Ethnicity, socioeconomic status, income inequality, and colorectal cancer outcomes: evidence from the 4C2 collaboration.

PURPOSE: National Cancer Institute (NCI)-Designated Cancer Centers are required to assess and address the needs of their catchments. In rural regions, catchment areas are vast, populations small, and infrastructure for data capture limited, making analyses of cancer patterns challenging. METHODS: The four NCI-Designated Comprehensive Cancer Centers in the southern Rocky Mountain region formed the Four Corners Collaboration (4C2) to address these challenges. Colorectal cancer (CRC) was identified as a disease site where disparities exist. The 4C2 leaders examined how geographic and sociodemographic characteristics were correlated to stage at diagnosis and survival in the region and compared those relationships to a sample from the surveillance, epidemiology, and end results (SEER) program. RESULTS: In 4C2, Hispanics were more likely to live in socioeconomically disadvantaged areas relative to their counterparts in the SEER program. These residency patterns were positively correlated with later stage diagnosis and higher mortality. Living in an area with high-income inequality was positively associated with mortality for Non-Hispanic whites in 4C2. In SEER, Hispanics had a slightly higher likelihood of distant stage disease, and disadvantaged socioeconomic status was associated with poor survival. CONCLUSION: CRC interventions in 4C2 will target socioeconomically disadvantaged areas, especially those with higher income inequality, to improve outcomes among Hispanics and Non-Hispanic whites. The collaboration demonstrates how bringing NCI-Designated Cancer Centers together to identify and address common population catchment issues provides opportunity for pooled analyses of small, but important populations, and thus, capitalize on synergies among researchers to reduce cancer disparities.

Access to Care as a Barrier to Mammography for Black Women.

Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.

Perceptions of the dental education-wide climate: Analysis of the 2022 ADEA climate study focus groups.

OBJECTIVE: Climate assessments in higher and postsecondary education institutions are essential in landscaping inclusiveness and belonging for students, faculty, and staff. Although some climate assessments in dental education have been conducted either as part of their own campus or parent university climate assessment, a dental education-wide climate study has not been conducted across dental schools and allied dental education programs in the United States and Canada. METHODS: As integral part of the 2022 ADEA Climate Survey in Dental Education, focus groups were conducted from March to April 2022 to ascertain the perceptions of students, faculty, and staff in dental education. A phenomenological study on 85 focus group participants comprised of students, faculty, and staff at U.S. and Canadian dental schools and allied dental education programs was conducted. Thematic analyses were structured on four overarching categories: (1) belonging, (2). bias, (3) challenges and barriers, and (4) future recommendations. RESULTS: Several themes emerged across all groups. The lack of inclusion and belonging on campuses, deficit of faculty of color, microaggressions and differential treatment of students of color, and the need to enhance recruitment of diverse students and faculty of color were among themes identified. Exclusive to U.S. allied dental education programs, exposure to unique community and clinical opportunities for students was identified as an important theme to enhance diversity, equity, inclusion, and belonging (DEIB). CONCLUSION: The first-ever dental education-wide climate study exposes the need to undertake this initiative in academic dentistry. The ongoing challenges unveiled in this study offer an opportunity to identify solutions that are meaningful, inclusive, impactful, and that foster humanistic learning environments for students, faculty, and staff in dental education.

Patient-Centered Core Impacts Sets (PC-CIS): What They Are and What They Are Not.

Letter to the Editor We are writing regarding the Innovations in Pharmacy commentary entitled, "Evidentiary Standards for Patient-Centered Core Impact Value Claims."(1) We thank Dr. Langley for commenting on the National Health Council's work on patient-centered core impact sets (PC-CIS), an initiative spearheaded by the nonprofit organization and its membership with multi-stakeholder representation and input.(2-4) While we have tried to be clear and transparent about the intent of PC-CIS, the commentary made it apparent to us we need to (and will) do more to be explicit about what a PC-CIS is and is not, and its possible downstream uses. We believe the PC-CIS concept was misrepresented in the commentary and want to provide clarification for readers so they can consider the merits of the initiative for themselves.

Co-creation of the Global Patient Experience Data Navigator: a multi-stakeholder initiative to ensure the patient voice is represented in health decision-making.

BACKGROUND: Putting patients' needs and priorities at the forefront of healthcare initiatives and medical product development is critical to achieve outcomes that matter most to patients. This relies on the integration of early, meaningful patient engagement (PE) to learn what is important to patients, and collection of representative patient experience data (PXD). The increased number of PE/PXD efforts across global regulatory, health technology assessment, and healthcare systems is an important step forward to deliver improved health outcomes for patients. However, these initiatives are fragmented and lack integration, which is necessary to maximize efforts and reduce burden on patients. To overcome these challenges, the Global Patient Experience Data Navigator has been co-created by Patient Focused Medicines Development to provide practical resources that can facilitate and optimize PXD generation, collection, analysis, and dissemination for patient benefit and aims to be applicable across all therapeutic areas for all stakeholders. METHODS: Co-creation of the Navigator took place through an iterative process of validation and formalization driven by a diverse, multi-stakeholder working group with individuals who have varying knowledge/experience in PE/PXD. RESULTS: A series of workshops took place to conduct a gap analysis, develop a taxonomy model, and integrate existing frameworks. The collective insights led to the development of the Navigator consisting of four specific tools in the form of downloadable templates, which can be used to: (1) prioritize outcomes that matter most to patients and their caregivers; (2) select appropriate measurement methods for these outcomes; (3) identify when and why PXD is used throughout the product development cycle for each stakeholder; (4) identify when and why PXD is used throughout the healthcare process for each stakeholder. A public consultation was carried out to collect user feedback before the Navigator was made publicly available in December 2022. CONCLUSION: To our knowledge, the Global Patient Experience Data Navigator is the only publicly available toolkit developed with a multi-stakeholder and disease-agnostic approach providing taxonomically grouped resources to optimize the collection and collation of PXD for patient benefit. Future work will aim to further engage patients by adding a PE dimension to the Navigator.

Engaging patients at the start of healthcare and medical product development projects can help better understand their experiences and what is most important to them. Ultimately this will achieve the best outcomes. However, if not carefully planned, projects that engage patients can lead to inefficiencies, such as patients being asked for the same information repeatedly. The collection of patient experience data­information related to patients' experiences, needs, and priorities­also needs to be carefully managed. To help solve this problem, Patient Focused Medicines Development developed a publicly available "toolkit" called the Global Patient Experience Data Navigator. The Navigator has downloadable templates that can be filled in and used for projects in any disease area and by anyone collecting patient experience data. To represent different perspectives, individuals with a range of experiences and understanding of patient engagement projects worked together to co-create the toolkit. Several meetings took place to understand what the toolkit needed to do and to help provide a structure for the templates. There are four templates in the toolkit. These can be used to: (1) prioritize outcomes that matter most to patients and their caregivers; (2) select the best ways of measuring these outcomes; (3) identify when, why, and by whom patient experience data is used throughout the product development cycle; and (4) identify when, why and by whom patient experience data is used throughout the healthcare process. Future work will utilize public feedback to make the toolkit more user-friendly and provide education on how the Navigator can be used.

Operational and financial impact of the COVID-19 pandemic on U.S. dental school clinics.

PURPOSE: This study assessed the impact of the COVID-19 pandemic on U.S. dental schools and their school-based clinic operations and finances during the first eight months (April to December 2020) of the outbreak. School-based clinics are critical to training and educating future dentists and delivering oral health care services to underserved communities. METHODS: The American Dental Education Association (ADEA) conducted a structured survey with the 67 accredited U.S. dental schools between November 2020 and January 2021 to assess the impact of the COVID-19 pandemic on their operations, especially on their school-based clinics. The response rate was 67%. The authors employed descriptive statistics and text analysis to examine the survey results. RESULTS: This study revealed that from April to December 2020, dental schools experienced a 50% reduction in patient visits at dental school clinics, a 7% median decrease in budget, a 42% decline in revenue, changes in clinical and nonclinical faculty and staff, and investments related to infection control measures to remain operational. Ninety-two percent of dental school clinics suspended community-based patient care experiences outside the dental school in the first eight months of the pandemic compared to the same time period the year prior. CONCLUSIONS: This research shows the extent of the operational and financial challenges dental school clinics faced in the pandemic's first eight months, April to December 2020. In these unique times, dental school clinics continued to train and educate the dentists of tomorrow and deliver oral health care services to vulnerable communities while implementing safeguards and infection control measures to combat the propagation of the COVID-19 virus in their institutions.

Curricular and clinical approaches to addressing the opioid epidemic: Results from the 2019 ADEA opioid dental school survey.

PURPOSE/OBJECTIVES: Dental educators have played a critical role in addressing the opioid public health crisis. METHODS: The American Dental Education Association (ADEA) conducted a semi-structured survey with all 66 accredited U.S. dental schools in 2019. The survey was organized into four modules to facilitate response and descriptive statistics and qualitative thematic analyses were performed. RESULTS: Seventy percent of the dental schools consented to participate. Each module varied in response rate: curricular (Module 1, 48%), clinical (Module 2, 47%), implemented curricular/clinical changes (Module 3, 56%), and willingness to participate in future studies (Module 4, 47%). The survey revealed that 87% of respondent dental schools have implemented curricular changes or curricular changes were in process in response to the opioid epidemic. Ninety-three percent of responding schools reported making clinical changes or that clinical changes were in process. Schools reported two factors that most frequently influence changes made: the adoption of state-specific regulations/mandates and the Commission on Dental Accreditation (CODA) Standard 2-24e, which requires competency in prescription practices on substance use disorders. An analysis of the open-ended questions found four overarching themes to curricular changes, in order of frequency: didactic curriculum; integration of opioid epidemic subject matter experts in curricula; Screening, Brief, Intervention, and Referral to Treatment (SBIRT) training; and prescription guidelines. Similarly, four overarching themes were identified for clinical changes: protocol and policy development, Prescription Drug Monitoring Programs (PDMP), faculty and provider education, and prescription guidelines. CONCLUSIONS: This research shows that dental educators are working to ensure that new dental professionals gain the necessary competencies in substance abuse, specifically related to opioids, to prevent and minimize prescription drug misuse.