Socioeconomic Determinants of the Use of Molecular Testing in Stage IV Colorectal Cancer.

OBJECTIVES: Treatment with epidermal growth factor receptor monoclonal antibodies extends life for patients with advanced colorectal cancers (CRCs) whose tumors exhibit wild-type KRAS, but KRAS testing may be underused. We studied the role of socioeconomic factors in the application of KRAS testing. MATERIALS AND METHODS: We identified subjects with stage IV colorectal adenocarcinoma diagnosed 2010-2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We used multivariable logistic regression models to evaluate associations between clinical/demographic factors and the rate of KRAS testing. We used multivariable-adjusted Cox proportional hazards models to assess survival. RESULTS: We identified 37,676 patients with stage IV CRC, 31.1% of whom were tested for KRAS mutations, of those who had documented KRAS testing, 44% were KRAS mutant. Patients were more likely to be tested if they were younger (odds ratio [OR]=5.10 for age 20 to 29 vs. 80+, 95% confidence interval [CI]: 3.99-6.54, P<0.01), diagnosed more recently (OR=1.92 for 2015 vs. 2010, 95% CI: 1.77-2.08, P<0.01), or lived in an area of high median household income (OR=1.24 for median household income of >$69,311 vs. <$49,265, 95% CI: 1.14-1.35, P<0.01). Patients were less likely to be tested if they had Medicaid (OR=0.83, 95% CI: 0.77-0.88, P<0.01) or were unmarried (OR=0.78, 95% CI: 0.75-0.82, P<0.0001). The risk of death was decreased in patients who received KRAS testing (hazard ratio=0.77, 95% CI: 0.75-0.80, P<0.01). CONCLUSIONS: We found a low rate of KRAS testing in CRC patients with those living in low-income areas less likely to be tested, even after controlling for Medicaid insurance. Our study suggests that socioeconomic disparities persist despite Medicaid insurance.

Responses to bullying among individuals with intellectual and developmental disabilities: Support needs and self-determination.

BACKGROUND: Compared to the general population, individuals with intellectual and developmental disabilities (IDD) more often experience bullying and its negative social and emotional impacts. Prior studies explored bullying of individuals with IDD primarily through investigations of the perspectives of others and the negative impacts of bullying. The current study examined how individuals with IDD describe their responses to experiences of bullying, with a focus on whether responses included component skills of self-determination. METHOD: Eighteen adults with IDD (50% female) aged 18-63 years were interviewed about their experiences with bullying. Interviews were analysed to determine responses to bullying and the degree to which their responses demonstrated self-determination. RESULTS: Data analysis revealed two primary themes, outside support and self-determination, with additional subthemes. CONCLUSIONS: Findings provide a more nuanced description of the ways in which individuals with IDD respond to bullying, including the demonstration of self-determination skills. Implications for research and practice are discussed.

In Their Own Words: Perceptions and Experiences of Bullying Among Individuals With Intellectual and Developmental Disabilities.

Despite the high incidence of bullying among people with intellectual and developmental disabilities (IDD), little research has been conducted with people with IDD as participants reporting their own perceptions and experiences of bullying. To address this shortcoming, we interviewed 18 adults with IDD regarding these issues. Four major themes emerged from our qualitative analysis of the transcribed interviews: (a) bullying is hurtful, (b) why people bully, (c) bullying takes many forms, and (d) bullying can happen anywhere. Though participants' definitions of bullying and explanations for why people bully aligned well with traditional understandings, several reported incidents of bullying were discrepant from the traditional definition, including incidents of abuse and rude behavior. Implications for future research and practice are discussed.

Teaching young adults with disabilities to respond appropriately to lures from strangers.

We taught 5 adults with mild intellectual disabilities to respond appropriately to lures from strangers. Skills were taught in the classroom first and then in situ. Before training, participants did not walk away from confederate strangers who tried to lure them away. Participants demonstrated appropriate responses during classroom and in situ training, although performance during assessments was somewhat inconsistent. Appropriate responses were observed during weekly maintenance probes and at follow-up assessments for up to 3 months after training.

Characteristics of inclusive faith communities: a preliminary survey of inclusive practices in the United States.

BACKGROUND: Although participation in faith communities is important to many individuals with disabilities, few studies have examined differences between communities that are more (versus less) inclusive. This study investigated characteristics of faith communities in the United States related to greater inclusion. METHODS: Participants were 160 respondents to an anonymous survey about inclusion. Survey items grouped together to form three inclusion-related outcomes: the degree to which faith communities welcome and include individuals with disabilities; the roles and contributions of congregants with disabilities; and physical accessibility. RESULTS: Across these outcomes, more inclusive communities (i) featured faith leaders who were more committed to inclusion; (ii) used educational resources to address disability-related issues; (iii) portrayed people with disabilities positively in their religious teachings; (iv) had stronger ties to disability organizations; and (v) had a stronger orientation towards promoting social justice. CONCLUSIONS: These five characteristics have important implications for promoting inclusion in faith communities.