A Community-Academic Partnership to Explore and Address Cancer Disparities in Southwest Chicago Arab Americans.

BACKGROUND: Despite the need to consider multiple sources of evidence to guide locally and culturally relevant interventions, few studies have documented the process by which evidence is integrated. OBJECTIVES: We leveraged a community-academic partnership to describe a participatory approach to integrating community and academic sources of evidence to inform cancer programming priorities in the Arab American (ArA) community in Southwest Chicago. METHODS: Informed by Intervention Mapping, this study comprised three phases led by community and academic partners: 1) qualitative assessment of cancer-related priorities through eight focus groups with 48 ArA community members, 2) a focused literature review to identify models of cancer interventions implemented with ArAs, and 3) integration of focus group and literature review findings and development of a strategy for a community-based cancer program administered by the community partner. RESULTS: Focus groups revealed attitudes and beliefs across the cancer control continuum. The literature review highlighted two cancer interventions utilizing education, community health workers, and patient navigation components. Through facilitated discussions with community partners, we integrated community and academic sources of evidence to develop a comprehensive cancer program plan that is informed by the data we generated as well as our community partners' preferences and organizational capacity. CONCLUSIONS: Our participatory approach for integrating community and academic sources of evidence generated a locally relevant strategy to address cancer burden in the ArA community in Chicago. We discuss the benefits and challenges of utilizing this approach in intervention development.

Changes in clinical conversations when providers are informed of asthma patients' beliefs about medication use and integrative medical therapies.

OBJECTIVES: To explore whether patient's personal beliefs about inhaled corticosteroid (ICS) and integrative medicine (IM) are discussed at routine primary care visits for asthma. BACKGROUND: Negative medication beliefs and preferences for IM can be salient barriers to effective asthma self-management. METHOD: A qualitative analysis of transcripts from 33 audio-recorded primary care visits using conventional content analysis techniques. RESULTS: Four themes emerged when providers had knowledge of patient's beliefs: negative ICS beliefs, IM use for asthma, decision-making and healthy lifestyles. Two themes were identified when providers did not have this knowledge: asthma self-management and healthy lifestyles. CONCLUSION: When providers had knowledge of their patient's IM endorsement or negative ICS beliefs, they initiated conversations about these modifiable beliefs. Without training in IM and in effective communication techniques, it is unlikely that providers will be able to effectively engage in shared decision-making aimed at improving asthma self-management.

Innovative use of a standardized debriefing guide to assist in the development of a research questionnaire with low literacy demands.

Prevalence and impact of low literacy has resulted in greater attention to developing written materials at lower reading levels for both patient education and research. The purpose of this study was to develop and evaluate how well a research questionnaire about self-management preferences, intentionally developed as a tool for individuals with low literacy skills, performed. The investigators created a standardized debriefing guide to evaluate comprehension and ease of instrument completion to accompany the administration of the Conventional and Alternative Management for Asthma (CAMA) instrument. The use of a standardized debriefing guide following cognitive interviewing techniques, allowed for the identification of problematic words, unclear meanings and confusion over scaling despite a deliberate attempt to develop a tool with low literacy demands. Such approaches might be considered critically important to insure the accuracy of patient-reported outcomes when self-administered tools are used to collect research and clinical data.

Health-related quality of life among breast cancer patients in Lebanon.

BACKGROUND: High incidence rates of breast cancer (BC) emphasize the need to address health-related quality of life (QoL) in this population. The aim of this study was to evaluate the QoL, symptom prevalence and management, functional ability, and quality of care in Lebanese women with BC at a tertiary health care facility. METHODS: Cross-sectional descriptive survey targeting Lebanese adults with cancer and using a combination of four instruments: European Organization for Research and treatment of Cancer-Quality of Life Questionnaire, Memorial Symptom Assessment Scale; Barthel Index; Needs at End of life Screening Tool, and a demographic/clinical characteristics section. 89 breast cancer patients participated in the study; data was collected from 2009 to 2010. Descriptive analysis in addition to independent sample t-test, ANOVA, and Pearson r correlation were used for data analysis. RESULTS: The most prevalent symptoms were feeling nervous, feeling sad, lack of energy, and pain; symptom management was inadequate; high scores were reported on functional ability, medical care, spirituality, and relationships. Younger, single, and better educated participants who were diagnosed for less than 30 months, had no metastasis, and paid less than $450 dollars per month on medical expenses showed better global health status/QoL. Payments per month for medical expenses, presence of metastasis, time since diagnosis, and type of treatment received were significantly associated with QoL, the different functioning dimensions, and symptoms. CONCLUSION: Strategies addressing symptom management in particular psychological symptoms need to be developed and implemented in addition to a holistic multidisciplinary palliative care approach.

Perspectives on palliative care in Lebanon: knowledge, attitudes, and practices of medical and nursing specialties.

OBJECTIVE: Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties. METHOD: We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223). RESULTS: Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing education in PC, exposure to terminally ill patients, and knowledge and attitude scores. Acute critical care and oncology were found to have lower practice scores than other specialties. SIGNIFICANCE OF RESULTS: Formal education in palliative care and development of palliative care services are very much needed in Lebanon to provide holistic care to terminally ill patients.