A framework and process for community-engaged, mixed-methods cancer needs assessments.

PURPOSE: Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS: We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS: The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION: This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Evidence-based tobacco cessation treatment by dental hygienists.

PURPOSE: Dental hygienists have opportunities to take a substantive role in tobacco control efforts. Previous research has suggested that implementation of tobacco cessation strategies has been sub-optimal, but few studies have examined factors associated with dental hygienists' delivery of evidence-based tobacco cessation treatment. Among dental hygienists, the current study investigated tobacco-related knowledge and attitudes, as well as clinical practices consistent with evidence-based guidelines for tobacco cessation. METHODS: Practicing dental hygienists in the state of Kentucky (n=308) responded to a paper and pencil questionnaire that collected information regarding their demographic, clinical characteristics and knowledge, attitudes and clinical practices regarding tobacco cessation treatment. RESULTS: Participants were somewhat familiar with evidence-based clinical practice guidelines regarding tobacco cessation treatment, but reported infrequent implementation of the 5 A's (Ask, Advise, Assess, Assist, Arrange). While participants were well aware of health risks associated with tobacco use and the value of cessation, few reported comfort or confidence in their ability to employ evidence-based interventions. However, several key variables were associated with implementation of recommended clinical practices (guideline awareness, comfort with specific tobacco cessation activities and self-efficacy). CONCLUSION: Results identified potential deficiencies in areas of tobacco control knowledge and confidence among dental hygienists. Correlations with evidence-based tobacco control practices suggest that knowledge and attitudes could serve as targets for education and training programs to promote greater implementation. While dental hygienists have unique opportunities to reduce tobacco-related morbidity and mortality, more education and training is necessary to increase adoption, implementation and sustainability of these important interventions.

"Providers practice prevention": promoting dental hygienists' use of evidence-based treatment of tobacco use and dependence.

High rates of tobacco use prompted the development of a provider education program in Kentucky to promote implementation of evidence-based tobacco cessation treatment among registered dental hygienists (R.D.H.s). All R.D.H.s throughout the state were notified of the program and invited to participate. Participants were asked to complete a pre-program survey and post-program evaluation. A follow-up survey was administered one year following program participation. Two hundred and ninety-four R.D.H.s completed the pre- and post-program surveys, and the follow-up survey was completed by 53 percent (N=156) of the initial sample. Analyses exploring the immediate effect (from pre- to post-program) found the program to have had a universally positive impact (p<.05) across knowledge, attitudes, and intended clinical practices regarding tobacco use and treatment. Regarding the program's durable effects (from pre-program to follow-up), statistically significant (p<.05) and positive effects were realized for most of the outcomes, including subjective knowledge, attitudes, and practices. It was concluded that the program serves as an effective introduction to the Treating Tobacco Use and Dependence: Clinical Practice Guideline. Additional intervention might enhance the durability of the program's efficacy and promote more complete adoption of evidence-based tobacco cessation strategies by dental hygienists, leading to an even broader impact on cancer prevention and control of tobacco-related malignancy.

Tobacco cessation treatment knowledge, attitudes and practices of Kentucky physicians.

Kentucky continues to report the highest adult smoking rates in the nation, and this persistent public health problem leads to substantial morbidity, mortality, and economic costs for the state. Given that physician intervention has been shown to increase cessation rates, the Kentucky Cancer Program developed a self-study continuing education program for physicians to promote the implementation of effective tobacco cessation treatment strategies. As a preliminary component, a pre-program survey was administered to participants to measure current knowledge, attitudes, and practices regarding the treatment of tobacco use and dependence. Results from this survey offered an opportunity to describe and analyze the areas in which physicians were utilizing tobacco cessation treatment approaches consistent with clinical practice guidelines as well as areas in which further training and resources were needed to improve clinical tobacco cessation treatment practices. Overall, physicians accepted their primary role in tobacco cessation treatment and acknowledged a moderate level of comfort with this role. They also reported implementing several of the recommended "5 A's" from the Treating Tobacco Use and Dependence: Clinical Practice Guideline. Further examination of the data, however, revealed that knowledge, attitudes, and practices were weaker regarding specific, formal, and systematic implementation of tobacco cessation treatment. Effective training and resources would provide physicians with the tools necessary to intervene with tobacco users more consistently and to reduce the health and economic burden of tobacco use and dependence in Kentucky.

Kentucky breast cancer report card.

The Kentucky Breast Cancer Task Force in conjunction with the Kentucky Cancer Registry and the Kentucky Cancer Program has prepared a Breast Cancer Report Card concerning the incidence and mortality of this disease among Kentucky women for the period of 1995 to 2000. Comparison of Kentucky data with those from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute reveals that the incidence rate of breast cancer in Kentucky is lower than that for the SEER population. The incidence of "early" stage disease is significantly lower among Kentucky women, but the incidence of "late" stage disease is similar in both data sets. The incidence rate is lower in rural than urban Kentucky, and is lowest in rural Appalachian Kentucky. The ratio of "early" to "late" stage breast cancer is lower for Kentucky women than for the SEER population and lowest in women over age 65, the group in which approximately half of the new cases of breast cancer are detected each year. Mortality rates are similar for Kentucky and for the SEER population. Improving the breast cancer mortality rate in Kentucky will depend on increased case-finding of "early" stage disease and increasing the ratio of "early" to "late" stage incident cases.

Developing and implementing a statewide breast cancer action plan.

BACKGROUND: This article describes a model used by the Kentucky Breast Cancer Task Force to develop and implement a statewide breast cancer action plan. METHODS: The authors examine the challenges encountered during different phases of plan development and the ways in which these challenges were addressed. CONCLUSIONS: To successfully move from planning to implementation, task forces must have broad-based participation, a "lead organization" to coordinate the planning process, focused work agendas, and firm commitments from cancer-related organizations and groups to spearhead activities in specific implementation areas.