Computer-tailored intervention increases colorectal cancer screening among low-income African Americans in primary care: Results of a randomized trial.

INTRODUCTION: Although African Americans have the highest colorectal cancer (CRC) incidence and mortality rates of any racial group, their screening rates remain low. STUDY DESIGN/PURPOSE: This randomized controlled trial compared efficacy of two clinic-based interventions for increasing CRC screening among African American primary care patients. METHODS: African American patients from 11 clinics who were not current with CRC screening were randomized to receive a computer-tailored intervention (n = 335) or a non-tailored brochure (n = 358) designed to promote adherence to CRC screening. Interventions were delivered in clinic immediately prior to a provider visit. Univariate and multivariable logistic regression models analyzed predictors of screening test completion. Moderators and mediators were determined using multivariable linear and logistic regression analyses. RESULTS: Significant effects of the computer-tailored intervention were observed for completion of a stool blood test (SBT) and completion of any CRC screening test (SBT or colonoscopy). The colonoscopy screening rate was higher among those receiving the computer-tailored intervention group compared to the nontailored brochure but the difference was not significant. Predictors of SBT completion were: receipt of the computer-tailored intervention; being seen at a Veterans Affairs Medical Center clinic; baseline stage of adoption; and reason for visit. Mediators of intervention effects were changes in perceived SBT barriers, changes in perceived colonoscopy benefits, changes in CRC knowledge, and patient-provider discussion. Moderators of intervention effects were age, employment, and family/friend recommendation of screening. CONCLUSION: This one-time computer-tailored intervention significantly improved CRC screening rates among low-income African American patients. This finding was largely driven by increasing SBT but the impact of the intervention on colonoscopy screening was strong. Implementation of a CRC screening quality improvement program in the VA site that included provision of stool blood test kits and follow-up likely contributed to the strong intervention effect observed at that site. The trial is registered at ClinicalTrials.gov as NCT00672828.

Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans.

Racial disparities, including decreased hospice utilization, lower quality symptom management, and poor-quality end-of-life care have been well documented in Black Americans. Improving health equity and access to high-quality serious illness care is a national palliative care (PC) priority. Accomplishing these goals requires clinician reflection, engagement, and large-scale change in clinical practice and health-related policies. In this article, we provide an overview of key concepts that underpin racism in health care, discuss common serious illness disparities in Black Americans, and propose steps to promote the delivery of antiracist PC.

A Call for Comprehensive Care in the Fourth Trimester.

Childbirth is an event that is remembered for years to come. At the time of discharge from a hospital, new mothers are sent home with many instructions on how to properly care for their newborns, but many may be unprepared for the changes to their bodies and their emotions. Unfortunately, the postpartum period can be a time of great angst and unanswered questions. This commentary describes the personal experience of one of the authors, who encountered difficulty navigating the health care system during the postpartum period. She shares her experience with the hope of promoting change for other women. After reading the account of her birth and recovery, individuals are encouraged to advocate for regular care of new mothers in the fourth trimester. The time to advocate for change is now.

They Just Don't Get Me: A Qualitative Analysis of Transgender Women's Health Care Experiences and Clinician Interactions.

Transgender individuals face many barriers when accessing health care, including having to teach clinicians how to care for them to receive appropriate care. We conducted a secondary analysis of qualitative data collected via semistructured interviews with 18 transgender women ranging in age from 21 to 60 years and living with HIV. Data were analyzed using conventional content analysis. Participants encountered two clinician types: Those who get me and Those who don't get me. Clinicians who get me provided gender-affirming care, fostered patient engagement, performed appropriate health screenings, and were willing to learn about transgender health. Clinicians who don't get me were aloof, uninterested, and unwilling to provide care. Clinicians who don't get me and system-level factors such as fragmented care, lack of insurance, and a low volume of transgender-competent clinicians contributed to transgender women's unmet health and education needs. Recommendations for improving transgender health care are provided.

Advance Care Planning Outcomes in African Americans: An Empirical Look at the Trust Variable.

CONTEXT: Racial disparities in rates of hospice use, a marker of quality of end-of-life (EOL) care, have been a long-standing problem. Although distrust has been cited as a main reason for the preference of intensive EOL care among African Americans, the role of trust has not been closely analyzed in predicting EOL care in the context of advance care planning (ACP) outcomes. OBJECTIVES: The goal of this review was to empirically examine the role of trust in ACP outcomes. METHODS: For this systematic review, we utilized methods adapted from the GRADE process developed by the Cochrane Collaboration. The research question guiding this review was "What is the quantitative influence of trust in the health care system or health care providers on the ACP process for African Americans?" We searched Medline, Embase, and Web of Science for articles published between 1975 and 2016. RESULTS: We identified nine quantitative studies that measured and evaluated trust as a predictor or correlate of ACP preferences. Of the studies, eight were observational and one was a pre-post-test study. Three studies were designated as low quality, and six studies were of moderate quality. CONCLUSION: Distrust has been cited as a central reason for African Americans' tendency to choose life-sustaining treatments over comfort-focused care; however, our findings do not support this hypothesis. The majority of studies found no significant differences in trust between African Americans and their White counterparts. Further, we found that trust was not associated with ACP outcomes in the majority of studies.