up after the visit (e.g., scheduling another visit). We conducted multivariable logistic regression to determine whether an active response or follow-up was associated with secondary acceptance of HPV vaccination. RESULTS: Only about one-third of parents reported an active response during the visit (35%) or follow-up after the visit (39%) following HPV vaccination declination. Parents had higher odds of secondary acceptance of HPV vaccine if they received any provider follow-up after the visit (43% vs. 20%, aOR:3.19; 95% CI:2.00:5.07). Receipt of an active provider response was not associated with secondary acceptance. More parents thought a provider should actively respond and follow-up (61% and 68% respectively), compared with those who received such a response (both p < .01). CONCLUSIONS: Providers' follow-up after the visit may be important for promoting secondary acceptance of HPV vaccination. Parents who decline HPV vaccination often prefer to receive an active response or follow-up from a provider.

A Pilot Study of Medical Misinformation Perceptions and Training Among Practitioners in North Carolina (USA).

Medical misinformation (MM) is a problem for both medical practitioners and patients in the 21st century. Medical practitioners have anecdotally reported encounters with patient-held misinformation, but to date we lack evidence that quantifies this phenomenon. We surveyed licensed practitioners in the state of North Carolina to better understand how often patients mention MM in the clinical setting, and if medical practitioners are trained to engage with patients in these specific conversations. We administered an anonymous, online survey to physicians and physician assistants licensed to practice in the state of North Carolina. Questions focused on demographics, clinical encounters with MM, and training to discuss MM with patients. We received over 2800 responses and analyzed 2183 after removing ineligible responses. Our results showed that most respondents encountered MM from patients (94.2% (2047/2183)), with no significant differences between clinical specialty, time spent in practice, or community type. When asked about specific training, 18% (380/2081) reported formal experiences and 39% (807/289) reported informal experiences. MM has been salient due to the COVID-19 pandemic; however, it was present before and will remain after the pandemic. Given that MM is widespread but practitioners lack training on engaging patients in these conversations, a sustained effort to specifically train current and future practitioners on how to engage patients about MM would be an important step toward mitigating the spread of MM.

News coverage about aspirin as a countervailing force against low-dose aspirin campaign promotion.

Organized health promotion efforts sometimes compete with news media, social media, and other sources when providing recommendations for healthy behavior. In recent years, patients have faced a complicated information environment regarding aspirin use as a prevention tool for heart health. We explored the possibility that campaign promotion of low-dose aspirin use might have been undermined by news coverage in the USA detailing controversies regarding aspirin use. Using time series data on low-dose aspirin sales in Minnesota, USA, we assessed whether news coverage of aspirin or audience engagement with the Ask About Aspirin campaign website predicted subsequent changes in low-dose aspirin sales, over and above any secular trend. News coverage predicted actual low-dose aspirin purchases whereas exposure to a state-level campaign did not. While a campaign effort to encourage people at risk to discuss low-dose aspirin use with their health care providers did not generate substantive changes in low-dose aspirin tablet sales in the areas of Minnesota monitored for this study, past news coverage about aspirin use, including news about negative side effects, may have suppressed low-dose aspirin sales during this same period. The extent of news coverage about aspirin and heart health had a negative effect on tablet sales recorded in greater Minnesota approximately a month later in an ARIMA time series model, coefficient = -.014, t = -2.33, p = .02. Presented evidence of news coverage effect suggests health campaign assessment should consider trends in the public information environment as potential countervailing forces.

Predictors of willingness to get a COVID-19 vaccine in the U.S.

BACKGROUND: As COVID-19 vaccine distribution efforts continue, public health workers can strategize about vaccine promotion in an effort to increase willingness among those who may be hesitant. METHODS: In April 2020, we surveyed a national probability sample of 2279 U.S. adults using an online panel recruited through address-based sampling. Households received a computer and internet access if needed to participate in the panel. Participants were invited via e-mail and answered online survey questions about their willingness to get a novel coronavirus vaccine when one became available. The survey was completed in English and Spanish. We report weighted percentages. RESULTS: Most respondents were willing to get the vaccine for themselves (75%) or their children (73%). Notably, Black respondents were less willing than White respondents (47% vs. 79%, p < 0.001), while Hispanic respondents were more willing than White respondents (80% vs. 75%, p < 0.003). Females were less likely than makes (72% vs. 79%, p < 0.001). Those without insurance were less willing than the insured (47% vs. 78%, p < 0.001). Willingness to vaccinate was higher for those age 65 and older than for some younger age groups (85% for those 65 and older vs. 75% for those 50-64, p < 0.017; 72% for those 35-49, p < 0.002; 70% for those 25-34, p = NS and 75% for ages 18-24, p = NS), but other groups at increased risk because of underlying medical conditions or morbid obesity were not more willing to get vaccinated than their lower risk counterparts. CONCLUSIONS: Most Americans were willing to get a COVID-19 vaccine, but several vulnerable populations reported low willingness. Public health efforts should address these gaps as national implementation efforts continue.

Development and validation of prescription drug risk, efficacy, and benefit perception measures in the context of direct-to-consumer prescription drug advertising.

PURPOSE: Understanding patient perceptions of prescription drug risks and benefits is an important component of determining risk-benefit tradeoffs and helping patients make informed medication decisions. However, few validated measures exist for capturing such perceptions. The purpose of this study was to develop and validate measures of perception of prescription drug risk, efficacy, and benefit. METHODS: We conducted a mixed-methods study to develop and validate the measures, including three waves of quantitative testing (item nonresponse, criterion-related validity, and convergent validity). We conducted quantitative testing with a probability-based online consumer panel of U.S. adults (n = 7635), eliminating weaker items after each testing wave. RESULTS: Upon completion of all testing, we identified 21 validated measures that represent 11 distinct risk/benefit constructs. The final measures demonstrated face validity, convergent validity, criterion-related validity, and scale reliability in both illness and general population samples, among patients with both symptomatic and asymptomatic health conditions, and in response to both television and print direct-to-consumer prescription drug advertisements. CONCLUSIONS: Our study produced a set of items that researchers and practitioners can use to assess patient perceptions of prescription drug risk, benefit, and efficacy and to ensure greater future comparability between studies.

News coverage and online advertising effects on patient-led search for aspirin, heart health, and stroke information and educational tool use.

OBJECTIVE: Using indicators of campaign effort and relevant news stories, we sought to predict two patterns of patient behavior regarding information about aspirin and heart health: patient use of a campaign web tool to determine whether they should talk with a physician about using aspirin and patient searches for information about aspirin and the heart. METHODS: We used ARIMA modeling to predict two time series as a function of independent variables. RESULTS: We found significant prediction of time series in both models, but campaign expenditure only predicted use of a campaign web tool whereas weekly news stories predicted online searches regarding aspirin and the heart originating from Minnesota. CONCLUSION: Patient information engagement is a function of information salience at least in part. Campaign advertising expenditure can prompt audience use of campaign tools but news coverage also operates as an important force on patient search behavior. PRACTICE IMPLICATIONS: Health promotion professionals charged with reaching patients with heart health and stroke prevention messages should monitor news coverage as a potential complementary or rival force while at the same time promoting campaign-related information online.

Multilevel communication to improve well-being during a pandemic.

The COVID-19 pandemic has highlighted existing crises and introduced new stressors for various populations. We suggest that a multilevel ecological perspective, one that researchers and practitioners have used to address some of public health's most intransigent challenges, will be necessary to address emotional distress and mental health problems resulting from the COVID-19 pandemic. Multiple levels of influence (individual, interpersonal, organizational, community, and policy) each contribute (individually and in combination) to population health and individual well-being. We use the convergence strategy to illustrate how multilevel communication strategies designed to raise awareness, educate, or motivate informed decision-making or behavior change can address various sources of information surrounding a person to synergistically affect mental health outcomes. Looking ahead, dissemination and implementation researchers and practitioners will likely need to coordinate organizations and networks to speak in complementary and resonant ways to enhance understanding of complex information related to the pandemic, mitigate unnecessary anxiety, and motivate healthy behavior to support population mental health. Plain language abstract: The current COVID-19 pandemic has threatened the mental health and well-being of various populations. The pandemic also has compounded health disparities experienced by communities of color and magnified the vast treatment gaps they experience related to behavioral health and substance use treatment access. A multilevel approach to future communication interventions focused on mental health likely will be useful, as we need to know about and address interactions with health care professionals, mass media information sources, social networks, and community influences rather than solely trying to reach people with carefully crafted videos or advertisements. Implementation researchers and practitioners likely will need to coordinate organizations and networks to speak in complementary and resonant ways to support population mental health.

Experimental evidence of consumer and physician detection and rejection of misleading prescription drug website content.

BACKGROUND: Consumers and primary care physicians (PCPs) sometimes encounter deceptive promotional claims about prescription drugs. Whether consumers and PCPs can detect deceptive claims or whether those claims negatively affect medical decision making, however, remain important, unanswered research questions. OBJECTIVES: This article explores (1) the ability of consumers and PCPs to identify deceptive prescription drug promotion at various levels of deception, (2) the influence of such tactics on obstructing risk recognition, and (3) whether perceived deception mediates relationships between exposure to deceptive tactics and various outcomes (including false-claim acceptance, attitudes, information-seeking intentions, and interest toward the promoted drug). METHODS: Two experiments-1 with consumers (N = 366) and 1 with PCPs (N = 378)-were conducted to determine whether participant exposure to deceptive prescription drug website content corresponds to detection and acceptance (or rejection) of claims and tactics. In each experiment, the number of deceptive claims and tactics on a consumer- or PCP-targeted website for a fictitious chronic pain medication were varied, in a 1 × 3 (none, fewer, more) between-subjects design. RESULTS: Among consumers, exposure to more deceptive claims or tactics did not increase suspicion about the veracity of the website (relative to fewer claims and tactics) and actually had a limited positive direct effect on false-claim acceptance and attitudes toward the drug. Among PCPs, a mediation effect existed such that exposure to more deceptive claims and tactics resulted in higher perceived website deceptiveness relative to those in the fewer deceptive claims condition, which, in turn, resulted in lower acceptance of deceptive claims and tactics, lower perceived drug effectiveness, more negative attitudes toward the drug, and lower interest and intentions. CONCLUSION: These experiments demonstrate potential differences between consumers and PCPs as well as implications for consumer and PCP vulnerability to website deception.

Función de los profesionales de la salud de rectificar la información errónea que tienen los pacientes más allá de corregir los hechos / Roles for Health Care Professionals in Addressing Patient-Held Misinformation Beyond Fact Correction

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Mental Models of Infectious Diseases and Public Understanding of COVID-19 Prevention.

The emergence of viral diseases such as Ebola virus disease, Zika virus disease, and the coronavirus disease (COVID-19) has posed considerable challenges to health care systems around the world. Public health strategy to address emerging infectious diseases has depended in part on human behavior change and yet the perceptions and knowledge motivating that behavior have been at times inconsistent with the latest consensus of peer-reviewed science. Part of that disjuncture likely involves the existence and persistence of past ideas about other diseases. To forecast and prepare for future epidemic and pandemic response, we need to better understand how people approach emerging infectious diseases as objects of public opinion during the periods when such diseases first become salient at a population level. In this essay, we explore two examples of how existing mental models of past infectious diseases appear to have conditioned and constrained public response to novel viral diseases. We review previously reported experiences related to Zika virus in Central America and discuss public opinion data collected in the early months of the COVID-19 pandemic. In the case of Zika virus disease, we assess how thinking about earlier mosquito-borne disease seems to have affected public consideration of the virus in Guatemala. In the case of COVID-19, we assess how previous vaccination behavior for a different disease is associated with intention to obtain vaccination for COVID-19 in the future.

Patients' understanding of oncology clinical endpoints: A literature review.

OBJECTIVES: Oncology clinical trials use a variety of clinical endpoints. Patients' understanding of the differences between clinical endpoints is important because misperceptions of treatment efficacy may affect treatment decisions. The objective of this literature review is to find and synthesize available empirical publications assessing patients' understanding of common oncology clinical endpoints. METHODS: We conducted a literature search of 5 databases and 3 conferences, limiting the search to articles and abstracts published in English through September 2018. We reviewed the titles and abstracts for inclusion, then reviewed full texts to determine if they reported empirical research studies focused on (1) clinical endpoints, (2) oncology, and (3) patient understanding. The original search identified 497publications, of which 13 met the inclusion criteria. RESULTS: Available literature yields little information on this topic.The few publications that do exist suggest that healthcare professionals and cancer patients generally do not discuss clinical endpoint concepts and that patients can be confused about the purpose of a treatment based on misperceptions about endpoints. CONCLUSIONS: Research is needed on how to discuss oncology clinical endpoints with patients. PRACTICE IMPLICATIONS: Patient-friendly definitions of clinical endpoints may help healthcare providers communicate important information about treatments to patients.