Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program.

CONTEXT: Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. OBJECTIVE: We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. METHODS: The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. RESULTS: In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. CONCLUSIONS: This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.

The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.

Establishment of a vaccine administration training program for medical students.

While vaccine administration training is included in the curriculum for several health professions, it is not universally incorporated into the medical school preclinical curriculum. To fill this education gap, a pilot vaccine training program for first- and second-year medical students was conducted using an online Centers for Disease Control and Prevention module and an in-person simulation with nursing faculty. The aim of this study was to evaluate the effectiveness of the training program. Pre- and post-surveys used a Likert 5-point scale to assess the training effectiveness. Ninety-four students completed the surveys (response rate, 93.1%). Following the training, students felt more comfortable giving a patient a vaccine under the supervision of a physician (P < 0.0001), volunteering in a community-wide vaccine campaign (P < 0.0001), and administering vaccines during clinical rotations (P < 0.0001). Most students, 93.6%, found the in-person training to be "effective" or "very effective," and 97.8% felt that learning how to administer vaccines should be incorporated into the preclinical medical curriculum. Without this program, 76 students (80.1%) would not have been able to participate in a vaccine training. The interdisciplinary training program outlined in this study may serve as a model for similar initiatives at other medical schools.

Evaluation of Scholarship Motivators and Barriers for Non-Tenure-Track Faculty in a Department of Pharmacy Practice.

The Accreditation Council for Pharmacy Education (ACPE) Standards 2016 set explicit expectations for faculty scholarship. However, many non-tenure-track faculty have struggled with the scholarship portion of the academic tripart mission of clinical practice, teaching, and scholarship. Therefore, we sought to identify themes regarding the barriers, motivators, and potential solutions associated with non-tenure-track faculty scholarship. Four focus group interviews were held via videoconference during July 2021, which consisted of non-tenure-track faculty within the TTUHSC Jerry H. Hodge School of Pharmacy. Each focus group answered a standard script of questions that were evaluated for face validity over a 30-60 min session. Twenty-two non-tenure-track faculty members (47% response) participated in one of the four focus group interviews. The four common barriers were insufficient time, lack of acknowledgment, obscurity of scholarship expectations, and a lack of resources and support. Scholarship's lasting impact on academia, students, and clinical practice was the one common motivator identified by the groups. The barriers identified were not unique to our faculty, despite the unique four-city structure of our program. Actions have continued to be taken to help address the barriers and potential solutions identified by the focus groups. In summary, our results echo that non-tenure-track faculty need more time and training to help them feel like they can meet institutional scholarship requirements.

Evaluation of a Narrative Video to Promote Prevention and Early Detection of Cervical Cancer Among Latinas.

OBJECTIVE: To evaluate the impact of an online-delivered, theory-based narrative video on cervical cancer screening knowledge, attitudes, and beliefs in a predominantly Latino community. METHODS: The study design was a nonrandomized pretest-posttest evaluation. The eligibility criteria included men and women 18 years or older not previously enrolled in our community cervical cancer screening program who had internet access. Participants were recruited via in-person county-wide flyer distribution and social media dissemination. The intervention involved a narrative video designed for Latinas delivered via the internet. The 17-minute video is novella style, with a culturally tailored storyline and setting that covers cervical cancer risk factors and statistics, importance of screening, and addresses testing barriers. The measures were knowledge about cervical cancer and screening, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, subjective norms, and self-efficacy. Analysis was performed using change scores for knowledge and psychosocial variables and descriptive statistics for satisfaction and acceptability of the video. RESULTS: Data from 227 surveys were analyzed; respondent mean age: 37.6 years; 98.8% female, 88.8% Hispanic; 42.0% had an annual income of $20,000 or less; and 85.2% had at least a high school education. Knowledge and all psychosocial variables improved significantly. More than 90% of the participants rated all of the satisfaction items as good or excellent. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A culturally appropriate narrative video about cervical cancer and screening disseminated online effectively improved knowledge and psychosocial variables among Latinas. Our findings indicate that health promotion interventions online could be effective for improving desired health behavior through a new means of educational dissemination by way of websites and social media outlets.

Intention to Receive COVID-19 Vaccine by U.S. Health Sciences University Employees.

OBJECTIVES: Understanding vaccine intentions and attitudes of health professionals is critical as the Pfizer-BioNTech and the Moderna COVID19 vaccines are being administered throughout the United States. This study estimates the level of vaccine hesitancy at a health sciences center in West Texas prior to the distribution of the vaccines. METHODS: An analytical cross-sectional study was performed via anonymous Qualtrics survey administered to approximately 4500 faculty, staff, postdoctoral research associates/medical residents, and employees at a multi-campus health sciences university in the United States. Respondents were asked demographic questions and intention to receive the vaccine. Factors associated with the intention to receive a vaccine were determined using logistic regression analysis. RESULTS: A total sample of 2258 subjects were evaluated (50.0% response rate). Among all respondents, 64.6% reported that they would probably or definitely receive the COVID-19 vaccine. Men had higher levels of intention to receive the vaccine (OR = 2.11, 95% CI 1.64-2.71); respondents who indicated yearly influenza vaccines are necessary were also more likely to receive the vaccine (OR = 6.04, 95% CI 4.70-7.75). Eighty-three percent of faculty and 56% of the staff reported intention to receive the vaccine. Respondents who had previously tested positive for COVID-19 reported more interest in receiving the vaccine (58.5% yes vs 41.5% no). CONCLUSION: In this study, the intention to receive the COVID-19 vaccination at a United States health sciences center falls below the necessary herd immunity estimates. Public health initiatives must be developed to decrease vaccine hesitancy, especially among health professionals.

The influence of individual and neighborhood-level characteristics on rural-urban disparities in cardiovascular disease mortality among U.S. women diagnosed with breast and gynecologic cancers.

OBJECTIVE: Rural-urban disparities exist in cancer and cardiovascular disease (CVD) mortality. Investigations of CVD mortality among breast and gynecologic cancer (BGC) survivors from rural/urban communities are limited. We evaluated the influence of individual and neighborhood-level factors on rural-urban disparities in CVD mortality among BGC survivors. METHODS: Data were from 1,139,767 women aged ≥20 years from the Surveillance, Epidemiology, and End Results program who were diagnosed with BGC from 2000 to 2016 that was merged with Area Health Resource Files for neighborhood-level factors (smoking, cancer screening, primary care provider density and socioeconomic index). Standardized mortality ratios (SMRs) for CVD mortality were calculated and multilevel Cox models, accounting for competing events, were used to estimate hazards ratios (HR) and 95% confidence intervals (CI). RESULTS: The average age of BGC survivors was 60 years, with 10.3% of them living in rural counties. During a median follow-up of 5.1 years, 47,995 CVD deaths occured. Women with BGC had excess CVD mortality compared to general population women (SMR 6.05; CI: 6.00-6.11). This risk was highest among women aged <50 years (SMR = 27.16; CI: 25.74-28.62). In models adjusted for demographics, cancer stage and cancer therapy, women with BGC in rural communities had higher CVD deaths than those in urban communities (HR = 1.10, CI:1. 05-1.15). Additional adjustment for neighborhood-level characteristics attenuated the relation of rurality with CVD mortality (HR = 1.02, CI: 0.98-1.07). CONCLUSIONS: BGC survivors living in rural communities have elevated risk of CVD mortality. Neighborhood-level characteristics explained the rural-urban disparities in CVD mortality observed among BGC survivors.

The association of skipping breakfast with cancer-related and all-cause mortality in a national cohort of United States adults.

PURPOSE: Many lifestyle and dietary factors have been recognized as risk factors for cancer morbidity and mortality. However, investigations of the association of the frequency of breakfast consumption and cancer are limited. This study aimed to examine the association of skipping breakfast with all-cause and cancer-related mortality in a national cohort of United States men and women. METHODS: Data were from 7,007 adults aged ≥ 40 years who participated in the third National Health and Nutrition Examination Survey (1988-1994) and had follow-up information on mortality up until 31 December 2015. Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: The mean age of participants was 55.4 years, with 54.4% and 79% being women and non-Hispanic whites, respectively. Approximately, 16% of participants rarely consumed breakfast, 23.0% consumed breakfast some days, and 61% consumed breakfast every day. During a median follow-up of 22.2 years, 3,573 deaths occurred with 795 being related to cancer. In models adjusting for sociodemographic factors, smoking, physical activity, body mass index, hypertension, diabetes, cholesterol levels, total energy intake and diet quality, persons who rarely consumed breakfast had a higher risk of cancer-related mortality (HR = 1.52; CI:1.06-2.18) and all-cause (HR = 1.69; CI: 1.42-2.02) compared to those who took breakfast every day. CONCLUSION: In this nationally representative sample, skipping breakfast was associated with elevated risks for all-cause and cancer-related mortality. This study provides evidence for the benefits of regular breakfast consumption in reducing the risk of all-cause and cancer mortality.

Outcomes of a Multicomponent Culturally Tailored Cervical Cancer Screening Intervention Among Underserved Hispanic Women (De Casa en Casa).

Hispanic women have almost double the cervical cancer incidence and are twice as likely to die from cervical cancer compared with non-Hispanic White women. Cervical cancer is preventable with screening, and based on available data, multiple component screening interventions have been proposed as a strategy to maximize screening, but such studies are lacking. We sought to test the effectiveness of a multicomponent screening intervention for primary prevention and early detection of cervical cancer among underserved Hispanic women. We conducted a prospective community-based cervical cancer screening intervention utilizing a quasi-experimental design. The intervention was theory based, delivered by bilingual community health workers, combined education and reduction of noneconomic barriers, and addressed economic barriers. Components included outreach, education, provision of no-cost Papanicolaou and human papillomavirus screening, on-site diagnostic and treatment colposcopy, and patient navigation with tracking to facilitate screening, diagnosis, and treatment. The main outcome was self-reported screening. We recruited 300 intervention group and 299 control group participants. Mean age of the sample was 44.7 years. The majority were Hispanic (98%), born in Mexico (79%), and had a Spanish-language preference (86%). In intention-to-treat analyses, the intervention group had a relative risk of screening of 14.58 (95% confidence interval = 8.57-24.80, p < .001) compared with the control group. A multilevel, multiple component culturally tailored bilingual cervical cancer screening intervention combining education, navigation, and no-cost screening can significantly increase cervical cancer screening uptake in a high-risk, underscreened population and has the potential to affect cervical cancer health disparities.

Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial.

PURPOSE: To determine whether group education is as effective as individual education in improving cervical cancer screening uptake along the US-Mexico border. DESIGN: Cluster randomized controlled study. SETTING: El Paso and Hudspeth Counties, Texas. PARTICIPANTS: Three hundred women aged 21 to 65 years, uninsured, due for a Pap test, no prior history of cervical cancer or hysterectomy. INTERVENTION: Theory-based, culturally appropriate program comprised of outreach, educational session, navigation services, and no-cost cervical cancer testing. MEASURES: Baseline, immediate postintervention, and 4-month follow-up surveys measured knowledge and theoretical constructs from the Health Belief Model, Theory of Reasoned Action, and the Social Cognitive Theory. ANALYSIS: Relative risk regression analyses to assess the effects of educational delivery mode on the uptake of screening. Mixed effect models to analyze changes in psychosocial variables. RESULTS: One hundred and fifty women assigned to each educational group; 99% Hispanic. Of all, 85.7% completed the follow-up survey. Differences in screening rate at follow-up were analyzed by education type. Overall screening rate at follow-up was 73.2%, no significant difference by education type (individual: 77.6%, group: 68.9% P = .124). Significant increases among group education at follow-up for knowledge, perceived susceptibility, perceived seriousness, and subjective norms and significant decrease for perceived benefits. CONCLUSION: This study provides evidence to support the effectiveness of group education to promote cervical cancer screening among vulnerable Hispanic women and offers an additional method to address cervical cancer disparities.

Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population.

INTRODUCTION: Colorectal cancer (CRC) is the third leading cancer cause of death among US Hispanics. CRC screening among the Hispanic population is lower compared with non-Hispanic Whites. METHOD: The purpose of this qualitative, exploratory study was to better understand the barriers and facilitators of CRC screening and preference for stool-based testing collection methods among the predominantly Hispanic population of El Paso, Texas. Nine focus groups were conducted by a trained bilingual facilitator with a moderator guide informed by the literature. Transcripts of the focus groups were entered into qualitative analysis software and a thematic network was developed. RESULTS: Fifty-six participants were recruited: average age was 68.5 years, 58.9% were female, 98.2% were Hispanic, 87.5% had an annual income of less than $20,000, 58.9% had 9th grade education or less, 12.5% had a discount program, and 5.4% had no insurance. Barriers to CRC screening included cost, fear, and embarrassment. Facilitators to screening included in-person health education and physician recommendation. Participants preferred the hygienic nature of a stool test collected with a brush and bottle. CONCLUSION: Overall, there was a lack of knowledge regarding CRC and significant barriers to CRC screening. A community-based CRC screening program was subsequently developed from our findings.

Change in Breast Cancer Screening Knowledge is Associated With Change in Mammogram Intention in Mexican-Origin Women After an Educational Intervention.

PURPOSE: To determine the relationship between breast cancer screening knowledge and intent to receive a mammogram within 6 months in a sample of Mexican-origin women living in El Paso, Texas. METHODS: A total of 489 uninsured Mexican-origin women were assigned to treatment or control and completed surveys at pre- and postintervention. Pre-post associations between breast cancer screening knowledge and intent were tested. RESULTS: Participants were on average were 56.7 years of age and spoke primarily Spanish (92.6%). Most of the samples had not had a mammogram in 3 or more years (51.6%) and 14.6% had never had a mammogram. At baseline, the majority intended to be screened for breast cancer within the next 6 months (93.4%). At postintervention, half of the intervention group changed their 6-month intent to be screened for breast cancer from likely to unlikely. Change in intent was associated with a change in knowledge of risk of having a first child by the age of 30 and breast cancer being rare after the age of 70. DISCUSSION: Intent to be screened for breast cancer in Mexican-origin women may be influenced by the type of knowledge. CONCLUSIONS: Change in screening knowledge may influence perceived risk that influences intention to be screened.

Cost-Effectiveness of Community Interventions for Colorectal Cancer Screening: Low-Income Hispanic Population.

OBJECTIVE: To assess the cost-effectiveness of interventions to increase colorectal cancer (CRC) screening among low-income uninsured Hispanics in El Paso, Texas. METHOD: Participants 50 to 75 years old who were due for screening, were uninsured, and had a Texas address were randomized to promotora, video, or promotora and video interventions. High-risk participants were offered colonoscopy, while others were offered fecal immunochemical testing. A nonintervention comparison group was recruited from a similar Texas U.S.-Mexico border county. Screening was determined at 6 months postintervention. Resources were tracked prospectively to determine cost. Incremental cost-effectiveness ratios were assessed with "intention to treat" methods. Uncertainty in the estimates was analyzed with sensitivity analysis and nonparametric bootstrap methods. RESULTS: The interventions achieved screening rates of between 75% and 87% compared to 10% in the comparison group. The cost per participant ranged from $72 for group sessions to $93 for individual video sessions with video and promotora. The group video sessions cost $104 per additional person screened. CONCLUSION: The CRC screening interventions were effective for increasing CRC screening. Compared to the experience in the control county, the group-based video-only intervention was the most cost-effective CRC screening promotion intervention.

Irritable Bowel Syndrome on the US Mexico Border: A Survey in an Indigent Population Using Rome III Criteria.

GOALS: To investigate the prevalence of irritable bowel syndrome (IBS), and its association with health perception and health care-seeking behavior in this Mexican American population. BACKGROUND: The prevalence of IBS ranges from 3% to 20.4% in the United States and 4.4% to 16% in Mexico, based on Rome III and II criteria. However, its epidemiological profile in the US Mexico border is unknown. STUDY: We conducted a survey in a randomly selected indigent population (N=521) recruited into a colon cancer screening program (ACCION). The prevalence of IBS was estimated and a multivariable logistic regression was carried out to determine the associated risk factors. Results are summarized using odds ratio and 95% confidence interval (CI). RESULTS: A total of 464 (89%) completed the survey (mean age, 56.7 y; female, 74.8%). Country of birth was Mexico in 90.5% and the United States in 8.2% and acculturation was more Spanish (94.8%) than English (5.2%). Overall, 5.6% (95% CI, 3.7-8.1) fulfilled criteria for IBS with a predominance among women (6.9%) versus men (1.7%) (P=0.03). On the basis of multivariable analysis, lower number of bowel movements/week (odds ratio, 0.89; 95% CI, 0.80-1.00), having a primary care physician: 4.09 (1.51-11.12), using herbal treatments: 2.76 (1.08-7.06) and a previous IBS diagnosis: 23.11 (3.44-155.45), were significantly associated with the presence of IBS. CONCLUSIONS: The prevalence of IBS on the US Mexico border is comparable with data obtained from studies in both countries. Consulting a primary care physician as an associated factor may reveal the high rate of health-care seeking in IBS patients, while herbal treatments may reflect a cultural influence.

Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas.

BACKGROUND: Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population. METHODS: Eligible women who were out of adherence with cervical cancer screening (>3 years since their last Papanicolaou [Pap] test) were identified via medical record review by a federally qualified local health center. The effects of a low-intensity intervention (video delivered to participants' homes; n = 150) and a high-intensity intervention (video plus a home-based educational session; n = 146) on cervical cancer screening uptake in comparison with a control arm (usual care; n = 147) were investigated. A cost-effectiveness analysis of the interventions was conducted: all intervention costs were calculated, and the incremental cost-effectiveness ratio was computed. Finally, women with positive Pap tests were provided navigation by a community health educator to ensure that they received follow-up care. RESULTS: A total of 443 Latinas participated. Seven months after randomization, significantly more women in the high-intensity arm received a Pap test (53.4%) in comparison with the low-intensity arm (38.7%; P < .001) and the usual-care arm (34.0%; P < .01). The incremental cost-effectiveness ratio for high-intensity women versus the control group amounted to $4.24. Twelve women had positive Pap tests, which encompassed diagnoses ranging from atypical squamous cells of unknown significance to invasive cancer; these women received navigation for follow-up care. CONCLUSIONS: A culturally appropriate, in-home, promotora-led educational intervention was successful in increasing cervical cancer screening among Latinas. Cancer 2017;123:666-674. © 2016 American Cancer Society.

Against colorectal cancer in our neighborhoods (ACCION): A comprehensive community-wide colorectal cancer screening intervention for the uninsured in a predominantly Hispanic community.

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Screening is widely recommended but underutilized, particularly among the low income, the uninsured, recent immigrants and Hispanics. The study objective was to determine the effectiveness of a comprehensive community-wide, bilingual, CRC screening intervention among uninsured predominantly Hispanic individuals. This prospective study was embedded in a CRC screening program and utilized a quasi-experimental design. Recruitment occurred from Community and clinic sites. Inclusion criteria were aged 50-75years, uninsured, due for CRC screening, Texas address and exclusions were a history of CRC, or recent rectal bleeding. Eligible subjects were randomized to either promotora (P), video (V), or combined promotora and video (PV) education, and also received no-cost screening with fecal immunochemical testing or colonoscopy and navigation. The non-randomly allocated controls recruited from a similar county, received no intervention. The main outcome was 6month self-reported CRC screening. Per protocol and worst case scenario analyses, and logistic regression with covariate adjustment were performed. 784 subjects (467 in intervention group, 317 controls) were recruited; mean age was 56.8years; 78.4% were female, 98.7% were Hispanic and 90.0% were born in Mexico. In the worst case scenario analysis (n=784) screening uptake was 80.5% in the intervention group and 17.0% in the control group [relative risk 4.73, 95% CI: 3.69-6.05, P<0.001]. No educational group differences were observed. Covariate adjustment did not significantly alter the effect. A multicomponent community-wide, bilingual, CRC screening intervention significantly increased CRC screening in an uninsured predominantly Hispanic population.

Is "Active Surveillance" an Acceptable Alternative?: A Qualitative Study of Couples' Decision Making about Early-Stage, Localized Prostate Cancer.

The objective of our study was to describe decision making by men and their partners regarding active surveillance (AS) or treatment for early-stage, localized prostate cancer. Fifteen couples were recruited from a cancer center multispecialty clinic, which gave full information about all options, including AS. Data were collected via individual, semi-structured telephone interviews. Most patients were white, non-Hispanic, had private insurance, had completed at least some college, and were aged 49-72 years. Ten chose AS. All partners were female, and couples reported strong marital satisfaction and cohesion. All couples described similar sequences of a highly emotional initial reaction and desire to be rid of the cancer, information seeking, and decision making. The choice of AS was built on a nuanced evaluation of the man's condition in which the couple differentiated prostate cancer from other cancers and early stage from later stages, wanted to avoid/delay side effects, and trusted the AS protocol to identify negative changes in time for successful treatment. Treated couples continued to want immediate treatment to remove the cancer. We concluded that having a partner's support for AS may help a man feel more comfortable with choosing and adhering to AS. Using decision aids that address both a man's and his partner's concerns regarding AS may increase its acceptability. Our research shows that some patients want to and do involve their partners in the decision-making process. Ethical issues are related to the tension between desire for partner involvement and the importance of the patient as autonomous decision-maker. The extended period of decision making, particularly for AS, is also an ethical issue that requires additional support for patients and couples in the making of fully informed choices that includes AS.

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border.

OBJECTIVE: The purpose of this study was to assess the acceptability and intention to use cervicovaginal self-sampling for high-risk human papillomavirus infection after receiving an educational intervention among the predominantly Hispanic population residing along the US-Mexico border. METHODS: Women received an educational intervention about cervical cancer prevention through screening with conventional cytology and with self-sampling for high-risk human papillomavirus. After the educational intervention, women performed the self-sampling test. Women's attitudes toward the self-sampling test and cervical cytology were assessed and compared. RESULTS: A total of 110 women aged 30 to 65 years completed the study. The mean (SD) age of the population was 48 (9.3) years. Most (87%) self-identified as being Hispanic and half were born in Mexico; 16% had not had cervical cytology done in 3 years. Self-sampling was more acceptable than cervical cytology; mean (SD) acceptability scores were 25.0 (2.9) and 22.7 (3.0), respectively, with the maximum possible score being 28 (p < .001). A large proportion (42.7%) of women preferred both tests equally. We found high intention to use and recommend self-sampling. Contrary to previous studies, there were no differences between cervical cytology and self-sampling regarding women's concerns about performing the test well and the accuracy of the test, which we attribute to the educational intervention. CONCLUSION: The high acceptability of self-sampling after participants received education about the test and the reported intention to use it if made available add to the evidence on the feasibility of integrating self-testing within cervical cancer screening guidelines.

Designing Normative Messages About Active Surveillance for Men With Localized Prostate Cancer.

Active surveillance is increasingly recognized as a reasonable option for men with low-risk, localized prostate cancer, yet few men who might benefit from conservative management receive it. The authors examined the acceptability of normative messages about active surveillance as a management option for patients with low-risk prostate cancer. Men with a diagnosis of localized prostate cancer who were recruited through prostate cancer support organizations completed a web-based survey (N = 331). They rated messages about active surveillance for believability, accuracy, and importance for men to hear when making treatment decisions. The message "You don't have to panic … you have time to think about your options" was perceived as believable, accurate, and important by more than 80% of the survivors. In contrast, messages about trust in the active surveillance protocol and "knowing in plenty of time" if treatment is needed were rated as accurate by only about 36% of respondents. For active surveillance to be viewed as a reasonable alternative, men will need reassurance that following an active surveillance protocol is likely to allow time for curative treatment if the cancer progresses.